Complications Associated With Dose-adjusted EPOCH-rituximab Therapy for Non-Hodgkin Lymphoma

Certain aggressive non-Hodgkin lymphoma subtypes are increasingly being treated with infusional DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab), which requires a central venous catheter. This study aims to identify the rates and predictors of line-associated complications (LACs) associated with DA-EPOCH-R therapy in NHL.

We retrospectively identified all patients treated with DA-EPOCH-R at our institution between March 2011 and July 2016. We also identified a concurrent cohort of patients with diffuse large B-cell lymphoma treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone).

Forty-three patients received DA-EPOCH-R during the study period; 17 (39.5%; 95% confidence interval, 0.25-0.56) patients experienced at least 1 LAC (including venous thromboembolism, chemotherapy extravasation, and line-associated infection). Forty-four patients received R-CHOP during the study period; 8 (18.2%; 95% confidence interval, 0.08-0.32) patients experienced at least 1 complication. Compared with the R-CHOP cohort, patients treated with DA-EPOCH-R experienced a significantly higher rate of these complications (P = .03). In the DA-EPOCH-R cohort, grade 3 toxicity was seen in 41% (7/17). In univariate analysis, body mass index ≥ 35 kg/m² and using a peripherally inserted central catheter line were significantly associated with an increased risk of venous thromboembolism (P = .04 and P = .02, respectively).

Forty percent of patients receiving DA-EPOCH-R therapy developed LACs, almost one-half of whom experienced grade 3 toxicities. The complication rate was significantly greater in patients undergoing therapy with DA-EPOCH-R compared with those undergoing R-CHOP therapy. Clinicians need to balance these risks when selecting therapy. Future studies are needed to evaluate prophylactic anticoagulation strategies in this population.