Mitoxantrone, prednimustine, and vincristine for elderly patients with aggressive non-Hodgkin's lymphoma

Abstract

Elderly patients with intermediate-or high-grade non-Hodgkin's lymphoma have a worse outcome than those who are younger than 60 years. It has been shown that aggressive combination chemotherapy is poorly tolerated in older patients resulting in a subsequent decrease in dose intensity. A phase II trial was conducted with mitoxantrone, prednimus-tine, and vincristine (NSO) in this group of patients. NSO consists of mitoxantrone 12 mg/M 2 intravenously on day one, vincristine 1.4 mg/M 2 intravenously on day 1 (maximum dose of two mg), and prednimustine 100 mg/M 2 orally once a day for four days. NSO was repeated every 21 days. Thirty-six patients were able to be evaluated. There were 18 males and 18 females with the median age of 71 (range 60-85). NSO was well tolerated and nonhematological toxicities were uncommon. More than 80% of the patients received 90% or greater of the intended dose. The complete response rate was 60.6% and partial response was 21.8%. At 60 months the Kaplan-Meier estimate of progression-free survival was 47.9% (standard error 8.6%) and actual survival was 40.6% (standard error 8.8%). There were no differences in outcome between those with performance status (PS) of zero or one and those with PS > 1. NSO is well tolerated by elderly patients including those with PS > 1. These results compare favorably with other combinations in elderly patients with aggressive non-Hodgkin's lymphoma. Am. J. Hematol. 59:156-160, 1998.

Pharmacology of cytotoxic agents: a helpful tool for building dose adjustment guidelines in the elderly

“…Moreover, these authors showed that in elderly patients with aggressive NHL who had relapsed after first-line VNCOP-B, a combination of vinorelbine, epirubicin, and prednisone could be an effective treatment with a low level of toxicity [63]. Several other regimens were evaluated in elderly patients suffering from non-Hodgkin's lymphoma, leading to the same conclusions [64][65][66]. The same benefit, with a toxicity similar to that observed in younger patients, was observed in elderly patients with chronic lymphocytic leukemia (CLL) treated with cladribine [67], acute myeloid leukemia treated with idarubicin containing regimens [68,69], daunorubicin and cytarabine [70,71], or the VAD regimen (vincristine, doxorubicin, dexamethasone) [72].…”