Non-Hodgkin's lymphoma in elderly patients: a phase II study of MCOP chemotherapy in patients aged 70 years or over with intermediate- or high-grade histology

Bessell, E.M.; Coutts, Alison; Fletcher, J.; Toghill, P J; Moloney, A.J.; Ellis, Ian O.; Hulman, G.; Jenkins, David

doi:10.1016/0959-8049(94)90183-x

Cited by 30 publications

(7 citation statements)

References 12 publications

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“…15 (35) 12 ( 5 5 In recent years the literature on morphological aspects, genotypic abnormalities and the clinical spectrum of the E histological subgroups has increased dramatically, but it is not clear which therapeutic guidelines are to be given. Recently Zucca et aZ.37 had demonstrated with multivariate analysis that there was a benefit in terms of response rate and survival for patients treated with a doxorubicin containing regimen, but the response rate and survival are poor.…”

Section: Discussionmentioning

confidence: 99%

The Treatment of Elderly Patients with Aggressive Non-Hodgkin's Lymphomas: Feasibility and Efficacy of an Intensive Multidrug Regimen

Bertini

Freilone

Vitolo

et al. 1996

Leukemia & Lymphoma

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The results of a prospective trial of an 8 week treatment for elderly patients with advanced intermediate-high grade NHL are reported. Our aim was to reduce general toxicity without losing an antilymphoma effect. For this reason the use of growth factor was studied. We also analysed the behavior of different histological groups (E + F vs G + H). From November 1991 to November 1993 100 patients older than 65 years with combination intermediate-high grade advanced stage NHL were treated with the P-VEBEC regimen, an original including epirubicin 50 mg/sqm, cyclophosphamide 300 mg/sqm and etoposide 100 mg/sqm on weeks 1, 3, 5, 7; vinblastine 5 mg/sqm and bleomycin 5 mg/sqm on weeks 2, 4, 6, 8; prednisone 50 mg/sqm/day per os in the first two weeks and thereafter every other day .46 pts received rG-CSF 5 micrograms/Kg/day throughout the treatment starting on day 2 of every week for 4 consecutive days. Twenty eight pts had B symptoms, 41 had bulky disease, 37 LDH levels above normal, 50 stage IV patients and 30 had bone marrow involvement. Sixty two percent achieved a complete remission (CR). Adverse prognostic factors for CR were E and F histology, stage IV disease, bone marrow infiltration, serum LDH levels above normal, international Prognostic Index (I.I.) intermediate-high and high risk categories and relative dose intensity (RDI) less than 0.80. Severe toxicity was rarely recorded and only one toxic death was observed. With a median follow-up of 33 months OS, DFS and EFS were 44%, 60% and 30% respectively. EFS was influenced by stage, BM involvement, level of LDH and I.I. intermediate-high and high risks. The 52 patients with DLCL (diffuse large cell lymphomas--G + H according to WF) did better with a higher CR, OS, DFS and EFS rates, than the other WF subtypes. In conclusion P-VEBEC is a feasible combination to use in elderly patients, mainly in DLCL. The use of rG-CSF improves the RDI. A RDI > 0.80 could play a role in improving the outcome, especially in patients with adverse prognostic factors. For other subgroups another schedule is probably justified.

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Section: Discussionmentioning

confidence: 99%

The Treatment of Elderly Patients with Aggressive Non-Hodgkin's Lymphomas: Feasibility and Efficacy of an Intensive Multidrug Regimen

Bertini

Freilone

Vitolo

et al. 1996

Leukemia & Lymphoma

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“…Since 1993, CHOP therapy consisting of CPA, DOX, VCR and PSL has been considered the gold standard chemotherapy regimen [18]. In elderly patients, many treatment regimens for NHL have been reported and most are similar to CHOP therapy [8,19,20]. Although a reduced-dose CHOP regimen is often used in the treatment of elderly patients [21], determining which doses of drugs should be used for elderly patients is difficult because the plasma concentrations of the drugs that are usually attained are altered.…”

Section: Discussionmentioning

confidence: 99%

A phase II study of a THP‐COP regimen for the treatment of elderly patients aged 70 years or older with diffuse large B‐cell lymphoma

Tsurumi

Hara

Goto

et al. 2007

Hematological Oncology

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Pirarubicin (tetrahydropyranyl adriamycin: THP) is an anthracycline drug that reportedly has fewer cardiotoxic effects than doxorubicin. A phase II study was conducted in order to determine the efficacy of a treatment regimen incorporating THP, namely THP-COP in the treatment of elderly patients aged 70 years or older with diffuse large B-cell lymphoma (DLBCL). The treatment regimens for Group A (aged 70-79 years, n = 45) and Group B (aged 80 years or older, n = 16) consisted of cyclophosphamide, THP, vincristine, and prednisolone, repeated six times, every 3 weeks. The complete remission rate was 72.1%. The 5-year survival rate was 38.1%. For elderly patients with favourable prognostic factors, the 5-year survival rate was significantly better at 77.9% compared with 15.6% for patients with poor prognostic factors (p < 0.01). Death associated with the treatment regimen was not observed. We conclude that the THP-COP treatment regimen has fewer side effects and is very effective in the treatment of DLBCL in elderly patients, especially those with favourable prognostic factors. The present findings indicate the necessity of future studies investigating a combination therapy comprised of rituximab and THP-COP for the treatment of elderly patients with CD20-positive DLBCL.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Mainwaring

Cunningham

Gregory

et al. 2001

Blood

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A prospective, multicenter, randomized trial was undertaken to compare the efficacy and toxicity of adriamycin with mitoxantrone within a 6-drug combination chemotherapy regimen for elderly patients (older than 60 years) with highgrade non-Hodgkin lymphoma (HGL) given for a minimum of 8 weeks. A total of 516 previously untreated patients aged older than 60 years were randomized to receive 1 of 2 anthracycline-containing regimens: adriamycin, 35 mg/m 2 intravenously (IV) on day 1 (n ‫؍‬ 259), or mitoxantrone, 7 mg/m 2 IV on day 1 (n ‫؍‬ 257); with prednisolone, 50 mg orally on days 1 to 14; cyclophosphamide, 300 mg/m 2 IV on day 1; etoposide, 150 mg/m 2 IV on day 1; vincristine, 1.4 mg/m 2 IV on day 8; and bleomycin, 10 mg/m 2 IV on day 8. Each 2-week cycle was administered for a minimum of 8 weeks in the absence of progression. Forty-three patients were ineligible for analysis. The overall and complete remission rates were 78% and 60% for patients receiving PMitCEBO and 69% and 52% for patients receiving PAdriaCEBO (P ‫؍‬ .05, P ‫؍‬ .12, respectively). Overall survival was significantly better with PMitCEBO than PAdriaCEBO (P ‫؍‬ .0067). However, relapse-free survival was not significantly different (P ‫؍‬ .16)

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Non-Hodgkin's lymphoma in elderly patients: a phase II study of MCOP chemotherapy in patients aged 70 years or over with intermediate- or high-grade histology

Cited by 30 publications

References 12 publications

The Treatment of Elderly Patients with Aggressive Non-Hodgkin's Lymphomas: Feasibility and Efficacy of an Intensive Multidrug Regimen

The Treatment of Elderly Patients with Aggressive Non-Hodgkin's Lymphomas: Feasibility and Efficacy of an Intensive Multidrug Regimen

A phase II study of a THP‐COP regimen for the treatment of elderly patients aged 70 years or older with diffuse large B‐cell lymphoma

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

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