P-VEBEC - A NEW 8-WEEKLY SCHEDULE WITH OR WITHOUT RG-CSF FOR ELDERLY PATIENTS WITH AGGRESSIVE NON-HODGKINS-LYMPHOMA (NHL)

Background: Chemotherapy regimens devised for elderly patients with in termediate-high grade NHL are a matter of discussion. The aim is to re duce general toxicity without loosing an antilymphoma effect. The most important limiting factor of chemotherapy is myelotoxicity; for this reason the use of growth factor may be useful in these patients. Patie nts aad methods: From November '91 to November '92, 67 pts older than 65 years with intermediate-and high-grade advanced-stage NHL, were tre ated with the P-VEBEC regimen, an original scheme with epirubicin 50 m g/m(2), cyclophosphamide 350 mg/m(2) and etoposide 100 mg/m(2) on week s 1, 3, 5, 7; vinblastine 5 mg/m(2) and bleomycin 5 mg/ m(2) on weeks 2, 4, 6, 8, prednisone 50 mg/m(2)/day p. os in the first 2 weeks and t hereafter every other day. Twenty-eight pts received r-GSF 5 mu g/kg/d ay throughout the treatment starting on day 2 of every week for 4 cons ecutive days. Their median age was 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-five percent of pts had B symptoms, 35% had bulky disease, 41 % LDH level > normal, 44% stage TV and 26% had B.M. involvement. Resul ts: C.R. was achieved by 66% of pts. Adverse prognostic factors for CR were E histology, stage IV, bone marrow infiltration and LDH above no rmal. 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%, a nd 33%, respectively. EFS was influenced by stage, BM involvement and level of LDH. The relative dose intensity (RDI) was calculated by the method of Hryniuk and Bush. Patients who received rG-CSF had a signifi cantly higher median RDI (94% vs 79%) and lower myelotoxicity (neutrop hil nadir <500 18% vs 56%). The rate of CR was influenced by RDI>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 of rG-CSF improves RDI. In patients with ad verse prognostic factors (BM involvement, poor performance status) a R DI > 0.80 could play a role in improving the outcome.