VEPEMB in elderly Hodgkin’s lymphoma patients. Results from an Intergruppo Italiano Linfomi (IIL) study

Abstract

VEPEMB is an effective and low toxic regimen for HL in the elderly. Co-morbidity is a prognostic factor more important than age itself.

The IVDG Regimen is the Possible Treatment of Choice as First Line Therapy For Hodgkin’s Lymphoma in Elderly Patients with Cardiovascular and Pulmonary Comorbidity

“…Так, в исследовании А. Levis и соавт. [9] 105 пожилых пациентов получали терапию по программе VEPEMB (винбластин, циклофосфамид, прокарбазин, этопозид, митоксантрон, блеомицин). В многофакторном анализе показано значимое отри-цательное влияние на бессобытийную выживаемость (БСВ) и ОВ не только таких классических факторов прогноза, как стадия и наличие В-симптомов, но и наличия сопутствующих заболеваний (5-летняя ОВ без сопутствующих заболеваний -69 %, при на-личии сопутствующих заболеваний -54 %; p < 0, 01).…”

“…При исключении этопозида (BACOPP) летальность, связанная с токсичностью, снижается до 12 %, что все же считается неприемлемым риском для больных ЛХ [8]. В 2 проспективных исследованиях, по-казавших эффективность режима VEPEMB (винбластин, циклофосфамид, прокарбазин, этопозид, митоксантрон, блеомицин), смертность в результате токсичности те-рапии составила 3 и 7 % соответственно [9,10].…”

Treatment of Early Stage Hodgkin Lymphoma

“…Examples of such regimens include vinblastine, cyclophosphamide, procarbazine, etoposide, mitoxantrone and bleomycin (VEPEMB) (Levis, Anselmo, Ambrosetti, et al, 2004), vincristine, doxorubicin, bleomycin, etoposide and prednisone (ODBEP) (Macpherson, Klasa, Gascoyne, et al, 2002), prednisone, vinblastine, doxorubicin and gemcitabine (PVAG) (Boll, Bredenfeld, Gorgen, et al, 2011), and bleomycin, doxorubicin, cyclophosphamide, vincristine, procarbacine and prednisone (BACOPP) (Halbsguth, Nogova, Mueller, et al, 2010). However, randomized studies are highly recommended in this elderly heterogenous population in order to adopt any of the new regimens as standard of care compared to traditional regimens such as ABVD.…”

Classical Hodgkin's lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up

“…54,55 Moreover, cardiovascular, respiratory and/or metabolic co-morbidities are important determinants of the less favorable prognosis of Hodgkin's lymphoma in the elderly. 56,57 The EP defined as elderly patients over 70 years and addressed the question of whether a conventional strategy or a reduced-intensity approach is more appropriate for this category of patients.…”

“…Regimens with reduced intensity compared to ABVD are better tolerated; however, this advantage is counterbalanced by the lower remission rate and the higher relapse rate compared to standard dose regimens. 57,64 Reduced-intensity chemotherapy, with or without limited RT, should be adopted in patients older than 80 years, as well as in those with severe co-morbidities (frail patients), where the most sensible goal of therapy should be to preserve a good quality of life with a palliative approach. …”