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. Favorable retrospective reports on the application of CODOX-M/IVAC-R are subject to selection bias as only young fit patients can tolerate this treatment. We conducted a retrospective analysis to investigate outcome differences between CODOX-M/IVAC-R and DA-EPOCH-R in DHL/THL patients aged 60 years or younger. 113 patients were identified; CODOX-M/IVAC-R (N=49) and DA-EPOCH-R (N=64). 80% (39/49) achieved complete (CR) after completing CODOX-M/IVAC-R compared to 58% (37/64) with DA-EPOCH-R. The median follow-up was 5.3 years and 3.3 years for the CODOX-M/IVAC-R and DA-EPOCH-R group respectively. CODOX-M/IVAC-R demonstrated superior EFS on univariate (HR=0.54, 95%CI=0.31-0.97) and multivariable analysis adjusted for age, BCL translocation (BCL2 vs BCL6 vs both), IPI score and receipt of ASCT (aHR=0.52, 95%CI=0.29-0.93); however there was no significant influence on OS (aHR=0.92, 95%CI=0.46-1.84). The 1, 2 and 5 years EFS in the CODOX-M/IVAC-R group was 68.3%, 64.1% and 61.5% respectively compared to 52.4%, 48.9% and 39.5% respectively in the DA-EPOCH-R group. Primary refractory disease or relapse occurred in 33% (16/49) of CODOX-M/IVAC-R and 54% (35/64) of DA-EPOCH-R recipients, and produced median OS of 10.3 months and 33.7 months, respectively, indicating poor outcomes in the CODOX-M/IVAC-R subgroup with R/R disease. 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.

中文翻译：

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CODOX-M/IVAC-R 与 DA-EPOCH-R 在 60 岁或以下的双重打击/三次打击淋巴瘤患者中的比较。


强化化学免疫治疗方案通常用于患有双重打击和三次打击淋巴瘤 （DHL/THL） 的年轻患者，尽管与 R-CHOP 相比没有生存获益。关于 CODOX-M/IVAC-R 应用的有利回顾性报告存在选择偏倚，因为只有年轻健康的患者才能耐受这种治疗。我们进行了一项回顾性分析，以探讨 60 岁或以下 DHL/THL 患者 CODOX-M/IVAC-R 和 DA-EPOCH-R 的结局差异。确定了 113 例患者;CODOX-M/IVAC-R （N = 49） 和 DA-EPOCH-R （N = 64）。80% （39/49） 在完成 CODOX-M/IVAC-R 后达到完全 （CR），而 DA-EPOCH-R 为 58% （37/64）。CODOX-M/IVAC-R 和 DA-EPOCH-R 组的中位随访时间为 5.3 年和 3.3 年。CODOX-M/IVAC-R 在单变量 （HR=0.54,95%CI=0.31-0.97） 和根据年龄、BCL 易位 （BCL2 vs BCL6 vs两者）、IPI 评分和 ASCT 接受 （aHR=0.52,95%CI=0.29-0.93） 调整的多变量分析中表现出优异的 EFS;但对 OS 无显著影响 （aHR=0.92,95%CI=0.46-1.84）。CODOX-M/IVAC-R 组的 1 年、 2 年和 5 年 EFS 分别为 68.3% 、 64.1% 和 61.5%，而 DA-EPOCH-R 组分别为 52.4% 、 48.9% 和 39.5%。33% （16/49） 的 CODOX-M/IVAC-R 和 54% （35/64） 的 DA-EPOCH-R 受者发生原发性难治性疾病或复发，中位 OS 分别为 10.3 个月和 33.7 个月，表明 CODOX-M/IVAC-R 亚组的 R/R 疾病预后不良。DA-EPOCH-R 组有更多患者能够接受后续挽救治疗。没有患者死于方案毒性，两组的 CNS 复发率和治疗相关血液系统肿瘤的发生率相似。