R-COMP 21 for frail elderly patients with aggressive B-cell non-Hodgkin lymphoma: A pilot study

Abstract

We evaluated the toxicity and efficacy of nonpegylated liposomal doxorubicin (Myocet) when substituted for conventional doxorubicin in the CHOP-21 regimen in the treatment of frail elderly patients with aggressive non-Hodgkin lymphoma. Twenty frail patients (median age, 73 years), as defined by Balducci et al., with diffuse large B cell or grade IIIb follicular lymphoma, either at diagnosis (15 patients) or relapsed (five patients), were prospectively enrolled. Nine out of 20 (45%) had a World Health Organisation (WHO) performance status > or =2. Fifteen out of 20 patients (75%) had an International Prognostic Index (IPI) score > or =3. Thirteen out of 20 (65%) evaluable patients obtained a complete response. Five additional patients (25%) achieved a partial response. With a median follow-up of 24 months (range 18-27), 15/18 responding patients (83%) are alive and disease free, as well as 3/18 are alive with active disease. Toxicity was mainly hematological with grade 3/4 neutropenia in 26% of cycles and febrile neutropenia in 5%. However, 3/20 patients presented a grade III-IV WHO toxicity (one fatal pulmonary embolism, one congestive, and one ischemic heart failure) while receiving R-COMP chemotherapy. In conclusion, R-COMP-21 is an effective regimen with promising response rates for frail and elderly patients with aggressive non-Hodgkin lymphoma.

Activity and safety of dose‐adjusted infusional cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy with rituximab in very elderly patients with poor‐prognostic untreated diffuse large B‐cell non‐Hodgkin lymphoma

“…As expected, the most frequent grade 3 to 4 AEs were neutropenia and febrile neutropenia, which occurred in 48% and 13% of patients, respectively. However, the observed rates of AEs with DA-POCH-R did not differ from those reported in other dose-adjusted regimens [14][15][16][17] and were substantially lower than AE rates observed in a series of doxorubicin-free protocols [31][32][33][34][35][36][37][38][39][40]42,44 specifically tailored for elderly patients with DLBCL (Table 6).…”

“…31,33,40 Despite the favorable outcome reported, grade 3 to 4 neutropenia was observed in 75% to 83%, with febrile neutropenia occurring in 30% of cases. 31 The use of liposome-encapsulated doxorubicin was also tested with encouraging results in patients with DLBCL and with concurrent cardiac disease or pretreated with anthracyclines, 41 in frail patients with DLBCL, 42 and in patients with AIDS-related nonHodgkin lymphoma. 43 In a series of untreated DLBCL patients aged over 60 years, 44 substitution of the nonpegylated liposomal doxorubicin, Myocet TM , for doxorubicin (5) 1 (8) 4 (5) 1 (10) 2 (4) NS Anemia 3 (13) 5 (4) 2 (15) 3 (4) 1 (10) 2 (4) NS Neutropenic fever 3 (13) 8 (6) 1 (8) 4 (5) 2 ( in the standard R-CHOP showed similar efficacy (Table 6).…”

Individualized Liposomal Doxorubicin-Based Treatment in Elderly Patients with Non-Hodgkin’s Lymphoma

“…Nearly 90% of the patients in the present study had a historyofcardiacdisease,suchascoronaryheartdiseaseand/ or hypertension, including mild ECG abnormalities such as ectopicrhythm,conductionabnormalities,andST-Tsegment changes; this was slightly higher than that in other reports [12][13][14]. No serious infections, bleeding, or other complicationsoccurredaftersymptomatictreatmentofchemotherapyrelatedbonemarrowsuppression.Thesefindingssuggestthat liposomaldoxorubicinwaswelltoleratedandsafe.…”

Nonpegylated Liposomal Doxorubicin as a Component of R-CHOP Is an Effective and Safe Alternative to Conventional Doxorubicin in the Treatment of Patients With Diffuse Large B-Cell Lymphoma and Preexisting Cardiac Diseases

“…[25][26][27] Some smaller studies that examined the use of NPLD as a replacement for conventional doxorubicin as a component of the R-CHOP regimen showed the promising tolerability and efficacy of this regimen in elderly patients. [28][29][30][31][32][33] Of note, in prospective studies, patients with previous chemo-or radiotherapy, myocardial infarction during the previous 12 months and reduced LVEF < 45% 32 or < 50% and significant comorbidities 29 were excluded. Gimeno et al 31 administered NPLD in reduced dosages of 30 mg/m 2 in frail elderly patients with comorbidities, leading to a 2-year PFS and OS of 58% and 70%, respectively, but these results included patients with NHLs other than DLBCL.…”