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Blood, Vol. 94 No. 1 (July 1), 1999:
pp. 33-38
Elderly Aggressive-Histology Non-Hodgkin's Lymphoma: First-Line
VNCOP-B Regimen Experience on 350 Patients
Pier Luigi Zinzani,
Sergio Storti,
Alfonso Zaccaria,
Luciano Moretti,
Massimo Magagnoli,
Enzo Pavone,
Patrizia Gentilini,
Luciano Guardigni,
Marco Gobbi,
Pier Paolo Fattori,
Brunangelo Falini,
Vito
Michele Lauta,
Maurizio Bendandi,
Filippo Gherlinzoni,
Amalia De Renzo,
Francesco Zaja,
Patrizio Mazza,
Ettore Volpe,
Monica Bocchia,
Enrico Aitini,
Maurizio Tabanelli,
Giuseppe Leone, and
Sante Tura
From the Institute of Hematology "Seràgnoli," University
of Bologna, Bologna; the Department of Hematology,
"Cattolica" University of Roma, Roma; the Hematology Division,
Ravenna Hospital, Ravenna; the Hematology Division, Pesaro Hospital,
Pesaro; the Department of Hematology, University of Bari, Bari; the
Oncology Division, Forlì Hospital, Forlì; Hematology
Unit, Cesena Hospital, Cesena; the Department of Hematology, University
of Genova, Genova; the Oncology Division, Rimini Hospital, Rimini; the
Department of Hematology, University of Perugia, Perugia; the
Department of Medicine, University of Bari, Bari; the Department of
Hematology, University of Napoli, Napoli; the Department of Hematology,
University of Udine, Udine; the Hematology Division, Taranto Hospital,
Taranto; the Division of Hematology, Avellino Hospital; the Department
of Hematology, Siena Hospital, Siena; the Oncology Division, Mantova
Hospital, Mantova; the Hematology Unit, Lugo Hospital, Lugo, Italy.
Age is a risk factor and a prognostic parameter in elderly
aggressive-histology non-Hodgkin's lymphoma (NHL) patients. Several adapted chemotherapeutic regimens have recently been designed and
tested on elderly patients. Several of these trials have shown that
older aggressive-histology NHL patients can benefit from specific and
adequate treatment capable of curing a percentage of these patients.
Between January 1992 and September 1997, 350 previously untreated
aggressive-histology NHL patients greater than 60 years of age were
treated with a combination therapy including cyclophosphamide,
mitoxantrone, vincristine, etoposide, bleomycin, and prednisone
(VNCOP-B). Complete remission (CR) was achieved by 202 (58%) patients
and partial remission (PR) by 87 (25%), whereas the remaining 61 (17%) patients were nonresponders. The overall response rate (CR + PR) was 83%. Clinical and hematologic toxicities were modest, because
71% of the patients received granulocyte colony-stimulating factor
(G-CSF). The CR rates for the three age groups (60 to 69, 70 to 79, and
 80 years) were similar: 61%, 59%, and 56%, respectively. At 5 years, the relapse-free survival rate was 65%, the overall survival
rate was 49%, and the failure-free survival rate was 33%. In the
multivariate analysis, prognostic factors associated with longer
survival or longer relapse-free survival turned out to be localized
disease stage (P = .001) and good performance status
(P = .0002). Application of the International Prognostic
Factor Index was significantly associated with outcome (P
= .001). These data confirm on a large cohort of patients that the VNCOP-B regimen is effective in inducing good CR and relapse-free survival rates with only moderate toxic effects in elderly
aggressive-histology NHL.
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