CN3OP: an active regimen in patients with relapsed/refractory Hodgkin's lymphoma

Patients with recurrent or refractory Hodgkin's and non-Hodgkin's lymphoma are increasingly being treated with high-dose therapy and hematopoietic cel l transplantation. As minimal disease status at the time of transplant has been a repeatedly proven significant prognostic factor for long-term surviv al, effective initial cytoreduction is an important step in the process. Mo dern chemotherapy programs for Hodgkin's lymphoma include virtually all act ive agents and little is left for effective salvage. Mitoxantrone is an act ive agent in lymphoma that is not generally used in first-line treatment. T he aim of this study was to determine toxicity and response rate to CN3OP ( fractionated mitoxantrone 6 mg/m(2) on days 1, 2, and 3, combined with stan dard dose cyclophosphamide, vincristine, and prednisone) in 44 patients wit h relapsed or refractory lymphoma. Most of patients had advanced disease an d one or more extranodal sites at relapse. Median response duration to imme diate past therapy was four months, and one third of patients had not respo nded to prior treatment. A median of 4 cycles of CN3OP were given per patie nt for a total of 173 cycles. Grade III-IV neutropenia occured in 53% of cy cles, Grade I-III mucositis in 24%, and Grade I-III infection in 17% of cyc les. Of 34 evaluable patients with Hodgkin's lymphoma 12 (35%) achieved com plete remission (CR) and 15 (44%) partial remission (PR) for an overall res ponse rate of 79%. Two of five evaluable non-Hodgkin's lymphoma patients re sponded with PR. Median overall survival and event free survival in the ent ire group was 29 months and 11 months respectively. At this time 16 patient s have died; 12 of lymphoma, two of unknown cause and two of other causes. Complete response to CN3OP correlated with survival. CN3OP is an effective and safe regimen for cytoreduction in Hodgkin's lymphoma patients pretreate d with doxorubicin/alkylator/etoposide-containing primary therapies.