EVALUATION OF LONG-TERM DAILY ADMINISTRATION OF ORAL LOW-DOSE ETOPOSIDE IN ELDERLY PATIENTS WITH RELAPSING OR REFRACTORY NON-HODGKINS-LYMPHOMA

Etoposide produces reversible inhibition of topoisomerase II, leading to cleavage of DNA, and thereby has an antitumor effect. This mechanis m suggests that the longer treatment is continued, the greater the ant itumor effect will be. In the present study, both therapeutic and adve rse effects of long-term treatment with low-dose oral etoposide were s tudied in 29 patients aged greater than or equal to 65 years with non- Hodgkin's lymphoma (NHL) for whom standard chemotherapy was not effect ive or refractory. These patients received etoposide at a dose of 50 m g/d for as long as possible. Treatment was continued until white blood cell count decreased to less than or equal to 2,000/mu L or the plate let count decreased to less than or equal to 5 x 10(4)/mu L. According to the World Health Organization (WHO) criteria of therapeutic effect s, 6 (20.7%) of the 29 patients achieved complete remission and 13 pat ients (44.8%) had partial remission, for a response rate of 65.5%. Adv erse effects of greater than or equal to grade 3 included leukopenia i n 24 patients (82.8%) and anemia in 7 (24.1%). Granulocyte colony-stim ulating factor (GCSF) was given in combination with etoposide to eight patients because of leukopenia (granulocyte count less than or equal to 1,000/mu L). In view of the excellent subjective tolerance, low inc idence of serious adverse effects, and good activity, single agent ora l etoposide given continuously over prolonged periods represents a use ful treatment for elderly patients with NHL.