Outcome is not improved by the use of alternating chemotherapy in elderly patients with aggressive lymphoma.

Abstract

INTRODUCTION:

A prospective randomised study involving 810 elderly patients was conducted in an attempt to compare alternating chemotherapy with conventional first-line chemotherapy in aggressive non-Hodgkin's lymphoma in order to improve prognosis with an acceptable toxicity for elderly patients.

PATIENTS AND METHODS:

Patients included were 55-69 years old and had at least one adverse prognostic factor. Patients were treated either with ACVBP followed by consolidation (n = 396) or with an alternating regimen (n = 414). This regimen was an association of active drugs in NHL relapsing patients, alternating VIMMM with ACVBP for induction and alternation of VIM and ACVM in consolidation. Eight hundred and sixty-six patients were randomised. After histological review, 810 patients met the inclusion criteria: 396 in arm A, 414 in arm B.

RESULTS:

The complete response rate after induction was superior for conventional first-line therapy (58.5% vs 48%, P = 0.003) but at the end of treatment, the CR rate was not statistically different (52% vs 48%, P = 0.19). Conventional chemotherapy had a better five-year event-free survival than alternating regimen (33% (95% CI: 30-36%) vs 28% (95% CI: 26-30%), P = 0.0289) but overall survival was not statistically different (40% (CI 95% 38-42%) vs 36% (CI 95% 34-38%), P = 0.068). In this elderly high risk population, the toxicity was very high: 19% in arm A and 26% in arm B died during treatment.

CONCLUSION:

Alternating regimen did not improve outcome, was less efficient and more toxic.

• Authors: A Bosly, E Lepage, B Coiffier, G Fillet, R Herbrecht, M Divine, B Dupriez, C Nouvel, E Deconninck, H Tilly, D Bordessoule, P Gaulard, C Gisselbrecht, GELA
• Journal: The hematology journal : the official journal of the European Haematology Association (Hematol J) Vol. 2 Issue 4 Pg. 279-85 ( 2001) ISSN: 1466-4860 [Print] England
• PMID: 11920261 (Publication Type: Clinical Trial, Clinical Trial, Phase III, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Bleomycin
• Etoposide
• Doxorubicin
• Cyclophosphamide
• Mitoxantrone
• Vindesine
• Ifosfamide
• Prednisone
• Methotrexate

Topics

• Aged
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, therapeutic use, toxicity)
• Bleomycin (administration & dosage)
• Cyclophosphamide (administration & dosage)
• Doxorubicin (administration & dosage)
• Drug Administration Schedule
• Etoposide (administration & dosage)
• Female
• Humans
• Ifosfamide (administration & dosage)
• Lymphoma, Non-Hodgkin (complications, drug therapy, mortality)
• Male
• Methotrexate (administration & dosage)
• Middle Aged
• Mitoxantrone (administration & dosage)
• Prednisone (administration & dosage)
• Prospective Studies
• Remission Induction
• Survival Analysis
• Treatment Outcome
• Vindesine (administration & dosage)