Delivery of Full Dose CHOP Chemotherapy to Elderly Patients with Aggressive Non-Hodgkin's Lymphoma without G-CSF Support

Campbell, C.; Sawka, Carol; Franssen, Edmée; Berinstein, N. L.

doi:10.3109/10428199909145711

Cited by 19 publications

(7 citation statements)

References 28 publications

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“…It is known that high-dose intensities even in elderly NHL patients can lead to CR and cure [9,10,18]. One of the main toxicities is chemotherapy-induced neutropenia and infection [11]. Therefore, G-CSF may be valuable in reducing these toxicities and potentially leading to a higher number of patients being treated with CHOP chemotherapy and a higher dose intensity of CHOP.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The effect of optimal treatment on elderly patients with aggressive non-Hodgkin's lymphoma: more patients treated with unaffected response rates

et al. 2001

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A substantial part of elderly patients (with good performance) with intermediate or high-grade non-Hodgkin's lymphoma (NHL) are not treated with the standard chemotherapy of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). If NHL patients are not treated with CHOP, the outcome is inferior. By adding granulocyte colony-stimulating factor (G-CSF) to CHOP chemotherapy, we aimed at treating more patients with less toxicity. We performed a multicenter population-based study (in the southeast of the Netherlands) in which elderly patients (> or = 60 years) with intermediate or high-grade stage > or = IIB NHL were treated with CHOP chemotherapy and growth factor G-CSF to increase the number of patients treated according to standard protocols. We also evaluated elderly NHL patients who were not treated with CHOP chemotherapy. Adequate therapy was defined as > or = six cycles or a total of five cycles when complete remission was achieved after three cycles. Seventy-nine NHL patients fulfilled the selection criteria. The patients were treated with CHOP plus G-CSF (n=46), CHOP (n=19), cyclophosphamide, vincristine, and prednisone (COP) (n=2), chlorambucil and prednisone (n=2), or prednisone (n=1). Nine patients were not treated with chemotherapy. The median age was 72 years (60-87). Of the 79 NHL patients, 65 were treated with CHOP chemotherapy (82%); 38 of 65 patients (59%) were adequately treated. The complete remission rate in the NHL group treated with CHOP was 65% (42 of 65 patients). The overall 3-year survival was 50%. Most of the patients died from progressive NHL (53% in the CHOP and 77% in the group not treated with CHOP). The treatment-related mortality was 15% in the CHOP group. The most important reason for not treating patients with CHOP (with or without G-CSF) was poor performance (WHO > or = 2). A significant subset of patients can be treated with CHOP chemotherapy with acceptable toxicity. The combination of CHOP plus G-CSF increased the absolute number of treatable elderly patients, resulting in more (absolute) patients with complete remission and overall survival compared to our previous study.

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Section: Discussionmentioning

confidence: 99%

“…However, standard CHOP (cyclophosphamide 750 mg/m 2 , doxorubicin 50 mg/m 2 , vincristine 1.4 mg/m 2 , and prednisone) is still the gold standard [2,11,19,20].…”

Section: Introductionmentioning

confidence: 99%

The effect of optimal treatment on elderly patients with aggressive non-Hodgkin's lymphoma: more patients treated with unaffected response rates

et al. 2001

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“…Although many chemotherapeutic regimens have been developed, standard chemotherapy for NHL is still the CHOP regimen consisting of cyclophosphamide, hydroxydaunomycin, Oncovin (vincristine) and prednisolone. The complete response (CR) rate in patients with aggressive NHL treated by the CHOP regimen is reported to be from 47 to 67% [1,2,3]. In patients who fail to achieve CR, the tumor cells may confer drug resistance to varying degrees.…”

Section: Introductionmentioning

confidence: 99%

Immunohistochemical Expression of Multidrug Resistance Proteins as a Predictor of Poor Response to Chemotherapy and Prognosis in Patients with Nodal Diffuse Large B-Cell Lymphoma

