Mitoxantrone, Etoposide and Prednisolone (NOVEP) in Previously Untreated Elderly Patients with Non-Hodgkin’s Lymphoma (NHL) and as Salvage Therapy for Refractory NHL

Abstract

Background: Elderly patients with non-Hodgkin’s lymphoma (NHL) are often excluded from or underrepresented in clinical trials of combination chemotherapy regimens because of toxicity of the treatment. Materials and Methods: We report our results in a cohort of 32 patients aged over 60 years who received mitoxantrone, etoposide and prednisolone as first-line therapy and of another 14 patients with relapsed NHL as salvage therapy. 26 patients had high-grade NHL and 20 had low-grade NHL. Advanced stage was defined as Ann Arbor stages 3 and 4 and was seen in 38 patients. Results: Patients with NOVEP as first-line therapy achieved 41% complete remissions (CR) and 34% partial remissions (PR), leading to an overall response rate of 75%. Event-free 3-year survival was 29% in this subgroup. Pretreated patients achieved only 7% CR and 14% PR. Two patients died of treatment-related side effects. Conclusions: The combination of mitoxantrone, etoposide and prednisolone is successful in non-pretreated elderly patients with NHL and shows only low toxicity especially for this subgroup, even in advanced stages. It is of minor success as salvage therapy for older patients with relapsed NHL.

Palliative Therapies in Elderly Cancer Patients

“…A similar result was observed by the Italian Multiregional Non-Hodgkin's Lymphoma Study Group.l85) Recently, a German group recommended 8 cycles of the NOVEP regimen every 3 weeks (mitoxantrone 12 mg/m 2 intravenously day 1, etoposide 120 mg/m 2 intravenously days I to 3 and prednisone 50 mg/m 2 orally days 1 to 5) in previously untreated patients. [86) A retrospective analysis of patients older than 80 years of age, corresponding to 5.4% of alllymphoma patients, demonstrated that the tolerance of standard treatments is a major problem in this population of patients with different types and stages ofNHL. [87) For treatment of multiple myeloma, 4 generations of regimens are available, namely: • The first generation melphalan/prednisone regimen; • The second generation combination chemotherapies [vincristine, melphalan, cyclophosphamide, prednisone (VMCP); vincristine, carmustine, doxorubicin, prednisone (VBAP); doxorubicin, carmustine, cyclophosphamide, melphalan (ABCM)]; • The third generation intensified chemotherapy [vincristine, doxorubicin, dexamethasone (VAD)], or high dose glucocorticoids or intermediate dose cyclophosphamide; • The fourth generation autologous or allogenic bone marrow transplantation.…”