NEW YORKThe addition of G-CSF (Neupogen) to standard CHOP
(cyclophosphamide, doxorubicin, vincristine, prednisone) may improve
disease outcome in elderly patients with large-cell lymphoma by
allowing optimal drug dosing, Gerard Donnelly, MD, said at the
Fortieth Annual Meeting of the American Society of Hematology (ASH).
Although CHOP is the gold standard for large-cell lymphoma, elderly
patients may not get the full benefits of the regimen because of
dose-limiting hematologic toxicity.
Dr. Donnelly, a fellow in hematology-oncology at Memorial
Sloan-Kettering Cancer Center, said that in elderly patients, CHOP
doses are often reduced by 50% to 75% due to patient frailty or other
complications. With G-CSF, we can treat the disease more
aggressively, Dr. Donnelly commented.
The researchers worked with Dr. Carol Portlock at Memorial
Sloan-Kettering Cancer Center to retrospectively identify 51
previously untreated large-cell lymphoma patients over 60 years of
age who received CHOP plus G-CSF at Sloan-Kettering from 1991 to 1995.
Patients were ineligible for other protocols for a number of reasons,
including age (20 patients), another malignancy (5 patients), and
other co-morbidities (12 patients). All patients were negative for
The median age was 72 years (range, 61 to 85). Using the age-adjusted
International Prognostic Index (IPI), 27 patients were judged low or
low-intermediate risk; 13, high-intermediate risk; and 11, high risk.
Patients received CHOP at 3-week intervals (mean, 5.9 cycles per
patient). The G-CSF dose was 5 µg/kg/day for 5 to 8 days. It was
given after each CHOP cycle in 51% of patients and for the majority
of cycles in 86% of patients.
There were a total of 50 treatment delays occurring in 28 patients,
and 10 of these patients had two or more delays. There were no
treatment delays in 23 patients.
The actual cyclophosphamide dose was 695.2 mg/m² (93% of the
optimal dose). The patients received 47.8 mg/m² of doxorubicin
(96% of the optimal dose).
The researchers analyzed patient outcomes according to the
age-adjusted IPI, and then compared these data with the 5-year
results from the IPI study of large-cell lymphoma patients (N Engl
J Med 329:987-994, 1993).
Responses in Elderly
They found that their elderly patients who received G-CSF plus CHOP
had complete response rates, 5-year actuarial relapse-free survival,
and overall survival superior to those of the IPI patients over the
age of 60 and comparable to those of the IPI patients under the age
Dr. Donnelly said that by adding G-CSF, the standard CHOP treatment
could be given nearly at its optimal dosing level in these elderly
patients with large-cell lymphoma.
There are some limitations to the study, and there needs to be
further investigation, he commented, especially in a