title: CHOP compared with CHOP plus granulocyte colony-stimulating factor in elderly patients with aggressive non-Hodgkin's lymphoma.
abstract: OBJECTIVE
  To investigate whether the relative dose-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).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Hematology, Erasmus Medisch Centrum Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands. j.doorduijn@erasmusmc.nl
authors.forename: J K
authors.initials: JK
authors.lastname: Doorduijn
authors.forename: B
authors.initials: B
authors.lastname: van der Holt
authors.forename: G W
authors.initials: GW
authors.lastname: van Imhoff
authors.forename: K G
authors.initials: KG
authors.lastname: van der Hem
authors.forename: M H H
authors.initials: MH
authors.lastname: Kramer
authors.forename: M H J
authors.initials: MH
authors.lastname: van Oers
authors.forename: G J
authors.initials: GJ
authors.lastname: Ossenkoppele
authors.forename: M R
authors.initials: MR
authors.lastname: Schaafsma
authors.forename: L F
authors.initials: LF
authors.lastname: Verdonck
authors.forename: G E G
authors.initials: GE
authors.lastname: Verhoef
authors.forename: M M C
authors.initials: MM
authors.lastname: Steijaert
authors.forename: I
authors.initials: I
authors.lastname: Buijt
authors.forename: C A
authors.initials: CA
authors.lastname: Uyl-de Groot
authors.forename: M
authors.initials: M
authors.lastname: van Agthoven
authors.forename: A H
authors.initials: AH
authors.lastname: Mulder
authors.forename: P
authors.initials: P
authors.lastname: Sonneveld
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003520:Cyclophosphamide / Q000008:administration & dosage*; D004317:Doxorubicin / Q000008:administration & dosage*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008297:Male; D011241:Prednisone / Q000008:administration & dosage*; D011788:Quality of Life; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage*
chemical_list: D016179:Granulocyte Colony-Stimulating Factor; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone