COMPARISON OF DOXORUBICIN AND MITOXANTRONE IN THE TREATMENT OF ELDERLY PATIENTS WITH ADVANCED DIFFUSE NON-HODGKINS-LYMPHOMA USING CHOP VERSUS CNOP CHEMOTHERAPY
COMPARISON OF DOXORUBICIN AND MITOXANTRONE IN THE TREATMENT OF ELDERLY PATIENTS WITH ADVANCED DIFFUSE NON-HODGKINS-LYMPHOMA USING CHOP VERSUS CNOP CHEMOTHERAPY
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DOI：
10.1200/jco.1995.13.10.2530
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发表时间：
1995-10-01
影响因子：
45.3
通讯作者：
LOWENBERG, B
中科院分区：
文献类型：
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作者：
SONNEVELD, P;DERIDDER, M;LOWENBERG, B
目的和方法：我们进行了一项前瞻性、随机、多中心III期临床试验，以探讨环磷酰胺、阿霉素、长春新碱和泼尼松（CHOP）化疗在老年患者中的可行性（大于或等于60岁）中高度恶性的晚期非霍奇金淋巴瘤（NHL）患者，并比较多柔比星与米托蒽醌的耐受性和疗效（CHOP v hocP），结果：在157例入组患者中，148例合格，145例可评估缓解。31%的hocP患者和45%的CHOP患者完成了6个周期的治疗，没有减少剂量。6个周期后，CHOP和hocP的累积标准化剂量强度（NDI）分别为92%和90%。CHOP和hocP治疗患者的总体完全缓解（CR）率分别为49%和31%（P = 0.03）。与CHOP相比，hocP的生存率明显更差（P = 0.03），CHOP治疗的患者淋巴细胞特异性生存率明显更好（P = 0.034）。3年时，42%的CHOP患者和26%的hocP患者存活。诊断时其他不利的预后因素包括高血清乳酸脱氢酶（LDH）水平、巨大肿块和低体力状态，而不是年龄。完全应答者的中位无病间隔分别为27（CHOP）和15（hocP）个月。考虑到整个患者组，3年时17%的CHOP患者和13%的hocP患者存活且无疾病（P = 0.12）。共同毒性标准（CTC）等级大于或等于2与hocP和CHOP是没有different.Conclusion：CHOP是在晚期中或高级别NHL的老年患者的耐受性良好，其NDI没有严重受损。CHOP（多柔比星）治疗的CR率和生存率比CHOP（米托蒽醌）更好。CHOP应推荐用于老年高危NHL患者。(C)1995年，美国临床肿瘤学会。
Purpose and Methods: A prospective, randomized, multicenter phase III trial was performed to investigate the feasibility of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy in elderly patients (greater than or equal to 60 years) with advanced non-Hodgkin's lymphoma (NHL) of intermediate- and high-grade malignancy, and to compare the tolerance and efficacy of doxorubicin versus mitoxantrone (CHOP v CNOP),Results: Of 157 enrolled patients, 148 were eligible and 145 were assessable for response. Thirty-one percent of CNOP and 45% of CHOP patients completed six cycles without dose reduction. The cumulative normalized dose-intensity (NDI) was 92% with CHOP and 90% with CNOP after six cycles. The overall complete response (CR) rates were 49% and 31% in CHOP- and CNOP-treated patients, respectively (P = .03). Survival with CNOP was significantly worse as compared with CHOP (P = .03), Lymphomo-specific survival was significantly better in CHOP-treated patients (P = .034) At 3 years, 42% of CHOP and 26% of CNOP patients were alive. Additional unfavorable prognostic factors at diagnosis were high serum lactate dehydrogenase (LDH) level, bulky mass, and low performance status, but not age. The median disease-free intervals of complete responders were 27 (CHOP) and 15 (CNOP) months, respectively. Considering the complete group of patients, at 3 years 17% of CHOP and 13% of CNOP patients were alive and disease-free (P = .12). Common toxicity criteria (CTC) grade greater than or equal to 2 with CNOP and CHOP was not different.Conclusion: CHOP is well tolerated in elderly patients with advanced intermediate- or high-grade NHL and its NDI is not seriously impaired. Treatment with CHOP (doxorubicin) results in better CR and survival rates than CNOP (mitoxantrone). CHOP should be recommended for elderly patients with high-risk NHL. (C) 1995 by American Society of Clinical Oncology.