CHOP with high dose cyclophosphamide consolidation versus CHOP alone as initial therapy for advanced stage, indolent non-Hodgkin's lymphomas Journal Article
| Authors: | Pan, D.; Qin, J.; Farber, C.; O'Brien, J.; Filippa, D.; Portlock, C. S. |
| Article Title: | CHOP with high dose cyclophosphamide consolidation versus CHOP alone as initial therapy for advanced stage, indolent non-Hodgkin's lymphomas |
| Abstract: | The role of high dose therapy, including autologous stem cell transplantation (ASCT) in indolent non-Hodgkin's lymphomas remains controversial. We evaluated a dose intense regimen of CHOP induction followed by high dose cyclophosphamide consolidation (CHOP-HC) versus CHOP alone in a prospective comparison to assess intensified therapy without ASCT. Twenty-five patients with previously untreated advanced stage indolent NHL were enrolled: follicular lymphoma, grade 1 (11 patients) and grade 2 (8 patients); small lymphocytic lymphoma (5 patients); and lymphoplasmacytic lymphoma (1 patient). All patients were treated as clinically indicated. The median age was 47 years (21-70). There were 15 males, and 10 females. Three patients had intra-abdominal stage II, 2 patients with stage III, and 20 patients with stage IV disease. All patients received induction with CHOP for 4 cycles (weeks 1,4,7,10): cyclophosphamide 750 mg/m2 IV, doxorubicin 50 mg/m2 IV, vincristine 1.4mg/m2 IV (2mg capped dose) and prednisone 100mg PO x 5 days. Following induction, responding patients were given consolidation with either high dose cyclophosphamide 3 gm/m2 IV for 3 doses with G-CSF (weeks 13,15,17) or 2 additional cycles of CHOP (weeks 13,16), stratified by stage and bulk of disease. The overall response rate to CHOP was 92% (3 CR, 8 PR) and to CHOP-HC was 93% (4 CR, 8 PR). The overall response, complete response and partial response rates were comparable in both arms. Median progression free survival for CHOP was 15.9 and 23.0 months for CHOP-HC. At 74.3 months median follow-up, all patients in the CHOP arm have recurred; 3 patients in the CHOP-HC arm (3 CR) have not recurred. The median overall survival has not been reached (at 5 years, 77% OS for CHOP-HC versus 83% OS for CHOP alone]. Greater hematologic toxicity was observed with CHOP-HC resulting in an increased number of hospitalizations for sepsis. There were no treatment-related deaths. No myelodysplasia or acute leukemia has been seen to date. With no obvious improvement in CR and with greater hematologic toxicity than CHOP, CHOP-HC is not recommended for treatment of indolent non-Hodgkin's lymphomas. |
| Keywords: | adult; clinical article; controlled study; aged; middle aged; survival rate; prednisone; clinical trial; cancer recurrence; doxorubicin; advanced cancer; dose response; cancer staging; drug megadose; neurotoxicity; follow up; neoplasm staging; prospective study; controlled clinical trial; phase 2 clinical trial; bone marrow suppression; blood toxicity; randomized controlled trial; antineoplastic combined chemotherapy protocols; cyclophosphamide; vincristine; stem cell transplantation; cancer mortality; time factors; gastrointestinal toxicity; hyponatremia; survival time; hospitalization; acute leukemia; nonhodgkin lymphoma; lymphoma, non-hodgkin; sepsis; phase 3 clinical trial; granulocyte colony stimulating factor; follicular lymphoma; lymphocytoma; autotransplantation; chop; myelodysplasia; abdominal tumor; dose-intensification; humans; human; male; female; priority journal; article; first-line chemotherapy; indolent non-hodgkin's lymphomas |
| Journal Title: | Leukemia and Lymphoma |
| Volume: | 44 |
| Issue: | 6 |
| ISSN: | 1042-8194 |
| Publisher: | Taylor & Francis Group |
| Date Published: | 2003-06-01 |
| Start Page: | 967 |
| End Page: | 971 |
| Language: | English |
| DOI: | 10.1080/1042819031000067710 |
| PUBMED: | 12854895 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 12 September 2014 -- Source: Scopus |
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