Community-based trial of R-CHOP and maintenance rituximab for intermediate- or high-grade non-Hodgkin lymphoma with first-cycle filgrastim for older patients.
BACKGROUND
Administration of full-dose R-CHOP (rituximab/cyclophosphamide/doxorubicin/vincristine/prednisone) chemotherapy is important to maximize response in patients with intermediate-or high-grade non-Hodgkin lymphoma but might be difficult in older patients.


METHODS
This community-based study was conducted to determine response, toxicity, and disease-free survival in patients with intermediate-or high-grade non-Hodgkin lymphoma receiving R-CHOP with filgrastim. Patients received 6-8 cycles of R-CHOP followed by 4 cycles of maintenance rituximab for responders. Patients aged > 60 years or with increased infection risk received filgrastim 5 microg/kg per day in all R-CHOP cycles; other patients received filgrastim after a neutropenic event (no planned administration for cycle 1).


RESULTS
Of 101 patients enrolled, 60 (59%) were aged > 60 years and received filgrastim in all cycles. Thirty-three patients aged <or= 60 years (80%) received filgrastim, 7 (17%) as primary use in cycle 1. Chemotherapy average relative dose intensity was comparable between age groups (91% > 60 years vs. 93% <or= 60 years). Overall response was similar in both groups (87% > 60 years vs. 95% <or= 60 years; P=0.19); however, the complete response rate was significantly lower for older patients (42% > 60 years vs. 71% <or= 60 years; P=0.005). Seventy-six percent of patients (75% > 60 years vs. 78% <or= 60 years) had no evidence of progression after 2 years of follow-up. Febrile neutropenia (fever >or= 38.3 degrees C with absolute neutrophil count < 500/mm) occurred in 17% of patients overall (22% > 60 years vs. 10% <or= 60 years), and 8% had cycle-1 events (12% > 60 years vs. 2% <or= 60 years).


CONCLUSIONS
Patients aged > 60 years receiving R-CHOP with filgrastim support in all cycles received comparable doses of chemotherapy and had similar overall response rates compared wtih those of younger patients receiving no preemptive cycle-1 filgrastim.
Case
Delvyn C
DC
Maine Center for Cancer Medicine, Scarborough, ME 04074-9308, USA. chasee@mccm.org
Desch
Christopher E
CE
Kalman
Leonard A
LA
Vongkovit
Piyapong
P
Mena
Raul R
RR
Fridman
Moshe
M
Allen
Barbara
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D018450:Disease Progression; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D000069585:Filgrastim; D005500:Follow-Up Studies; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008297:Male; D008452:Maximum Allowable Concentration; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D011994:Recombinant Proteins; D012307:Risk Factors; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D000069585:Filgrastim; D011241:Prednisone