Copp chemotherapy for elderly patients with intermediate and high grade non‐Hodgkin's lymphoma

Abstract

One hundred and forty-one consecutive patients above and 231 below the age of 60 years with previously untreated intermediate or high grade non-Hodgkin's lymphoma were included in this study. Patients above the age of 60 years were treated with the COPP chemotherapy regimen. The younger patients, at or below the age of 60, received a doxorubicin-containing regimen (119 had CHOP, 65 had BACOP and 47 had m-BACOD). For stage I patients, the clinical results were similar but for stage II, III or IV disease, those receiving COPP had significantly worse CR rate and survival than those who had a doxorubicin-containing regimen. Multivariate analysis on patients receiving the COPP chemotherapy revealed that the independent prognostic variables significantly determining CR rate and survival included clinical stage (p = 0.04) and serum lactate dehydrogenase level (p = 0.001). Myelosuppression was the major toxicity following COPP chemotherapy in this group of patients. There were 10 (7 per cent) treatment-related deaths. Compared to the reported results using doxorubicin-containing regimens to treat elderly patients with aggressive NHL in the literature, the more aggressive treatment does not appear to improve significantly the clinical outcome of this group of patients and seems to produce treatment results very much similar to COPP. However, accurate comparison is difficult because of the variation in the patient characteristics. Further prospective controlled randomized trials will be necessary to determine the optimal therapy for these patients.

Treatment of non-Hodgkin's lymphoma in the elderly: an update

“…The COPP regimen, consisting of cyclophosphamide, vincristine, procarbazine and prednisone, commonly used for treating Hodgkin's disease, was chosen by Liang et al 28 to treat 141 elderly patients of all clinical stages. The authors reported the clinical outcome by stage of disease, showing an evident decrease in CR rate from stage I (76 per cent) to stage II and III (53 and 50 per cent) and to more advanced disease (22 per cent).…”

“…The high CR rate and good tolerance after the VNCOP-B regimen in comparison with those of the previously mentioned prospective studies can be partially explained by the relatively low median age (66 years) of this case series. On the contrary, the previously mentioned regimens, with the only exception that of Liang et al, 28 were all administered to patients with a median age of 70 years or more. Bessel et al treated 46 patients aged 60 years or more with intermediate-and high-grade NHL using the chemotherapy regimen MCOP (mitoxantrone, cyclophosphamide, vincristine and prednisolone).…”