Do you have a preferred strategy for front line induction therapy in DLBCL patients who have asymptomatic depressed ejection fraction and thus concern about anthracycline dosing?

I generally replace the anthracycline in RCHOP with etoposide 50 mg/m2 IVPB Days 1-3 based on an ASH abstract #408 in 2009 by Sehn L et al. If the day 2 and 3 doses of etoposide are given orally rather than IV the dose would be 100 mg/ m2.

The reference provided demonstrated that the outcome with this replacement appears no different than CHOP. In 2018, sadly, we don’t have an upfront replacement for RCHOP but perhaps in future the agents that you mention which have been used in salvage will find a place in the treatment of newly diag...