CHOP compared with CHOP plus granulocyte colony-stimulating factor in elderly patients with aggressive non-Hodgkin's lymphoma
CHOP compared with CHOP plus granulocyte colony-stimulating factor in elderly patients with aggressive non-Hodgkin's lymphoma
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DOI：
10.1200/jco.2003.01.076
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发表时间：
2003-08-15
影响因子：
45.3
通讯作者：
Sonneveld, P
中科院分区：
文献类型：
--
作者：
Doorduijn, JK;van der Holt, B;Sonneveld, P
目的：探讨老年侵袭性非霍奇金淋巴瘤（NHL）患者预防性应用粒细胞集落刺激因子（G-CSF）是否能改善环磷酰胺、阿霉素、长春新碱和泼尼松（CHOP）化疗的相对密集强度。65 - 90岁患者（中位数，72岁）II至IV期侵袭性NHL患者随机分配接受标准CHOP每3周或CHOP加G-结果：在389例符合条件的患者中，环磷酰胺的相对剂量强度（RDI）CHOP + G-CSF治疗的患者中，阿霉素（中位数，96.3%对93.9%; P = 0.01）和阿霉素（中位数，95.4%对93.3%; P = 0.04）更高。CHOP组和CHOP + G-CSF组的完全缓解率分别为55%和52%（P = 0.63）。在中位随访33个月时，单独使用CHOP的5年精算总生存率为22%，而CHOP + G-CSF为24%（P = 0.76）。接受CHOP + G-CSF治疗的患者感染发生率相同，世界卫生组织分级为3 - 4级（34/1，191个周期vs 36/1，195个周期）。只有CHOP + G-CSF组的抗生素累积天数少于CHOP单药组（中位数，0 v6天; P = 0.006）。住院人数和住院天数无差异。结论：在老年患者中，G-CSF改善了CHOP的RDI，但这并没有导致更高的完全缓解率或更好的总生存期。G-CSF不能预防严重感染。
Purpose : To investigate whether the relative close-intensity of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy could be improved by prophylactic administration of granulocyte colony-stimulating factor (G-CSF) in elderly patients with aggressive non-Hodgkin's lymphoma (NHL).Patients and Methods: Patients aged 65 to 90 years (median, 72 years) with stage II to IV aggressive NHL were randomly assigned to receive standard CHOP every 3 weeks or CHOP plus G-CSF every 3 weeks on days 2 to 11 of each cycle.Results: In 389 eligible patients, the relative dose intensities (RDIs) of cyclophosphamide (median, 96.3% v 93.9%; P =.01) and doxorubicin (median, 95.4% v 93.3%; P =.04) were higher in patients treated with CHOP plus G-CSF. The complete response rates were 55% and 52% for CHOP and CHOP plus G-CSF, respectively (P =.63). The actuarial overall survival at 5 years was 22% with CHOP alone, compared with 24% with CHOP plus G-CSF (P =.76), with a median follow-up of 33 months. Patients treated with CHOP plus G-CSF had an identical incidence of infections, with World Health Organization grade 3 to 4 (34 of 1, 191 cycles v 36 of 1,195 cycles). Only the cumulative days with antibiotics were fewer with CHOP plus G-CSF (median, 0 v 6 days; P =.006) than with CHOP alone. The number of hospital admissions and the number of days in hospital were not different.Conclusion: In elderly patients, G-CSF improved the RDI of CHOP, but this did not lead to a higher complete response rate or better overall survival. G-CSF did not prevent serious infections.