VEPEMB in elderly Hodgkin's lymphoma patients. Results from an Intergruppo Italiano Linfomi (IIL) study.
BACKGROUND
In advanced age the prognosis of Hodgkin's lymphoma (HL) is poor, but, as a consequence of the low incidence of HL in the elderly, prospective studies are lacking and the best treatment strategy is difficult to define.


METHODS
One-hundred and five HL patients over 65 years of age were treated homogeneously with an original reduced-intensity regimen designed for HL in the elderly containing vinblastine, cyclophosphamide, procarbazine, etoposide, mitoxantrone and bleomycin (VEPEMB). Forty-eight early stage (IA-IIA) patients received three courses of VEPEMB followed by involved field irradiation. Fifty-seven advanced stage (IIB-IV) patients received six courses followed by radiotherapy limited to the areas of bulky disease.


RESULTS
Mean age was 71 years (range 66-83). Co-morbidities were present in 39 patients (37%). A treatment plan modification for poor tolerance or toxicity was needed in 18 patients. Results were satisfactory, even if they were better in early rather than in advanced stage disease: complete response rate 98% versus 58% (P <0.01); 5-year failure-free survival 79% versus 34% (P <0.01). The results were affected by advanced stage, systemic symptoms and co-morbidity but they were not influenced by age itself.


CONCLUSIONS
VEPEMB is an effective and low toxic regimen for HL in the elderly. Co-morbidity is a prognostic factor more important than age itself.
Levis
A
A
Haematology Division of the Ospedale SS Antonio e Biagio, Alessandria, Italy. alevis@ospedale.al.it
Anselmo
A P
AP
Ambrosetti
A
A
Adamo
F
F
Bertini
M
M
Cavalieri
E
E
Gavarotti
P
P
Genua
A
A
Liberati
M
M
Pavone
V
V
Pietrasanta
D
D
Ricetti
M M
MM
Scalabrini
D R
DR
Salvi
F
F
Vitolo
U
U
Angelucci
E
E
Boccadoro
M
M
Gallo
E
E
Mandelli
F
F
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D015897:Comorbidity; D003520:Cyclophosphamide / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006689:Hodgkin Disease / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D006801:Humans; D007558:Italy; D008297:Male; D008942:Mitoxantrone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D011379:Prognosis; D011446:Prospective Studies; D014747:Vinblastine / Q000008:administration & dosage
D001761:Bleomycin; D011344:Procarbazine; D014747:Vinblastine; D005047:Etoposide; D003520:Cyclophosphamide; D008942:Mitoxantrone