title: Long-term follow-up of a randomized trial of fludarabine-mitoxantrone, compared with cyclophosphamide, doxorubicin, vindesine, prednisone (CHVP), as first-line treatment of elderly patients with advanced, low-grade non-Hodgkin's lymphoma before the era of monoclonal antibodies.
abstract: BACKGROUND
  This randomized study compared the efficacy and safety of fludarabine-mitoxantrone (FM) with mini-CHVP (cyclophosphamide, doxorubicin, vindesine, prednisone) in elderly patients with advanced, low-grade non-Hodgkin's lymphoma.
  
  
  METHODS
  End points were remission rates [overall response (OR) and complete response (CR)], failure-free survival (FFS), survival and toxicity. One hundred and fifty-five patients were randomized, 144 were evaluable for safety and 142 for response. Each treatment arm was given as six monthly cycles, followed by three bimonthly cycles. FM comprised fludarabine (20 mg/m(2) i.v.), days 1-5, plus mitoxantrone (10 mg/m(2) i.v.), day 1. CHVP cycles comprised cyclophosphamide (750 mg/m(2) i.v. infusion), doxorubicin (25 mg/m(2) i.v.) and vindesine (3 mg/m(2) i.v.) on day 1, and prednisone (50 mg/m(2)) on days 1-5.
  
  
  RESULTS
  FM therapy resulted in superior remission rates (OR 81% versus 64%, CR 49% versus 17%; P = 0.0004). Median FFS for FM patients was 36 months, compared with 19 months for CHVP patients, and has not yet been reached for early CR patients at 53 months. Treatment arm was the major risk factor influencing survival. Both treatments were well tolerated, with only few infectious complications.
  
  
  CONCLUSIONS
  FM was more effective than CHVP in achieving OR and CR, and favorably affected the outcome.
authors.affiliation: Hematology Department, CHU Angers, France.
authors.forename: C
authors.initials: C
authors.lastname: Foussard
authors.forename: P
authors.initials: P
authors.lastname: Colombat
authors.forename: H
authors.initials: H
authors.lastname: Maisonneuve
authors.forename: C
authors.initials: C
authors.lastname: Berthou
authors.forename: R
authors.initials: R
authors.lastname: Gressin
authors.forename: M-C
authors.initials: MC
authors.lastname: Rousselet
authors.forename: P
authors.initials: P
authors.lastname: Rachieru
authors.forename: B
authors.initials: B
authors.lastname: Pignon
authors.forename: B
authors.initials: B
authors.lastname: Mahé
authors.forename: C
authors.initials: C
authors.lastname: Ghandour
authors.forename: B
authors.initials: B
authors.lastname: Desablens
authors.forename: P
authors.initials: P
authors.lastname: Casassus
authors.forename: T
authors.initials: T
authors.lastname: Lamy
authors.forename: V
authors.initials: V
authors.lastname: Delwail
authors.forename: E
authors.initials: E
authors.lastname: Deconinck
mesh_terms: D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D011241:Prednisone / Q000008:administration & dosage; D012307:Risk Factors; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014751:Vindesine / Q000008:administration & dosage
chemical_list: D004317:Doxorubicin; D003520:Cyclophosphamide; D008942:Mitoxantrone; D014740:Vidarabine; C024352:fludarabine; D014751:Vindesine; D011241:Prednisone