Long-term follow-up of patients with intermediate or high-grade non-Hodgkin lymphoma treated with a combination of cyclophosphamide, epirubicin, vincristine, and prednisone

BACKGROUND: Doxorubicin cardiotoxicity is one of the most serious side effects of the cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy, regimen, especially among elderly patients. In the CEOP regimen, epirubicin was substituted for doxorubicin to reduce cardiotoxicity. METHODS: Between March 1984 and September 1998, 186 previously untreated patients with a histologically confirmed diagnosis of intermediate- or high-grade non-Hodgkin lymphoma according to the Working Formulation were treated with CEOP (cyclophosphamide, 750 mg/m(2), epirubicin, 75 mg/m(2), vincristine, 1.4 mg/m(2); and prednisone, 60 mg per day orally on Days 1-5). Of 186 patients, 85 (45.7%) had Stage IV disease, and 60 (32.3%) had an International Prognostic Index score > 2. Comorbidity was present in 36 patients (19.3%). RESULTS: Complete remission (CR) was achieved in 119 patients (64.3%), and partial remission was achieved in 30 patients (16.2%). Among the patients who achieved a CR, 95 (79.8%) were still disease free at a median follow-up time of 86.9 months (range, 14-200 months). The remaining 24 patients experienced disease recurrence, at a median follow-up time of 19 months (range, 3-101 months). The relative dose intensities were 0.69, 0.89, and 0.80 for vincristine, epirubicin, and cyclophosphamide, respectively. Two patients died of toxicity due to infection. Two patients, 59 and 73 years old, respectively, experienced arrhythmia. Another patient, age 64 years, who had a myocardial infarction 10 years earlier, had angina. One patient with hypertension experienced cardiac failure. No patients died of cardiac toxicity. CONCLUSION: Long-term follow-up confirmed that CEOP is an effective and well-tolerated chemotherapy regimen for intermediate- and high-grade lymphoma. The results were promising, especially among elderly patients.