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P-VEBEC: A new 8-weekly schedule with or without rG-CSF for elderly patients with aggressive non-Hodgkin's lymphoma (NHL) |
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| Authors: | Bertini M; Freilone R; Vitolo U; Botto B; Pizzuti M; Gavarotti P; Levis A; Orlandi E; Orsucci L; Pini M; Scalabrini D Rota; Salvi F; Secondo V; Todeschini G; Viero P; Volta C; Resegotti L |
| Institution: | 1Division di Ematologia Ospedale Molinette, Torino 2Divisione di Ematologia Ospedale S. Carlo, Potenza 3Cattedra di Ematologia, Università Torino 4Divisione di Ematologia, Ospedale Civile Alessandria 5Divisione di Ematologia Ospedale S. Matteo, Pavta 6Divisione di Medicina Generale Ospedale Civile, Biella 7Divisione di Ematologia Mauriziano, Torino 8Divisione di Medicina Ospedale Galliera, Genova 9Cattedra di Ematologia, Università Verona 10Divisione di Ematologia, Ospedali Riuniti Bergamo 11Cattedra di Clinica Medico, Università Novara Italy |
| Abstract: | BACKGROUND: Chemotherapy regimens devised for elderly patients with intermediate-highgrade NHL are a matter of discussion. The aim is to reduce generaltoxicity without loosing an antilymphoma effect. The most importantlimiting factor of chemotherapy is myelotoxicity; for this reasonthe use of growth factor may be useful in these patients. PATIENTS AND METHODS: From November '91 to November '92, 67 pts older than 65 yearswith intermediate-arid high-grade advanced-stage NHL were treatedwith the P-VEBEC regimen, an original scheme with epirubicin50 mg/m2, cyclophosphamide 350 mg/m2 and etoposide 100 mg/m2on weeks 1, 3, 5, 7; vinblastine 5 mg/m2 and bleomycin 5 mg/m2on weeks 2, 4, 6, 8, prednisone 50 mg/m2/day p. os in the first2 weeks and thereafter every other day. Twenty-eight pts receivedr-GSF 5 (µg/kg/day throughout the treatment starting onday 2 of every week for 4 consecutive days. Their median agewas 71 years (65–80), 31 pts were male and 36 female,histology according W.F. was D 6; E 17; F 16; G 19; H 9. Twenty-fivepercent of pts had B symptoms, 35% had bulky disease, 41% LDHlevel > normal, 44% stage IV and 26% had B.M. involvement. RESULTS: CR. was achieved by 66% of pts. Adverse prognostic factors forCR were E histology, stage IV, bone marrow infiltration andLDH above normal. Severe toxicity was never recorded, no toxic death was observed.With a median follow-up of 24 months OS, DFS and EFS were 55%,52%, and 33%, respectively. EFS was influenced by stage, BMinvolvement and level of LDH. The relative dose intensity (RDI) was calculated by the methodof Hryniuk and Bush. Patients who received rG-CSF had a significantlyhigher median RDI (94% vs 79%) and lower myelotoxicity (neutrophilnadir <500 18% vs 56%). The rate of CR was influenced byRDI >80% (89% vs 56%). EFS was also better in pts who received a RDI higher than 80%(50% vs 18% p = 0.05). CONCLUSION: P-VEBEC is a feasible cycle in elderly patients; the use ofrG-CSF improves RDI. In patients with adverse prognostic factors(BM involvement, poor performance status) a RDI >0.80 couldplay a role in improving the outcome. lymphoma, elderly patients, rG-CSF |
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