The importance of dose intensity of doxorubicin administration in non-Hodgkin's lymphoma. A case report.
A 30-year-old woman with Stage IIIA diffuse non-Hodgkins lymphoma was treated with doxorubicin, cyclophosphamide, vincristine, and prednisone (CHOP) every 3 weeks. When the cumulative doxorubicin dosage after nine courses of chemotherapy was 515 mg/m2 (average, 57 mg/m2/course and 19 mg/m2/week), the doxorubicin was discontinued. She relapsed 4.5 months later while receiving vincristine, prednisone, and an escalated dosage of cyclophosphamide (CVP) every 3 weeks. Single-agent chemotherapy consisting of weekly doxorubicin was administered for 15 courses (average dose 29 mg/m2/week) and resulted in a complete remission after nine courses. The cumulative dosage of doxorubicin was 955 mg/m2 at the end of the 15 courses. Mild cardiomyopathy was noted on left ventricular gated scan and electrocardiogram (ECG) at the cessation of therapy. Mild congestive heart failure occurred shortly after the discontinuation of the doxorubicin. It responded to treatment with digoxin and diuretics. At present, she has no dyspnea on exertion and no evidence of cardiomegaly on chest x-ray films; she continues to use digoxin alone. She remains in complete remission 29 months after discontinuation of intensive, weekly, single-agent doxorubicin administration (compared to a remission of only 4.5 months from the end of less intensive administration of doxorubicin every 3 weeks as part of combination chemotherapy). This case illustrates that intensive doxorubicin administration may be superior to conventional doxorubicin administration for the treatment of lymphomas, and raises the possibility that weekly administration could be superior to administration of doxorubicin every 3 weeks. Further studies investigating the efficacy of weekly versus conventional scheduling of doxorubicin are warranted in non-Hodgkin's lymphoma, particularly in light of published evidence that weekly doxorubicin administration is also less cardiotoxic than treatment given every 3 weeks.
D000328:Adult; D004317:Doxorubicin / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy*
D004317:Doxorubicin