Abstract
The treatment of diffuse large B-cell lymphoma with chemotherapy was retrospectively evaluated in 348 patients who had received at least three cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)-like, ACVBP (doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone)-like or CHVmP-BV (cyclophosphamide, hydroxorubicin, Vm-26, prednisone, vincristine and bleomycin) treatment in Belgium between 1995 and 2000. In our sample, the proportion who received each of the three regimens was 78.4, 16.4, and 5.2%, respectively. Of those prescribed CHOP-like regimens, 15% received <80% average relative dose intensity (ARDI). In 210 patients treated with CHOP-21 (77% of the CHOP-like group), median survival was 7.08 years in those who received >90% of the ARDI, significantly longer than in those who received ≤;90% of the ARDI (p = 0.002). Dose reductions and/or delays, mainly due to hematological toxicities, resulted in a reduction in treatment intensity. These data indicate that patient outcome is improved when the intensity of chemotherapy treatment is optimal.
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Armitage JO, Weisenburger DD (1998) New approach to classifying non-Hodgkin’s lymphomas: clinical features of the major histologic subtypes. Non-Hodgkin’s Lymphoma Classification Project. J Clin Oncol 16:2780–2795
Bastion Y, Bosly A, Gisselbrecht C, Reyes F, Tilly H, Herbrecht R et al (1993) A randomized double-blind phase III study of filgrastim (recombinant human G-CSF) vs placebo during intensive induction chemotherapy in 55 to 69-year old patients with poor prognosis aggressive non-Hodgkin’s lymphoma. Blood 82:143a (abstract)
Bjorkholm M, Osby E, Hagberg H, Kvaloy S, Teerenhovi L, Myhre J et al (1999) Randomized trial of r-metHu granulocyte colony-stimulating factor (G-CSF) as adjunct to CHOP or CNOP treatment of elderly patients with aggressive non-Hodgkin’s lymphoma (ASH 1999). 94:abstract 2665
Bobey N, Woodman RC (1998) Neutropenic complications in advanced-stage non-Hodgkin’s lymphoma: implications for the use of prophylactic recombinant human granulocyte-colony stimulating factor (G-CSF). Clin Invest Med 21:63–70
Bodey GP, Buckley M, Sathe YS, Freireich EJ (1966) Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 64:328–340
Cartwright R, Brincker H, Carli PM, Clayden D, Coebergh JW, Jack A et al (1999) The rise in incidence of lymphomas in Europe 1985–1992. Eur J Cancer 35:627–633
Coiffier B, Gisselbrecht C, Herbrecht R, Tilly H, Bosly A, Brousse N (1989) LNH-84 regimen: a multicenter study of intensive chemotherapy in 737 patients with aggressive malignant lymphoma. J Clin Oncol 7:1018–1026
Coiffier B, Lepage E, Briere J, Herbrecht R, Tilly H, Bouabdallah R et al (2002) CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large B-cell lymphoma. N Engl J Med 364:235–242
Dixon DO, Neilan B, Jones SE, Lipschitz DA, Miller TP, Grozea PN et al (1986) Effect of age on therapeutic outcome in advanced diffuse histiocytic lymphoma: the Southwest Oncology Group experience. J Clin Oncol 4:295–305
Doorduijn JK, van der Holt B, van der Hem KG, van Imhoff GW, Kramer MHH, van Oers MHJ et al (2000) Randomized trial of granulocyte-colony stimulating factor (G-CSF) added to CHOP in elderly patients with aggressive non-Hodgkin’s lymphoma (NHL). Blood 96:133a (abstract 575)
Epelbaum R, Faraggi D, Ben-Arie Y, Ben-Shahar M, Haim N, Ron Y et al (1990) Survival of diffuse large cell lymphoma. A multivariate analysis including dose intensity variables. Cancer 66:1124–1129
Fisher RI, Gaynor ER, Dahlberg S, Oken MM, Grogan TM, Mize EM et al (1993) Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin’s lymphoma. N Engl J Med 328:1002–1006
Greil R (1998) Prognosis and management strategies of lymphatic neoplasias in the elderly. I. Aggressive non-Hodgkin’s lymphomas. Oncology 55:189–217
Jaffe ES, Harris NL, Stein H, Verdiman JW (2001) WHO classifications of tumours, pathology and genetics of tumours of haematopoietic and lymphoid tissues. IARC Press, Lyon
Kwak LW, Halpern J, Olshen RA, Horning SJ (1990) Prognostic significance of actual dose intensity in diffuse large-cell lymphoma: results of a tree-structured survival analysis. J Clin Oncol 8:963–977
