e18527 Background: Diffuse large B-cell lymphoma (DLBCL) accounts for approximately 30 percent of newly diagnosed patients with NHL and, in the 1970s CHOP combination therapy proved curative. Higher complete remission rates and survival has been further improved with the addition of rituximab to CHOP (R-CHOP). Pegylated liposomal doxorubicin (Doxil) has an improved pharmacokinetic profile over conventional doxorubicin with decreased cardio toxicity, cytopenias, alopecia and other untoward effects. This retrospective study was performed to analyze the efficacy and safety of pegylated liposomal doxorubicin in a group of high-risk patients. METHODS Forty-five patients with DLBCL treated with MRCHOP were indentified. Their medical data was summarized in an Excel spread sheet using greater than 50 patient clinical parameters while maintaining HIPPA-compliance. All patients received intravenous LED, pegylated liposomal doxorubicin with average treatment dose of 27.4 mg/m² and, median treatment cycles of six. RESULTS In this poor-risk population (N=45) there were 47% males with an average age of 70.1 yr and 53% females with an average age of 73.8 yr. The overall average IPI score was 3.2, corresponding to High-Intermediate to High Risk range. The overall CR rate was 75.5%. For patients with stage I (N=2), II (N=7), and III (N=8) disease the CR rate was 100%. For patients with stage IV disease (N=28) the average IPI score was 3.7 and 62.2% of the patients achieved a CR. With long-term follow for most patients, as long as 124+ months, the overall survival is 74.2% with four patients dying of tumor progression, all with stage IV disease. At least one episode of neutropenia (ANC<1,000/mm3) was documented in 95.5% of the patients and hospitalization for neutropenic fever occurred 26.7% of the patients. The incidence of new onset CHF is none. CONCLUSIONS The overall CR rate of MRCHOP in this study is 68.6%. This is remarkable given most patients have had intermediate/high risk IPI. The use of pegylated liposomal doxorubicin instead of conventional doxorubicin appears at least as active as traditional R-CHOP and may be better tolerated.