Treatment of patients with high-grade non-Hodgkin's lymphoma aged over 70 years with an all-oral regimen combining idarubicin, etoposide and alkylators

In elderly patients age-specific comorbidity often reduces the possibility of administering intensive chemotherapy and of obtaining response to treatm ent. Therefore, chemotherapy must differ from that for non-elderly patients , while maintaining the primary goal of a complete clinical response. We tr eated 19 patients over the age of 70 years (median age 75 years, range 70-8 6) with stage II-IV high-grade non-Hodgkin's lymphoma (NHL) with a combinat ion regimen including idarubicin plus etoposide and prednimustine (or chlor ambucil + prednisone), all administered orally on an outpatient basis. The therapeutic schedule included six 5-day courses of idarubicin 20 mg/sqm on day 1 (or 1D mg/sqm on days 1 and 3 in the nine patients last treated), eto poside 60 mg/sqm/12 h days 2-5, prednimustine 60 mg/sqm days 2-5, G-CSF 300 mu g/day from day + 7 until PMN > 1000/mu l. In ten patients prednimustine was replaced by chlorambucil 10 mg/sqm, days 2-5, and prednisone 50 mg day s 2-5, because of non-availability of the drug. Of the 19 patients submitte d to this regimen 15 (79%) obtained a clinical response: eight reached a co mplete response (CR), and seven a partial response (PR). Hematologic toxici ty was generally mild. Only three patients had to be hospitalised for infec tion. Except alopecia, non-hematologic toxicities were negligible. At a med ian follow-up of 16 months, five of eight patients who obtained CR relapsed (median CR duration 7 months). The actuarial median survival is 34 months (range 6-46). This study demonstrates the feasibility and efficacy of an al l-oral regimen including idarubicin, plus etoposide and prednimustine (or c hlorambucil + prednisone) in NHL patients aged over 70 years. (C) 2000 Else vier Science Ireland Ltd. All rights reserved.