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Prepublished online as a Blood First Edition Paper on January 16, 2003; DOI 10.1182/blood-2002-10-3238.
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Blood, 15 May 2003, Vol. 101, No. 10, pp. 3840-3848
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
CHOP is superior to CNOP in elderly patients with aggressive
lymphoma while outcome is unaffected by filgrastim treatment:
results of a Nordic Lymphoma Group randomized trial
Eva Ösby,
Hans Hagberg,
Stein Kvaløy,
Lasse Teerenhovi,
Harald Anderson,
Eva Cavallin-Ståhl,
Harald Holte,
John Myhre,
Hannu Pertovaara, and
Magnus Björkholm for the
Nordic Lymphoma Group (NLG)
From the Department of Medicine, Karolinska Hospital,
Stockholm, Sweden; Department of Oncology, Uppsala
Academic Hospital, Uppsala, Sweden; Department of
Oncology, Det Norske Radiumhospital, Oslo, Norway;
Department of Oncology, Helsinki University Central Hospital, Helsinki,
Finland; Department of Cancer Epidemiology, Lund
University, Lund, Sweden; Department of Oncology, Lund
University Hospital, Lund, Sweden; Department of
Hematology, The Finsen Center, Rigshospitalet, Copenhagen,
Denmark; and Department of Oncology, Tampere University
Hospital, Tampere, Finland.
This study was designed to test the hypothesis that administration
of granulocyte colony-stimulating factor (G-CSF; filgrastim) during
induction chemotherapy with CHOP (cyclophosphamide, vincristine, doxorubicin, prednisone) or CNOP (doxorubicin replaced with
mitoxantrone) in elderly patients with aggressive non-Hodgkin
lymphoma (NHL) improves time to treatment failure (TTF), complete
remission (CR) rate, and overall survival (OS). Furthermore, the
efficacy of CHOP versus CNOP chemotherapy was compared. A total of 455 previously untreated patients older than 60 years with stages II to IV
aggressive NHL were included in the analysis. Patients (median age, 71 years; range, 60-86 years) were randomized to receive CHOP (doxorubicin 50 mg/m2) or CNOP (mitoxantrone 10 mg/m2) with
or without G-CSF (5 µg/kg from day 2 until day 10-14 of each
cycle every 3 weeks; 8 cycles). Forty-seven patients previously hospitalized for class I to II congestive heart failure were randomized to receive CNOP with or without G-CSF (not included in the CHOP versus CNOP analysis). The CR rates in the CHOP/CNOP plus G-CSF and
CHOP/CNOP groups were the same, 52%, and in the CHOP with or without
G-CSF and CNOP with or without G-CSF groups, 60% and 43%
(P < .001), respectively. No benefit of G-CSF in terms
of TTF and OS could be shown (P = .96 and
P = .22, respectively), whereas CHOP was superior to CNOP
(TTF/OS P < .001). The incidences of severe
granulocytopenia (World Health Organization grade IV) and
granulocytopenic infections were higher in patients not receiving G-CSF. The cumulative proportion of patients receiving 90% or more of
allocated chemotherapy was higher (P < .05) in patients receiving G-CSF. Concomitant G-CSF treatment did not improve CR rate,
TTF, or OS. Patients receiving CHOP fared better than those given CNOP
chemotherapy. The addition of G-CSF reduces the incidence of severe
granulocytopenia and infections in elderly patients with aggressive NHL
receiving CHOP or CNOP chemotherapy.
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