Epoch (epoetin beta biosimilar)

Intensified chemoimmunotherapy regimens are often used in young patients with double hit and triple hit lymphoma (DHL/THL) despite no survival benefit compared to R-CHOP...More patients were able to receive subsequent salvage therapies in the DA-EPOCH-R group. No patients died of regimen toxicity and the rates of CNS relapse and therapy related hematologic neoplasms were similar in both groups.

When stratified by variant epoch, patients with early epoch Long COVID had persistently elevated peripheral pro-inflammatory cytokine levels when compared to later epoch Long COVID. Patients with Long COVID have similar clusters of symptoms across epochs, suggesting that the underlying pathology is independent of the peripheral cytokine signature.

Case 1 represented a 59-year-old female with widespread lymphadenopathy and a diagnosis of HGBL who exhibited primary refractoriness to dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R) chemotherapy...Similarly, a literature review of 7 previously reported cases of HGBL with a quadruple-hit profile also demonstrated aggressive disease behavior. Our study adds 2 new cases to the rarely encountered quadruple-hit HGBL, and a brief meta-analysis of the 9 available cases indicates aggressive disease behavior conferred by this constellation of genetic events.

P=N/A, N=48, Active, not recruiting, University of Copenhagen | Trial completion date: Dec 2022 --> Jan 2024

The most common 1st line chemotherapy regimens overall were CHOP-based (N=506, 70%), including 60% receiving CHOP-like chemotherapy in both MER and LEO cohorts (CHOP [N=268, 37%], CHOEP [N=91, 13%] or EPOCH [N=75, 10%]), and 16% with CHOP-like in combination with novel agents in LEO cohort (BV+ [N=41, 9.3%], azacitidine+ [N=11, 2.5%], pralatrexate+ [N=10, 2.3%], lenalidomide+ [N=8, 1.9%]) (Table 1)...Outcomes continue to mature with longitudinal follow-up and ongoing accrual, which poise to shape benchmarks in the contemporary era. The lack of benefit of etoposide adding to CHOP induction and poor overall survival of non-ALCL subtypes underscores the unmet need of therapeutic breakthrough for non-ALCL frontline treatment, particularly through clinical trials with biomarker-guided approaches incorporating novel agents.

In CALGB 50303, patients with DLBCL received frontline R-CHOP or DA-EPOCH-R, and although there were no significant associations between interim PET responses assessed centrally after cycle 2 (iPET) using 5-PS with progression-free survival (PFS) or overall survival (OS), there were significant associations between central determinations of iPET ∆SUV with PFS/OS... These data suggest that local PET interpretation for response determination may be acceptable in clinical trials. Our findings also highlight limitations of VSS and call for incorporation of more objective measures of response assessment in clinical trials.

Presence of MYC rearrangement was not predictive of better PFS in patients treated with DA-EPOCH-R versus R-CHOP. Improvements in the diagnostic criteria and therapeutic approaches beyond dose-intense chemotherapy are needed to overcome the unfavorable prognosis of patients with HGBL-NOS.

Clinicopathologic Characteristics of 7 Patients with STAT6 Nuclear or Cytoplasmic Expression by Immunohistochemistry Abbreviations* F: Female; M: Male; NA: Not applicable; IHC: Immunohistochemistry; RCHOP: Rituximab, cyclophosphamide, doxorubicin hydrochloride (hydroxydaunorubicin), vincristine sulfate (Oncovin), and prednisone; R-EPOCH: Rituximab, etoposide, vincristine, doxorubicin, cyclophosphamide; CR: Complete remission; PMBL: Primary mediastinal B-cell lymphoma; ABVD: Doxorubicin hydrochloride (Adriamycin), bleomycin sulfate, vinblastine sulfate, and dacarbazine Figure 1: Click to view full size STAT6 IHC+ was detected in ~40% of patients in our cohort. STAT6 IHC+ was detected in ~40% of patients in our cohort. About half of STAT6 IHC+ cases with nuclear or cytoplasmic staining patterns harbored STAT6 mutations, all in exon 12 (predominantly D419 mutations). No strong correlation between positive STAT6 mutations and STAT6 IHC+ (nuclear or cytoplasmic) was appreciated in this cohort, arguing against the utility of STAT6 by IHC as a surrogate marker for STAT6 mutational status.

Prior treatments received included CHOP/R-CHOP, CHOEP/EPOCH, or BV/BV-chemo (all 36.6 %), salvage chemo after CHOP/R-CHOP or CHOEP/EPOCH (37.6%), and SCT (21.8%)... In this updated, expanded analysis of the PRIMO study, response by type of prior anticancer therapy was generally consistent with the overall population (range 43.2% to 54%). Response rates ≥35% were seen regardless of number of prior regimens. The types of AEs seen were consistent with those observed previously in the PRIMO trial with no additional unexpected treatment-related toxicities.