Elderly aggressive-histology non-Hodgkin's lymphoma: First-line VNCOP-B regimen experience on 350 patients

Age is a risk factor and a prognostic parameter in elderly aggressive-histo logy non-Hodgkin's lymphoma (NHL) patients. Several adapted chemotherapeuti c regimens have recently been designed and tested on elderly patients. Seve ral of these trials have shown that older aggressive-histology NHL patients can benefit from specific and adequate treatment capable of curing a perce ntage of these patients. Between January 1992 and September 1997, 350 previ ously untreated aggressive-histology NHL patients greater than 60 years of age were treated with a combination therapy including cyclophosphamide, mit oxantrone, vincristine, etoposide, bleomycin, and prednisone (VNCOP-B). Com plete remission (CR) was achieved by 202 (58%) patients and partial remissi on (PR) by 87 (25%), whereas the remaining 61 (17%) patients were nonrespon ders. The overall response rate (CR + PR) was 83%. Clinical and hematologic toxicities were modest, because 71% of the patients received granulocyte c olony-stimulating factor (G-CSF). The CR rates for the three age groups (60 to 69, 70 to 79, and greater than or equal to 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 th at the VNCOP-B regimen is effective in inducing good CR and relapse-free su rvival rates with only moderate toxic effects in elderly aggressive-histolo gy NHL. (C) 1999 by The American Society of Hematology.