title: Anthracyline-reduced sequential combination chemotherapy for younger patients with good-prognosis aggressive B-cell non-Hodgkin's lymphoma.
abstract: BACKGROUND
  Anthracyline-based chemotherapy is the treatment of choice for patients with aggressive B-cell non-Hodgkin's lymphoma (NHL). However, anthracyclines have been associated with long-term cardiac toxicity.
  
  
  METHODS
  We conducted a study using a sequential combination chemotherapy with a reduced cumulative dose of anthracyclines in younger patients with good-prognosis aggressive NHL. Chemotherapy consisted of one cycle of vincristine, ifosfamide, etoposide, and dexamethasone, followed by three cycles of epirubicin, cyclophosphamide, vincristine, and dexamethasone, and a fifth cycle containing carboplatin, etoposide, and dexamethasone. 86 patients were treated, 65 without and 21 with additional rituximab. Consolidating involved-field irradiation was applied in patients with stage I/II, bulky disease, or localized residual lymphoma.
  
  
  RESULTS
  Complete and partial remissions were achieved in 67 and 27% of patients, respectively, and the 3-year event-free and overall survival estimates were 75 and 87%. The survival estimates were substantially better in patients who received rituximab. Main toxicity was grade 3/4 leukocytopenia in 89% patients with neutropenic fever in 30%. Two patients died of septic shock.
  
  
  CONCLUSIONS
  The treatment appears to be effective in this group of patients. The hematological toxicities, particularly after the first and fifth cycle, require the use of G-CSF and/or a dose reduction in selected patients.
authors.affiliation: Department of Internal Medicine (Cancer Research), West German Cancer Center, University of Duisburg-Essen Medical School, Hufelandstrasse 55, 45122, Essen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Schütt
authors.forename: K
authors.initials: K
authors.lastname: Zimmermann
authors.forename: C
authors.initials: C
authors.lastname: Derks
authors.forename: P
authors.initials: P
authors.lastname: Ebeling
authors.forename: A
authors.initials: A
authors.lastname: Welt
authors.forename: M
authors.initials: M
authors.lastname: Poser
authors.forename: J
authors.initials: J
authors.lastname: Hense
authors.forename: K
authors.initials: K
authors.lastname: Metz
authors.forename: J
authors.initials: J
authors.lastname: Anhuf
authors.forename: M
authors.initials: M
authors.lastname: Sandmann
authors.forename: M
authors.initials: M
authors.lastname: Neise
authors.forename: T
authors.initials: T
authors.lastname: Moritz
authors.forename: M
authors.initials: M
authors.lastname: Stuschke
authors.forename: N
authors.initials: N
authors.lastname: Niederle
authors.forename: S
authors.initials: S
authors.lastname: Seeber
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Nowrousian