Lepage E, Gisselbrecht C, Haioun C, Sebban C, Tilly H, Bosly A et al (1993) Prognostic significance of received relative dose intensity in non-Hodgkin’s lymphoma patients: application to LNH-87 protocol. The GELA (Groupe d’Etude des Lymphomes de l’Adulte). Ann Oncol 4:651–656
Meerwaldt JH, Carde P, Somers R, Thomas J, Kluin-Nelemans JC, Bron D et al (1997) Persistent improved results after adding vincristine and bleomycin to a cyclophosphamide/hydroxorubicin/Vm-26/prednisone combination (CHVmP) in stage III–IV intermediate- and high-grade non-Hodgkin’s lymphoma. The EORTC Lymphoma Cooperative Group. Ann Oncol 8:67–70
Miller TP, Dahlberg S, Cassady JR, Adelstein DJ, Spier CM, Grognan TM et al (1998) Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate- and high-grade non-Hodgkin’s lymphoma. N Engl J Med 339:21–26
Ries LAG, Kosary CL, Hankey BF, Miller BA, Clegg L, Edwards BK (eds). SEER Cancer Statistics Review, 1973–1996, National Cancer Institute. Bethesda, MD, 1999
Pettengell R, Gurney H, Radford JA, Deakin DP, James R, Wilkinson PM et al (1992) Granulocyte colony-stimulating factor to prevent dose-limiting neutropenia in non-Hodgkin’s lymphoma: a randomized controlled trial. Blood 80:1430–1436
Pfreundschuh M, Trümper L, Kloess M, Schmits R, Feller AZC, Rübe C et al (2004) 2-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of elderly patients with aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL. Blood 104:634–641
Picozzi VJ, Pohlman BL, Morrison VA, Lawless GD, Lee MW, Kerr RO et al. (2001) Patterns of chemotherapy administration in patients with intermediate-grade non-Hodgkin’s lymphoma. Oncology (Williston Park) 15:1296–1306
Tilly H, Lepage E, Coiffier B, Blanc M, Herbrecht R, Bosly A et al (2003) Intensive conventional chemotherapy (ACVBP regimen) compared with standard CHOP for poor-prognosis aggressive non-Hodgkin’s lymphoma. Blood 102:4284–4289
Acknowledgment
This study was supported by Amgen Belgium.
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All authors must disclose any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work.
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See Appendix for a list of participating centers and physicians.
Appendix
Appendix
Names of participating centers and physicians
Dr. R. De Bock (Centrumziekenhuis, campus Middelheim, Antwerpen); Dr. P. Zachée (Centrumziekenhuis campus Stuivenberg, Antwerpen); Prof. G. Verhoef (U.Z. Gasthuisberg, Leuven); Prof. Z. Berneman (U.Z. Antwerpen); Dr. Ph. Spaas (St. Norbertusziekenhuis, Duffel); Dr. D. De Bal (St. Maartenziekenhuis, Duffel); Dr. J. Meyskens (St. Elisabethziekenhuis, Turnhout); Dr. P. Specenier (AZ Jan Portaels, Vilvoorde); Dr. D. Vanstraelen (Virga Jesseziekenhuis, Hasselt); Dr. A. Van Hoof (AZ St. Jan, Brugge); Dr. M. Petrick (St. Lucasziekenhuis, Gent); Dr. K. Van Eygen (AZ Groeningen, Kortrijk); Prof. H. Demuynck (H. Hartziekenhuis, Roeselare); Dr. F. Trullemans (U.Z. V.U. Brussel); Prof. F. Offner (U.Z. Gent); Prof. A. Ferrant (U.C.L. St Luc, Bruxelles); Dr. D. Boulet (Clinique St. Joseph, Mons); Dr. M. André (C.H. Notre-Dame Reine Fabiola, Charleroi); Dr. Ph. Mineur (Clinique St. Joseph, Gilly); Prof. D. Bron (Institut J. Bordet, Bruxelles); Prof. W. Feremans (Hôpital Erasme, U.L. Bruxelles); Dr. M. Maerevoet (Clinique St. Pierre, Ottignies); Dr. S. Lampertz (Hôpital Bois de l’Abbaye, Seraing); Dr. P. Pierre (Clinique St. Joseph, Arlon); Dr. L. Montfort (Clinique St. Luc, Bouge); Prof. A. Bosly (U.C.L. Mont Godinne, Yvoir and Clinique Sainte-Elisabeth, Namur); Prof. G. Fillet (C.H.U. Sart Tilman, Liège); Dr. L. Longrée (Hôpital St Joseph, Liège); Dr. M. Reginster (C.H. Hutois, Huy), Dr. J. Collignon (C.H. Hutois, Huy).
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Bosly, A., Bron, D., Van Hoof, A. et al. Achievement of optimal average relative dose intensity and correlation with survival in diffuse large B-cell lymphoma patients treated with CHOP. Ann Hematol 87, 277–283 (2008). https://doi.org/10.1007/s00277-007-0399-y
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DOI: https://doi.org/10.1007/s00277-007-0399-y