Elderly Aggressive-Histology Non-Hodgkin's Lymphoma: First-Line VNCOP-B Regimen Experience on 350 Patients

• Published in: Blood Vol. 94; no. 1; pp. 33 - 38
• Main Authors: Zinzani, Pier Luigi, Storti, Sergio, Zaccaria, Alfonso, Moretti, Luciano, Magagnoli, Massimo, Pavone, Enzo, Gentilini, Patrizia, Guardigni, Luciano, Gobbi, Marco, Fattori, Pier Paolo, Falini, Brunangelo, Lauta, Vito Michele, Bendandi, Maurizio, Gherlinzoni, Filippo, De Renzo, Amalia, Zaja, Francesco, Mazza, Patrizio, Volpe, Ettore, Bocchia, Monica, Aitini, Enrico, Tabanelli, Maurizio, Leone, Giuseppe, Tura, Sante
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 01.07.1999; The Americain Society of Hematology
• Subjects: Aged; Aged, 80 and over; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Biological and medical sciences; Bleomycin - administration & dosage; Chemotherapy; Cohort Studies; Cyclophosphamide - administration & dosage; Disease-Free Survival; Etoposide - administration & dosage; Female; Granulocyte Colony-Stimulating Factor - administration & dosage; Humans; Lymphoma, Non-Hodgkin - drug therapy; Lymphoma, Non-Hodgkin - pathology; Lymphoma, Non-Hodgkin - physiopathology; Male; Medical sciences; Mitoxantrone - administration & dosage; Pharmacology. Drug treatments; Prednisone - administration & dosage; Remission Induction; Survival Analysis; Vincristine - administration & dosage; Antineoplastic agent; Prognosis; Glucocorticoid; Alkaloid; Isomerases; Bleomycin; Lymphoproliferative syndrome; Adult; Mitoxantrone; Antimitotic; Human; Corticosteroid; DNA topoisomerase (ATP-hydrolysing); Drug combination; Anthraquinone derivatives; Enzyme; Etoposide; Enzyme inhibitor; Malignant hemopathy; Prednisone; Non Hodgkin lymphoma; Vincristine; Podophyllotoxine derivatives; Alkylating agent; Antibiotic; Chemotherapy; Cyclophosphamide; Oxazaphosphinane derivatives; Treatment; Antimetabolic; Follow up study; Nitrogen mustard; Therapeutic protocol; Elderly
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V94.1.33.413k08_33_38

Age is a risk factor and a prognostic parameter in elderly aggressive-histology non-Hodgkin's lymphoma (NHL) patients. Several adapted chemotherapeutic regimens have recently been designed and tested on elderly patients. Several of these trials have shown that older aggressive-histology NHL patients can benefit from specific and adequate treatment capable of curing a percentage of these patients. Between January 1992 and September 1997, 350 previously untreated aggressive-histology NHL patients greater than 60 years of age were treated with a combination therapy including cyclophosphamide, mitoxantrone, vincristine, etoposide, bleomycin, and prednisone (VNCOP-B). Complete remission (CR) was achieved by 202 (58%) patients and partial remission (PR) by 87 (25%), whereas the remaining 61 (17%) patients were nonresponders. The overall response rate (CR + PR) was 83%. Clinical and hematologic toxicities were modest, because 71% of the patients received granulocyte colony-stimulating factor (G-CSF). The CR rates for the three age groups (60 to 69, 70 to 79, and ≥80 years) were similar: 61%, 59%, and 56%, respectively. At 5 years, the relapse-free survival rate was 65%, the overall survival rate was 49%, and the failure-free survival rate was 33%. In the multivariate analysis, prognostic factors associated with longer survival or longer relapse-free survival turned out to be localized disease stage (P = .001) and good performance status (P = .0002). Application of the International Prognostic Factor Index was significantly associated with outcome (P= .001). These data confirm on a large cohort of patients that the VNCOP-B regimen is effective in inducing good CR and relapse-free survival rates with only moderate toxic effects in elderly aggressive-histology NHL.