Efficacy and Safety of the Modified EPOCH Regimen (Etoposide, Vincristine, Doxorubicin, Carboplatin, and Prednisolone) for Adult T-cell Leukemia/Lymphoma: A Multicenter Retrospective Study

We retrospectively analyzed 103 patients with untreated aggressive adult T-cell leukemia/lymphoma who received the modified EPOCH (mEPOCH) regimen, comprising etoposide, doxorubicin, vincristine, prednisolone, and carboplatin. We observed a response rate of 58% (complete response rate of 25%) and a median survival time of 9.8 months, comparable with previous studies. mEPOCH is an effective and well-tolerated alternative regimen for adult T-cell leukemia/lymphoma. Background: We retrospectively analyzed patients with untreated aggressive adult T-cell leukemia/lymphoma who received the modified EPOCH (mEPOCH) regimen. Patients and Methods: Patients received up to 6 mEPOCH cycles. Etoposide (50 mg/m(2)/day), doxorubicin (10 mg/m(2)/day), and vincristine (0.4 mg/m(2)/day) were each given as a continuous 96-hour infusion on days 1 to 4. Prednisolone (40 mg/m(2)/day) was given intravenously or orally on days 1 to 4 and then tapered and stopped on day 7, and carboplatin (dose calculated for each patient individually using Calvert's formula according to a target under the curve of 3 mg/mL/min) was given as a 2-hour intravenous infusion on day 6. Results: In 103 patients, overall response rate and complete response rate were 58% and 25%, respectively. With a median follow-up of 8.9 months, the median survival time was 9.8 months (95% confidence interval, 7.2-13.9 months). The median progression-free survival (PFS) was 4.2 months (95% confidence interval, 3.4-5.7 months). Patients who completed >= 4 cycles experienced significantly better overall survival and PFS compared with those who completed < 4 cycles. Twenty-eight patients underwent allogeneic hematopoietic stem cell transplantation after mEPOCH and demonstrated significantly prolonged overall survival and PFS compared with those who did not undergo transplantation. Conclusion: The mEPOCH regimen is effective with tolerable adverse effects and may be an alternative treatment option for adult T-cell leukemia/lymphoma. (C) 2020 Elsevier Inc. All rights reserved.