Document Detail


Outcome is not improved by the use of alternating chemotherapy in elderly patients with aggressive lymphoma.
MedLine Citation:
PMID:  11920261     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: A prospective randomised study involving 810 elderly patients was conducted in an attempt to compare alternating chemotherapy with conventional first-line chemotherapy in aggressive non-Hodgkin's lymphoma in order to improve prognosis with an acceptable toxicity for elderly patients. PATIENTS AND METHODS: Patients included were 55-69 years old and had at least one adverse prognostic factor. Patients were treated either with ACVBP followed by consolidation (n = 396) or with an alternating regimen (n = 414). This regimen was an association of active drugs in NHL relapsing patients, alternating VIMMM with ACVBP for induction and alternation of VIM and ACVM in consolidation. Eight hundred and sixty-six patients were randomised. After histological review, 810 patients met the inclusion criteria: 396 in arm A, 414 in arm B. RESULTS: The complete response rate after induction was superior for conventional first-line therapy (58.5% vs 48%, P = 0.003) but at the end of treatment, the CR rate was not statistically different (52% vs 48%, P = 0.19). Conventional chemotherapy had a better five-year event-free survival than alternating regimen (33% (95% CI: 30-36%) vs 28% (95% CI: 26-30%), P = 0.0289) but overall survival was not statistically different (40% (CI 95% 38-42%) vs 36% (CI 95% 34-38%), P = 0.068). In this elderly high risk population, the toxicity was very high: 19% in arm A and 26% in arm B died during treatment. CONCLUSION: Alternating regimen did not improve outcome, was less efficient and more toxic.
Authors:
A Bosly; E Lepage; B Coiffier; G Fillet; R Herbrecht; M Divine; B Dupriez; C Nouvel; E Deconninck; H Tilly; D Bordessoule; P Gaulard; C Gisselbrecht;
Publication Detail:
Type:  Clinical Trial; Clinical Trial, Phase III; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The hematology journal : the official journal of the European Haematology Association / EHA     Volume:  2     ISSN:  1466-4860     ISO Abbreviation:  Hematol. J.     Publication Date:  2001  
Date Detail:
Created Date:  2002-03-28     Completed Date:  2002-06-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  100965523     Medline TA:  Hematol J     Country:  England    
Other Details:
Languages:  eng     Pagination:  279-85     Citation Subset:  IM    
Affiliation:
Cliniques Universitaires UCL de Mont-Godinne, Yvoir, Belgium. andre.bosly@sang.ucl.ac.be
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MeSH Terms
Descriptor/Qualifier:
Aged
Antineoplastic Combined Chemotherapy Protocols / administration & dosage,  therapeutic use*,  toxicity
Bleomycin / administration & dosage
Cyclophosphamide / administration & dosage
Doxorubicin / administration & dosage
Drug Administration Schedule
Etoposide / administration & dosage
Female
Humans
Ifosfamide / administration & dosage
Lymphoma, Non-Hodgkin / complications,  drug therapy*,  mortality
Male
Methotrexate / administration & dosage
Middle Aged
Mitoxantrone / administration & dosage
Prednisone / administration & dosage
Prospective Studies
Remission Induction
Survival Analysis
Treatment Outcome
Vindesine / administration & dosage
Chemical
Reg. No./Substance:
0/IMVP-16 protocol; 0/LNH 87 protocol; 11056-06-7/Bleomycin; 23214-92-8/Doxorubicin; 33419-42-0/Etoposide; 3778-73-2/Ifosfamide; 50-18-0/Cyclophosphamide; 53-03-2/Prednisone; 53643-48-4/Vindesine; 59-05-2/Methotrexate; 65271-80-9/Mitoxantrone

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