Community-based trial of R-CHOP and maintenance rituximab for intermediate- or high-grade non-Hodgkin lymphoma with first-cycle filgrastim for older patients.

Abstract

BACKGROUND:

Administration of full-dose R-CHOP (rituximab/cyclophosphamide/doxorubicin/vincristine/prednisone) chemotherapy is important to maximize response in patients with intermediate-or high-grade non-Hodgkin lymphoma but might be difficult in older patients.

PATIENTS AND METHODS:

This community-based study was conducted to determine response, toxicity, and disease-free survival in patients with intermediate-or high-grade non-Hodgkin lymphoma receiving R-CHOP with filgrastim. Patients received 6-8 cycles of R-CHOP followed by 4 cycles of maintenance rituximab for responders. Patients aged > 60 years or with increased infection risk received filgrastim 5 microg/kg per day in all R-CHOP cycles; other patients received filgrastim after a neutropenic event (no planned administration for cycle 1).

RESULTS:

Of 101 patients enrolled, 60 (59%) were aged > 60 years and received filgrastim in all cycles. Thirty-three patients aged <or= 60 years (80%) received filgrastim, 7 (17%) as primary use in cycle 1. Chemotherapy average relative dose intensity was comparable between age groups (91% > 60 years vs. 93% <or= 60 years). Overall response was similar in both groups (87% > 60 years vs. 95% <or= 60 years; P=0.19); however, the complete response rate was significantly lower for older patients (42% > 60 years vs. 71% <or= 60 years; P=0.005). Seventy-six percent of patients (75% > 60 years vs. 78% <or= 60 years) had no evidence of progression after 2 years of follow-up. Febrile neutropenia (fever >or= 38.3 degrees C with absolute neutrophil count < 500/mm) occurred in 17% of patients overall (22% > 60 years vs. 10% <or= 60 years), and 8% had cycle-1 events (12% > 60 years vs. 2% <or= 60 years).

CONCLUSION:

Patients aged > 60 years receiving R-CHOP with filgrastim support in all cycles received comparable doses of chemotherapy and had similar overall response rates compared wtih those of younger patients receiving no preemptive cycle-1 filgrastim.

• Authors: Delvyn C Case Jr, Christopher E Desch, Leonard A Kalman, Piyapong Vongkovit, Raul R Mena, Moshe Fridman, Barbara Allen
• Journal: Clinical lymphoma & myeloma (Clin Lymphoma Myeloma) Vol. 7 Issue 5 Pg. 354-60 (Mar 2007) ISSN: 1557-9190 [Print] United States
• PMID: 17562245 (Publication Type: Clinical Trial, Phase II, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Murine-Derived
• Recombinant Proteins
• Granulocyte Colony-Stimulating Factor
• Rituximab
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Filgrastim
• Prednisone

Topics

• Adult
• Aged
• Aged, 80 and over
• Antibodies, Monoclonal (administration & dosage, adverse effects)
• Antibodies, Monoclonal, Murine-Derived
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects, therapeutic use)
• Cyclophosphamide (administration & dosage, adverse effects)
• Disease Progression
• Disease-Free Survival
• Dose-Response Relationship, Drug
• Doxorubicin (administration & dosage, adverse effects)
• Drug Administration Schedule
• Drug-Related Side Effects and Adverse Reactions
• Female
• Filgrastim
• Follow-Up Studies
• Granulocyte Colony-Stimulating Factor (administration & dosage, adverse effects)
• Humans
• Lymphoma, Non-Hodgkin (drug therapy)
• Male
• Maximum Allowable Concentration
• Middle Aged
• Neoplasm Staging
• Prednisone (administration & dosage, adverse effects)
• Recombinant Proteins
• Risk Factors
• Rituximab
• Treatment Outcome
• Vincristine (administration & dosage, adverse effects)