Cancers & treatments·Regimen libraryCurative

DA-EPOCH-R

Checked 2026-09-09

Primary mediastinal B-cell lymphoma, high-grade B-cell lymphoma with MYC and BCL2 rearrangements, Burkitt lymphoma in adults, and HIV-associated lymphomas

Also called EPOCH, R-EPOCH, dose-adjusted EPOCH-R.

One cycle

every 21 days × 6 · about 18 weeks in total

21-day cycle × 6 (about 18 weeks)IntravenousOral Continuous infusion Daily oral course

Components

Drug	Dose	Route	Days
Rituximab Monoclonal antibody (anti-CD20, chimeric)	375 mg/m²	IV	D1
Etoposide Topoisomerase II inhibitor (podophyllotoxin derivative)	50 mg/m² per day	IV	D1-4 (96 h infusion)
Doxorubicin Cytotoxic chemotherapy (anthracycline)	10 mg/m² per day	IV	D1-4 (96 h infusion)
Vincristine Vinca alkaloid (microtubule inhibitor)	0.4 mg/m² per day	IV	D1-4 (96 h infusion)
Cyclophosphamide Alkylating agent (oxazaphosphorine prodrug)	750 mg/m² (dose adjusted to the previous cycle's nadir)	IV	D5
Prednisone Glucocorticoid	60 mg/m² twice daily	Oral	D1-5

Cycles

21-day cycle

Emetogenicity

High (>90%)

G-CSF

Built into the protocol

Notes

Doses of etoposide, doxorubicin and cyclophosphamide are escalated or reduced each cycle according to the neutrophil nadir.
Continuous infusion needs a central line; G-CSF from day 6.

Used in

Diffuse large B-cell lymphoma Burkitt lymphoma Primary mediastinal (thymic) large B-cell lymphoma

Products

RituximabEtoposideDoxorubicinVincristineCyclophosphamidePrednisone

Source

Dunleavy, NEJM 2013: DA-EPOCH-R in primary mediastinal B-cell lymphoma

Reference doses for a typical adult from the cited protocol or label. Doses are adjusted for renal and hepatic function, age, performance status and prior toxicity, and institutional protocols vary. Verify against the current label and your local protocol before treating. Not medical advice.