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04 / DA- EPOCH- R treatment can cause adrenal insufficiency in non-Hodgkin lymphoma patients

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Background: ‎ The most frequent cause of adrenal insufficiency (AI) is prolonged use of ‎corticosteroids. However, shorter use of corticosteroid therapy may also ‎affect adrenal function. Patients with aggressive lymphoma are treated with R- CHOP, which ‎includes five days of prednisone at a dose of 100 mg/d. DA- EPOCH- R is ‎an alternative protocol for these patients. It consists of higher doses of ‎prednisone (five days of prednisone 60 mg/m2 twice daily). We hypothesized that DA- EPOCH- R protocol might be associated with ‎higher rates of AI. ‎ Aims: To compare the incidence of AI in non-Hodgkin lymphoma (NHL) ‎patients treated with R- CHOP vs. DA- EPOCH- R. ‎ Methods: We prospectively enrolled newly diagnosed NHL patients ‎receiving either DA- EPOCH- R (study group) or R- CHOP (control group). ‎ Exclusion criteria were: known adrenal disorders, past corticosteroid ‎treatment during the last six months, lymphoma adrenal involvement ‎and concomitant treatment that affects ACTH test. AI evaluation was ‎done by 250 microgram ACTH tests at five time points: pre-treatment, ‎on day 5 and 21 after the first cycle, at the completion of the 5th and at ‎the beginning of the 6th cycle. A positive ACTH test was defined as a cortisol level of less than 500 ‎nmol/liter. ‎ ‎ ‎ Results: Between 5.2015-5.2017 ten and 17 patients received DA- ‎EPOCH- R and R- CHOP, respectively (19-diffuse large B cell lymphoma; ‎‎1-Follicular lymphoma grade 3A, 6-primary mediastinal B cell lymphoma ‎and 1-primary effusion lymphoma). Patients' median age was 60 years ‎‎(range: 21-89). Baseline characteristics were similar between groups ‎except for age at diagnosis - patients in the control group were older ‎than those in the study group (63 vs. 34, respectively, p=0.001).‎ ACTH test was positive at least once during the study follow-up in nine ‎patients - seven who received DA- EPOCH- R and two who received R- ‎CHOP (P = 0.04). Tests were mostly positive on day 5‎‏ ‏after the first cycle ‎‎(eight patients). ‎ ‎ ‎ Conclusion: Our study suggests that patients who received DA- EPOCH- ‎R might be more prone to develop AI. ‎

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© Copyright 2021 Morressier GmbH.
All rights reserved.