Xiaoxiao Wang

Newly diagnosed diffuse large B-cell lymphoma benefit from the addition of thymosin alpha 1 to R-CHOP: A propensity matched study from single institution

and 42 (17.4%) and 20 patients (13.2%) exhibited progressive disease for R‐CHOP and R‐DA‐EPOCH regimens, respectively. After a median follow‐up of 46 months (range 14 to 126 months), no statistical difference was found in patients treated with R‐DA‐EPOCH compared to R‐ CHOP in all patients (P = 0.07 for PFS, P = 0.25 for OS, Fig. a and b). However, subgroup analysis according to cell of origin showed R‐DA‐ EPOCH regimen resulted in significant better PFS and OS than R‐ CHOP regimen (P = 0.003 for PFS, P = 0.013 for OS, Fig. c and d) in patients with germinal center B‐cell (GCB) phenotype. Furthermore, when categorizing patients according to International Prognostic Index (IPI) into low‐risk (IPI 0‐2) and high‐risk group (IPI 3‐5) as well as aged younger or older than 60 years, significant better PFS and OS were found in high‐risk group and younger group (P = 0.001, 0.01 for PFS, respectively, Fig. e and f; P = 0.033, 0.038 for OS, respectively, Fig. g and h). But survival superiority of R‐DA‐EPOCH therapy did not remain in patients with non‐GCB phenotype, low IPI, and patients older than 60 years (P = 0.96, 0.93, and 0.42 for PFS, respectively; 0.67, 0.64, and 0.17 for OS, respectively). We also compared 2 regimens in patients with double expressor lymphoma (DEL). In 189 patients with immunohistochemical data of Myc and Bcl‐2, we found 53 DEL patients (cutoff: 40% for Myc and 50% for Bcl‐2). The prognosis of DEL patients was significant worse than non‐DEL patients (P < 0.001 for PFS, P < 0.001 for OS, Fig. i and j), but R‐DA‐EPOCH regimen may not overcome the poor prognosis (P = 0.47 for PFS, P = 0.79 for OS, Fig. k and l). Conclusion: Compared with R‐CHOP, continuous‐infusion R‐DA‐ EPOCH regimen may not improve the treatment outcomes in all patients; however, patients younger than 60 years, with GCB phenotype, and those with high IPI will benefit from R‐DA‐EPOCH therapy. No survival benefit was observed in patients with DEL treated with R‐DA‐EPOCH compared to R‐CHOP regimen.