Ohsawa¹,

Ikura²,

Fukushima³

et al. 2005

Oncology

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Background/Aims: The aim of this study was to determine whether expression of P-glycoprotein (P-gp), multidrug-resistance-related protein 1 (MRP1), and lung resistance protein (LRP) was related to the response to induction chemotherapy and prognosis in untreated diffuse large B-cell lymphoma (DLBCL). Methods: We assessed immunohistochemical expression of P-gp, MRP1 and LRP, using formalin-fixed and paraffin-embedded specimens of lymph node in 41 patients with DLBCL. Association between expression of these three proteins and their impact on clinical outcome and prognosis was statistically evaluated. Results: P-gp was positive in 37% of subjects, MRP1 in 63%, and LRP in 68%. The complete remission rates achieved in the group expressing these multidrug resistance (MDR) proteins was significantly lower than in the group not expressing them (20 versus 58%; p = 0.025 in P-gp, 23 versus 80%; p < 0.001 in MRP1 and 32 versus 69%, p = 0.043 in LRP, respectively). Furthermore, the patients expressing LRP had a shorter overall survival rate than those that did not (median of 26 months versus median not reached; p = 0.013). Conclusions: These findings suggest that the three MDR proteins are important predictive factors for the clinical outcome and prognosis in patients with DLBCL.

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“…6,7 Because elderly patients with NHL probably tolerate the CHOP regimen and other more intensive chemotherapy combinations less well, many of these patients receive suboptimal (schedule/dosing) chemotherapy. 8 Myelosuppression is the major dose-limiting toxicity during the induction treatment in patients with aggressive NHL 9,10 and a large proportion of elderly patients cannot receive a planned chemotherapy dose at the scheduled intervals. 11 In general, such patients have done worse than those treated at full doses.…”

Section: Introductionmentioning

confidence: 99%

CHOP is superior to CNOP in elderly patients with aggressive lymphoma while outcome is unaffected by filgrastim treatment: results of a Nordic Lymphoma Group randomized trial

Ösby

Hagberg

Kvaløy

et al. 2003

Blood

174

103

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This study was designed to test the hypothesis that administration of granulocyte colony-stimulating factor (G-CSF; filgrastim) during induction chemotherapy with CHOP (cyclophosphamide, vincristine, doxorubicin, prednisone) or CNOP (doxorubicin replaced with mitoxantrone) in elderly patients with aggressive nonHodgkin lymphoma (NHL) improves time to treatment failure (TTF), complete remission (CR) rate, and overall survival (OS). Furthermore, the efficacy of CHOP versus CNOP chemotherapy was compared. A total of 455 previously untreated patients older than 60 years with stages II to IV aggressive NHL were included in the analysis. Patients (median age, 71 years; range, 60-86 years) were randomized to receive CHOP (doxorubicin 50 mg/m 2 ) or CNOP (mitoxantrone 10 mg/m 2 ) with or without G-CSF (5 g/kg from day 2 until day 10-14 of each cycle every 3 weeks; 8 cycles). Forty-seven patients previously hospitalized for class I to II congestive heart failure were randomized to receive CNOP with or without G-CSF (not included in the CHOP versus CNOP analysis). The CR rates in the CHOP/CNOP plus G-CSF and CHOP/CNOP groups were the same, 52%, and in the CHOP with or without G-CSF and CNOP with or without G-CSF groups, 60% and 43% (P < .001), respectively. No benefit of G-CSF in terms of TTF and OS could be shown (P ‫؍‬ .96 and P ‫؍‬ .22, respectively), whereas CHOP was superior to CNOP (TTF/OS P < .001).The incidences of severe granulocytopenia (World Health Organization grade IV) and granulocytopenic infections were higher in patients not receiving G-CSF. The cumulative proportion of patients receiving 90% or more of allocated chemotherapy was higher (P < .05) in patients receiving G-CSF. Concomitant G-CSF treatment did not improve CR rate, TTF, or OS. Patients receiving CHOP fared better than those given CNOP chemotherapy.

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Delivery of Full Dose CHOP Chemotherapy to Elderly Patients with Aggressive Non-Hodgkin's Lymphoma without G-CSF Support

Cited by 19 publications

References 28 publications

The effect of optimal treatment on elderly patients with aggressive non-Hodgkin's lymphoma: more patients treated with unaffected response rates

The effect of optimal treatment on elderly patients with aggressive non-Hodgkin's lymphoma: more patients treated with unaffected response rates

Immunohistochemical Expression of Multidrug Resistance Proteins as a Predictor of Poor Response to Chemotherapy and Prognosis in Patients with Nodal Diffuse Large B-Cell Lymphoma

CHOP is superior to CNOP in elderly patients with aggressive lymphoma while outcome is unaffected by filgrastim treatment: results of a Nordic Lymphoma Group randomized trial

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