Results of a randomized study of previously-untreated intermediate and high grade lymphoma using CHOP versus CNOP

Pavlovsky, Santiago; Santarelli, M; Erazo, A.; Maqueo, José C. Díaz; Somoza, N; Goñalons, M. Lluesma; Cervantes, Guadalupe; Véla, Errol; Corrado, Claudia; Magnasco, H; Milone, Gustavo

doi:10.1093/oxfordjournals.annonc.a058153

Cited by 31 publications

(28 citation statements)

References 10 publications

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“…12 The baseline serum LDH level was categorized as either greater than 300 U/L or less than or equal to 300 U/L and the baseline serum albumin level was classified as either less than or equal to 3.5 g/dL or greater than 3.5 g/dL. Bone marrow involvement was categorized as either present or absent and ANC at the time of presentation was dichotomized as either less than 1500/mm 3 or greater than or equal to 1500/mm 3 . Based on previous research, the following characteristics were predicted to be associated with a higher risk of hospitalization for febrile neutropenia: age 65 years or older, female gender, BSA less than 2.0 m 2 , advanced-stage disease, LDH level greater than 300 U/L, albumin level less than or equal to 3.5 g/dL, presence of bone marrow involvement, and ANC less than 1500/mm 3 .…”

Section: Independent Variables and Operational Definitionsmentioning

confidence: 99%

Risk and timing of hospitalization for febrile neutropenia in patients receiving CHOP, CHOP‐R, or CNOP chemotherapy for intermediate‐grade non‐Hodgkin lymphoma

Lyman

Delgado

2003

Cancer

164

111

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BACKGROUNDHospitalization for chemotherapy‐induced febrile neutropenia is associated with substantial cost and may negatively impact clinical outcome due to associated dose attenuation.METHODSMedical records of 1355 patients with intermediate‐grade non‐Hodgkin lymphoma receiving cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or similar chemotherapy were reviewed. The potential risk factors associated with first hospitalization for febrile neutropenia were evaluated.RESULTSIn the current study, 230 patients (17%) experienced 1 or more hospitalizations for febrile neutropenia and greater than one‐half of all initial hospitalizations for febrile neutropenia occurred in Cycles 1 or 2. Increased risk of hospitalization for febrile neutropenia, based on Cox proportional hazards models, was significantly associated with the following characteristics: age 65 years or older (hazard ratio [HR] = 1.79; 95% confidence interval [95% CI], 1.35–2.37), serum albumin level at presentation less than or equal to 3.5 g/dL (HR = 1.34; 95% CI, 1.01–1.78), planned average relative dose intensity greater than or equal to 80% (HR = 2.70; 95% CI, 1.47–4.98), baseline absolute neutrophil count less than 1500/mm3 (HR = 1.98; 95% CI, 1.28–3.06), and the presence of hepatic disease (HR = 2.18; 95% CI, 1.11–4.28). Lack of early granulocyte colony‐stimulating factor in Cycles 1 and 2 was also associated with increased risk of hospitalization for febrile neutropenia, but this did not reach statistical significance. A composite risk score based on these potential risk factors effectively distinguished patients at greater risk of hospitalization for febrile neutropenia (P < 0.001), the majority of which were observed during the first cycle of chemotherapy.CONCLUSIONSThe data from the current study demonstrated that the risk of initial hospitalization for febrile neutropenia occured early in the course of CHOP‐like chemotherapy. Identified risk factors for febrile neutropenia hospitalization may facilitate the use of targeted supportive care. Cancer 2003. © 2003 American Cancer Society.

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Section: Independent Variables and Operational Definitionsmentioning

confidence: 99%

Risk and timing of hospitalization for febrile neutropenia in patients receiving CHOP, CHOP‐R, or CNOP chemotherapy for intermediate‐grade non‐Hodgkin lymphoma

Lyman

Delgado

2003

Cancer

164

111

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“…The following chemotherapeutic regimen were used: CHOP in 125 patients, 18,19 ProMACE-CytaBOM in 25 patients, 20 CNOP in three patients, 21 P-DOCE in one patient, 22 and CEP in one patient. 23 In CS I/II patients without bulky disease, treatment consisted of 3-4 cycles of chemotherapy followed by involved field radiotherapy.…”

Section: Treatmentmentioning

confidence: 99%

Prognostic significance of molecular staging by PCR-amplification of immunoglobulin gene rearrangements in diffuse large B-cell lymphoma (DLBCL)

Mitterbauer-Hohendanner

Mannhalter

Winkler

et al. 2004

Leukemia

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The prognostic value of the detection of peripheral blood (PB) and/or bone marrow (BM) involvement by polymerase chain reaction (PCR) amplification of rearranged immunoglobulin heavy chain (IgH) and immunoglobulin kappa light chain (Igj) genes was evaluated in 155 patients with diffuse large B-cell lymphomas (DLBCL). Immunoglobulin gene rearrangements (IgR) were detected in 35/155 (23%) patients. The presence of IgR in PB/BM was related to clinical stage (CS I-III vs CS IV; Po0.001), histopathological detection of BM involvement (Po0.001), and the International Prognostic Index (Po0.001). IgR-positive cases had a significantly lower complete remission (CR) rate (18/35, 51%) than IgR-negative patients (85/120, 71%; P ¼ 0.042), and a significantly poorer overall survival (OAS) at 5 years (25 vs 66%; Po0.001). There was a significant difference in the estimated OAS at 5 years between patients with negative BM histology and negative PCR results (66%), patients with negative BM histology but positive IgR (37%), and patients with positive BM histology (12%). Our results indicate that molecular methods improve the accuracy of staging in patients with DLBCL and define a group of patients with normal bone marrow histology who have a significantly poorer OAS due to molecular detection of PB/BM involvement.

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“…17 The possibly reduced toxicity, and excellent activity of mitoxantrone in aggressive NHL led to the establishment of several randomized trials comparing adriamycin with mitoxantrone in multiagent regimens. 24,[27][28][29][30] This study was undertaken to establish the response rates, overall survival, and disease-specific survival obtained with an 8-week, 6-drug regimen and to compare the efficacy and toxicity of PAdriaCEBO with PMitCEBO in elderly patients with high-grade NHL.…”

Section: Introductionmentioning

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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Results of a randomized study of previously-untreated intermediate and high grade lymphoma using CHOP versus CNOP

Cited by 31 publications

References 10 publications

Risk and timing of hospitalization for febrile neutropenia in patients receiving CHOP, CHOP‐R, or CNOP chemotherapy for intermediate‐grade non‐Hodgkin lymphoma

Risk and timing of hospitalization for febrile neutropenia in patients receiving CHOP, CHOP‐R, or CNOP chemotherapy for intermediate‐grade non‐Hodgkin lymphoma

Prognostic significance of molecular staging by PCR-amplification of immunoglobulin gene rearrangements in diffuse large B-cell lymphoma (DLBCL)

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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