Age is a risk factor and a prognostic parameter in elderly high-grade non-Hodgkins lymphoma (NHL) patients. Several adapted chemotherapeutic regimens have recently been designed and tested in elderly patients. Several of these trials have shown that a percentage of older high-grade NHL patients can benefit from a specific and adequate treatment in terms of cure.
Between January 1992 and September 1997, 350 previously untreated patients 60 years and older with high-grade NHL (updated Kiel classification) were treated with the VNCOP-B regimen, a MACOP-B-like scheme, consisting of mitoxantrone(Drug information on mitoxantrone), 10 mg/m², and cyclophosphamide(Drug information on cyclophosphamide), 300 mg/m², on weeks 1, 3, 5, and 7; vincristine, 2 mg total dose, on weeks 2, 4, 6, and 8; etoposide(Drug information on etoposide), 150 mg/m², on weeks 2 and 6; bleomycin(Drug information on bleomycin), 10 mg/m², on weeks 4 and 8; and prednisone(Drug information on prednisone), 40 mg daily with dose tapering over the last 2 weeks (Haematologica 78:378, 1993).
Of the 350 patients, 202 (58%) obtained a complete response (CR) and 87 achieved a partial response (PR), but the remaining 61 patients did not respond to therapy. The overall response rate (CR + PR) was 83%; the CR rates for three age subgroups (60 to 69, 70 to 79, and ³ 80 years) were similar: 61%, 59%, and 56%, respectively. Clinical and hematologic toxicities were irrelevant because 71% of these patients utilized granulocyte colony-stimulating factor (G-CSF, filgrastim(Drug information on filgrastim) [Neupogen]) (Blood 89:3974, 1997). At 5 years, the relapse-free survival rate was 65% and the overall survival rate was 62%.
In a multivariate analysis, prognostic factors associated with longer survival or longer relapse-free survival were: localized disease stage (P = .001) and good performance status (P = .0002). The application of the International Prognostic Factor Index was significantly associated with outcome (P = .001).
CONCLUSION: These data confirm, in a large cohort of patients, that the VNCOP-B regimen is effective in inducing a good CR with moderate toxic effects and in producing long-term relapse-free survival in elderly patients with high-grade NHL