A combination of mitoxantrone, etoposide and prednisone in elderly patients with non-Hodgkin's lymphoma

Abstract

From January 1988 to December 1991, 55 elderly patients (14 pretreated and 41 previously untreated) with non-Hodgkin's lymphoma (NHL) entered a prospective study to evaluate the feasibility of a combination of mitoxantrone (7-9 mg/m2), VP 16-213 (150 mg, 2-hour infusion on day 1, and 200 mg per os on days 3 and 5) and low-dose prednisone (25 mg days 1-5) (MVP regimen), recycling every 21-28 days. The median age was 75 (range 64-93). All but 4 pretreated patients had intermediate- or high-grade lymphomas. Complete remissions were obtained in 22 of 40 (55%) evaluable previously untreated patients, and partial remissions in 10 (2 of these obtained complete remissions after radiotherapy), for an overall response rate of 80%. The median duration of response was 12 months. At 24 months the overall survival was 52% and the relapse-free survival was 31%. Of 14 pretreated patients complete remissions were obtained in 4 (29%) and partial remissions in 3. Granulocytopenia and fever were the most important side effects; two patients contracted bronchopneumonia and one of them died. Other toxicities were mild. We conclude that this combination chemotherapy is effective as first-line and salvage treatment in elderly patients with intermediate- and high-grade NHL, and that it is feasible on an outpatient basis, with manageable toxicity.

Activity and safety of dose‐adjusted infusional cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy with rituximab in very elderly patients with poor‐prognostic untreated diffuse large B‐cell non‐Hodgkin lymphoma

“…As expected, the most frequent grade 3 to 4 AEs were neutropenia and febrile neutropenia, which occurred in 48% and 13% of patients, respectively. However, the observed rates of AEs with DA-POCH-R did not differ from those reported in other dose-adjusted regimens [14][15][16][17] and were substantially lower than AE rates observed in a series of doxorubicin-free protocols [31][32][33][34][35][36][37][38][39][40]42,44 specifically tailored for elderly patients with DLBCL (Table 6).…”

“…All of these regimens were characterized by a shorter duration and by the use of doxorubicin-free protocols to reduce the incidence of treatment-related adverse events, mainly myeloid and cardiac toxicity. [33][34][35][36][37][38][39] Among these adapted regimens, R-VNCOP-B (etoposide, mitoxantrone, cyclophosphamide, vincristine, prednisolone, and bleomycin plus rituximab) is a doxorubicin-free combination therapy containing mitoxantrone, an anthracycline supposed to display reduced cardiotoxicity. 31,33,40 Despite the favorable outcome reported, grade 3 to 4 neutropenia was observed in 75% to 83%, with febrile neutropenia occurring in 30% of cases.…”

Mitoxantrone is superior to doxorubicin in a multiagent weekly regimen for patients older than 60 with high-grade lymphoma: results of a BNLI randomized trial of PAdriaCEBO versus PMitCEBO

“…Initiatives to improve cytotoxic delivery without compromising benefit have led investigators to develop weekly, multiagent chemotherapy regimens. [20][21][22][23]25,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] Improvements in supportive care enable the delivery of chemotherapy at standard doses and intensity to deliver maximum benefit to patients. 56 The minimum age of entry of 60 was chosen because patients younger than this were eligible for high-dose regimens and because this age carried prognostic significance in the international prognostic index (IPI) analyses.…”

Complications of cytotoxic chemotherapy in older patients: focus on myelotoxicity in lymphomas

“…Recently, age-adapted treatment regimens, from the first to the third generation, have been designed and tested for their feasibility and efficacy in elderly aggressive-histology non-Hodgkin's lymphoma patients [16,[31][32][33][34][35][36][37][38][39][40]. In addition, progress has been made in defining maximally tolerated doses of the cytotoxic drugs and specifically testing anthracyclines with reduced cardiotoxicity [11,[41][42][43], as well as in investigating the advantages of applying hematopoietic growth factors in this older population.…”