A phase III randomized trial of high‐dose CEOP + filgrastim versus standard‐dose CEOP in patients with non‐Hodgkin lymphoma: 10‐year follow‐up data: Australasian Leukaemia and Lymphoma Group (ALLG) NHL07 trial

Abstract

on behalf of the ALLG Increasing dose intensity (DI) of chemotherapy for patients with aggressive non-Hodgkin lymphoma (NHL) may improve outcomes at the cost of increased toxicity. This issue was addressed in a randomized trial aiming to double the DI of myelosuppressive drugs. Between 1994 and 1999, 250 patients with previously untreated aggressive NHL were randomized to treatment with six cycles of 3-weekly standard (s) or intensive (i) chemotherapy: s-CEOP-cyclophosphamide 750, epirubicin 75, vincristine 1.4 mg/m 2 all on day 1, and prednisolone 100 mg days 1-5; i-CEOP-cyclophosphamide 1,500, epirubicin 150, vincristine 1.4 mg/m 2 all on day 1, and prednisolone 100 mg days 1-5. Primary endpoint was 5-year overall survival (OS). Relative to s-CEOP patients, i-CEOP patients achieved a 78% increase in the DI of cyclophosphamide and epirubicin. Despite this, there was no significant difference in any outcome: 5-year OS (56.7% i-CEOP; 55.1% s-CEOP; P 5 0.80), 5-year progression free survival (PFS; 41% i-CEOP; 43% s-CEOP; P 5 0.73), 5-year time to progression (TTP; 44% i-CEOP; 47% s-CEOP; P 5 0.72), or complete remission (CR) 1 unconfirmed CR (CRu) rates (53% i-CEOP; 59% s-CEOP; P 5 0.64). Long-term follow up at 10 years also showed no significant differences in OS, PFS, or TTP. The i-CEOP arm had higher rates of febrile neutropenia (70 vs. 26%), hospitalisations, blood product utilisation, haematological and gastrointestinal toxicities, and lower quality of life scores during treatment, although without significant differences 6-month later. In the treatment of aggressive NHL in the prerituximab era, increasing DI did not result in improved outcomes, while at the same time lead to increased toxicity.

CEOP/IVE/GDP alternating regimen compared with CEOP as the first-line therapy for newly diagnosed patients with peripheral T cell lymphoma: results from a phase 2, multicenter, randomized, controlled clinical trial

“…Peripheral T cell lymphoma (PTCL) is a heterogeneous entity of non-Hodgkin lymphoma (NHL) with aggressive clinical behavior. Although cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) or CHOP-like chemotherapy is widely used in PTCL [1,2], a complete response rate (CRR) ranges from 35.9 to 65.8% and the 5-year overall survival (OS) rate is 38.5% for all PTCL patients receiving front-line anthracyclinebased treatment [3]. Multiple combinational regimens have been attempted in PTCL, including gemcitabine, cisplatin, prednisone (GDP) [4], and ifofamide, epirubicin, and etoposide (IVE) [5][6][7][8][9][10].…”

Up‐front autologous stem cell transplant in peripheral T‐cell lymphoma patients achieving complete response after first‐line treatment: A multicentre real‐world analysis

“…Nevertheless, long-term outcomes remain poor, with a 5year overall survival (OS) rate of only 30% for most PTCL subtypes, 3 except for anaplastic large cell lymphoma (ALCL) with anaplastic lymphoma kinas-positive status. 2,5 Given the poor prognosis of PTCL patients, autologous stem cell transplant (ASCT) as first-line consolidation therapy could be crucial for long-term disease management in eligible patients. However, whether PTCL patients in CR after first-line treatment benefit from ASCT remains controversial.…”

“…The ECHELON‐2 study using brentuximab vedotin plus CHOP has established a new standard of care and demonstrated survival benefits for patients with CD30‐positive PTCL. Nevertheless, long‐term outcomes remain poor, with a 5‐year overall survival (OS) rate of only 30% for most PTCL subtypes, 3 except for anaplastic large cell lymphoma (ALCL) with anaplastic lymphoma kinas‐positive status 2,5 …”