This regimen requires the use of prophylactic
antibiotics to prevent
infectious complications, as well as the use of
colony-stimulating factors (G-CSF) from the first day after the end of chemotherapy to the day of full blood count restoration (
ANC > 1000/μL). There is also an improved version of the regimen. In this version the chemotherapy dose varies from cycle to cycle depending on the patient's ability to tolerate chemotherapy and the degree of
neutropenia and
thrombocytopenia observed in this patient after each cycle. This approach is called "dose-adjusted EPOCH", or "DA-EPOCH" (DA-EPOCH-R, DA-R-EPOCH or R-DA-EPOCH are used when rituximab is included). Dose change rules are as follows: Twice a week a full blood count with white blood cell count (WBC) differential is obtained. Dose escalation above the starting doses in case of good patient's chemotherapy tolerability applies simultaneously to etoposide, doxorubicin and cyclophosphamide. Dose de-escalation below the starting doses in case of poor patient's chemotherapy tolerability applies to cyclophosphamide only. If the nadir ANC > 500/μL, then the doses of etoposide, doxorubicin, and cyclophosphamide for the next cycle are all increased by 20% over the doses used in the previous cycle. If the nadir ANC 25,000/μL, then the dose for the next course will remain the same. If the nadir ANC < 500/μL for 10 days or more, or if the nadir platelet count at every time falls below 25,000/μL, then the doses of etoposide, doxorubicin and cyclophosphamide are reduced by 20% below the doses used in the previous cycle, but doxorubicin and etoposide should not be reduced below the initial dose (dose in first course). == References ==