title: Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL.
abstract: Cyclophosphamide, doxorubicin, vincristine, and prednisone, given every 3 weeks (CHOP-21), is standard chemotherapy for aggressive lymphomas. To determine whether biweekly CHOP (CHOP-14) with or without etoposide is more effective than CHOP-21, 689 patients ages 61 to 75 years were randomized to 6 cycles of CHOP-21, CHOP-14, CHOEP-21 (CHOP plus etoposide 100 mg/m2 days 1-3), or CHOEP-14. Patients in the 2-weekly regimens received granulocyte colony-stimulating factor (G-CSF) starting from day 4. Patients received radiotherapy (36 Gy) to sites of initial bulky disease and extranodal disease. Complete remission rates were 60.1% (CHOP-21), 70.0% (CHOEP-21), 76.1% (CHOP-14), and 71.6% (CHOEP-14). Five-year event-free and overall survival rates were 32.5% and 40.6%, respectively, for CHOP-21 and 43.8% and 53.3%, respectively, for CHOP-14. In a multivariate analysis, the relative risk reduction was 0.66 (P =.003) for event-free and 0.58 (P <.001) for overall survival after CHOP-14 compared with CHOP-21. Toxicity of CHOP-14 and CHOP-21 was similar, but CHOEP-21 and in particular CHOEP-14 were more toxic. Due to its favorable efficacy and toxicity profile, CHOP-14 should be considered the new standard chemotherapy regimen for patients ages 60 or older with aggressive lymphoma.
authors.affiliation: Saarland University Medical School, Homburg/Saar, Germany. michael.pfreundschuh@uniklinik-saarland.de
authors.forename: Michael
authors.initials: M
authors.lastname: Pfreundschuh
authors.forename: Lorenz
authors.initials: L
authors.lastname: Trümper
authors.forename: Marita
authors.initials: M
authors.lastname: Kloess
authors.forename: Rudolf
authors.initials: R
authors.lastname: Schmits
authors.forename: Alfred C
authors.initials: AC
authors.lastname: Feller
authors.forename: Christian
authors.initials: C
authors.lastname: Rübe
authors.forename: Christian
authors.initials: C
authors.lastname: Rudolph
authors.forename: Marcel
authors.initials: M
authors.lastname: Reiser
authors.forename: Dieter K
authors.initials: DK
authors.lastname: Hossfeld
authors.forename: Hartmut
authors.initials: H
authors.lastname: Eimermacher
authors.forename: Dirk
authors.initials: D
authors.lastname: Hasenclever
authors.forename: Norbert
authors.initials: N
authors.lastname: Schmitz
authors.forename: Markus
authors.initials: M
authors.lastname: Loeffler
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005047:Etoposide / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000145:classification / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016399:Lymphoma, T-Cell / Q000145:classification / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone