Akademik Veri Yönetim Sistemi
ANNALS OF ONCOLOGY, cilt.36, sa.2025, ss.819-820, 2025 (SCI-Expanded, Scopus)
Background: While dose-adjusted EPOCH-R (DA-EPOCH-R) has demonstrated efficacy in aggressive B-cell lymphomas, comprehensive analysis of its toxicity profile in relation to molecular characteristics remains limited. We conducted a multicenter analysis to evaluate the safety of DA-EPOCH-R in patients with Diffuse Large B-Cell Lymphoma (DLBCL) and Primary Mediastinal B-Cell Lymphoma (PMBL), with particular emphasis on dose modifications and correlation between toxicities and molecular subgroups. Methods: In this multicenter retrospective cohort study, we analyzed 140 patients with DLBCL or PMBL who received DA-EPOCH-R between January 2015 and December 2020. Treatment consisted of DA-EPOCH-R for 6-8 cycles with dose adjustments based on nadir counts. Molecular profiling included MYC, BCL-2, and BCL-6 expression by immunohistochemistry and FISH analysis for gene rearrangements. Results: Dose modifications were required in 35% of patients in cycle 2, with decreasing frequency in subsequent cycles (28%, 22%, 15%, and 10% in cycles 3-6, respectively). Grade 3-4 neutropenia occurred in 52% of patients, with higher incidence in double-expressor (68%) and triple-expressor (72%) subtypes compared to non-expressors (47%, p=0.003). Grade 3-4 thrombocytopenia and anemia occurred in 31% and 27% of patients, respectively, with triple-expressor cases showing significantly higher rates (48% and 42%, p<0.001). Elevated liver enzymes (grade ≥2) were documented in 23% of patients. MYC expression was independently associated with increased risk of grade 3-4 neutropenia (HR 1.87, 95% CI 1.42-2.46) and thrombocytopenia (HR 1.65, 95% CI 1.23-2.21). Triple-expressor status predicted early dose reduction (cycle 1-2) (OR 2.34, 95% CI 1.76-3.12), while double-hit status was associated with sustained hematological toxicities across multiple cycles (OR 1.92, 95% CI 1.45-2.54). Conclusions: These findings provide important real-world evidence that may guide personalized toxicity management strategies and improve outcomes in high-risk molecular subgroups receiving DA-EPOCH-R therapy