title: Alternation of epirubicin and mitoxantrone in CHOP-like regimens retains efficacy and reduces overall toxicity in elderly patients with high and intermediate grade non-Hodgkin lymphomas.
abstract: Mitoxantrone and Epirubicin are active agents in non-Hodgkin's lymphomas (NHL). These drugs have reduced cardiotoxicity and therefore are indicated in treatment of elderly patients. Cyclophosphamide, mitoxantrone, vincristine and methylprednisone (CNOP) and cyclophosphamide, epirubicin, vincristine and methylprednisone (CEOP) are combination chemotherapy and contain Mitoxantrone and Epirubicin that have been shown to be effective in treatment of NHL of intermediate and highgrade of malignancy in the elderly. Since Mitoxantrone and Epirubicin are partially non-cross resistant their combined use may diminish emergence of resistant neoplastic clones and may be associated with enhanced anti-neoplastic activity. In this study, a polychemotherapy schedule alternating 3 cycles of CEOP and 3 cycles of CNOP, was used in a single center between December 1988 and April 1995 to treat 41 previously untreated patients, over 60 years of age affected by intermediate or high grade non-Hodgkin's lymphoma according to the Working Formulation. In treated patients, 57.5% achieved complete response, 35% partial response and 7.5% were non-responders. Overall survival was 52.4 % at 4 years, Disease free survival (DFS) for complete responders was 48.9%. Only one case of severe extrahematological toxicity (grade 3-4 WHO) was observed. Severe mucositis (grade 3-4 WHO) was absent, and delayed administration of chemotherapy was required in only 7/230 cycles. No treatment related deaths were registered. This regimen achieved results comparable to that of other anthracycline or mitoxantrone based chemotherapy, but determined lower toxicity. Alternating CEOP and CNOP may improve overall toxicity.
authors.affiliation: Chair and Division of Hematology, University of Catania Medical School, Ospedale Ferrarotto, Via S. Citelli 6, 95100 Catania, Italy. guwgim@tin.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Milone
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Raimondo
authors.forename: Felicina Li
authors.initials: FL
authors.lastname: Gioi
authors.forename: Giuseppe A
authors.initials: GA
authors.lastname: Palumbo
authors.forename: Giovanna Oriella
authors.initials: GO
authors.lastname: Manenti
authors.forename: Marzia
authors.initials: M
authors.lastname: Pafumi
authors.forename: Rosario
authors.initials: R
authors.lastname: Giustolisi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D019008:Drug Resistance, Neoplasm; D015251:Epirubicin / Q000008:administration & dosage* / Q000633:toxicity; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage* / Q000633:toxicity; D012074:Remission Induction / Q000379:methods; D016019:Survival Analysis
chemical_list: D015251:Epirubicin; D008942:Mitoxantrone