title: Long-term results of a multicenter randomized, comparative trial of modified CHOP versus THP-COP versus THP-COPE regimens in elderly patients with non-Hodgkin's lymphoma.
abstract: In treating elderly non-Hodgkin's lymphoma (NHL) patients, it is particularly important to use drugs that have a low incidence of adverse events and high efficacy. In this multicenter study, THP (pirarubicin)-COP (cyclophosphamide, vincristine, and prednisolone) was compared to two thirds dosage of full CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) regimen with regard to both adverse events and efficacy. For a third group, etoposide (E) was added to the THP-COP regimen (THP-COPE) in order to achieve high dose-intensity. Subjects were 486 previously untreated patients, aged 65 or older (range, 65-92 years; median, 74 years), with NHL. Subjects were randomly assigned to receive THP-COP, two thirds CHOP, or THP-COPE. Four hundred and forty-three patients were assessed for response and followed for 8 years after the last subject registered. The complete remission rates for the THP-COP, CHOP, and THP-COPE groups were 42.5%, 41.4%, and 48.0%, respectively. There was no difference in overall survival or progression-free survival among these 3 groups. In aggressive lymphoma, there was also no difference in complete response (CR) rate (45.3% in THP-COP, 44.9% in CHOP, 48.0% in THP-COPE), overall survival, and progression-free survival among these groups. The 5- and 8-year survival rates for all patients were 29.4% and 18.7%, respectively. The 5- and 8-year survival rates for patients with aggressive lymphoma were 27.4% and 17.4%, respectively. Although long-term survival for patients with aggressive lymphoma on our regimens was not worse compared to previous reports, the CR rate was lower. Because severe adverse events were not observed, higher dose chemotherapy may be directed to achieve better CR rates. In patients with T-cell-type lymphoma, the CR rate was greater after treatment with THP-COP (51.4%) or THP-COPE (57.7%) compared to treatment with CHOP (19.4%). Pirarubicin may be more useful for T-cell lymphoma than doxorubicin. Because adverse cardiac events were reported only in CHOP, adverse cardiac events might be low in the THP group.
authors.affiliation: Department of Hematology, Tokyo Metropolitan Geriatric Hospital, Japan. blut@tmgh.metro.tokyo.jp
authors.forename: Mayumi
authors.initials: M
authors.lastname: Mori
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kitamura
authors.forename: Michihiko
authors.initials: M
authors.lastname: Masuda
authors.forename: Tomomitsu
authors.initials: T
authors.lastname: Hotta
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Akira B
authors.initials: AB
authors.lastname: Miura
authors.forename: Hideaki
authors.initials: H
authors.lastname: Mizoguchi
authors.forename: Akira
authors.initials: A
authors.lastname: Shibata
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Saito
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Matsuda
authors.forename: Toru
authors.initials: T
authors.lastname: Masaoka
authors.forename: Mine
authors.initials: M
authors.lastname: Harada
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Niho
authors.forename: Fumimaro
authors.initials: F
authors.lastname: Takaku
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D011239:Prednisolone / Q000008:administration & dosage; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D012008:Recurrence; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D011241:Prednisone