Etoposide, mitoxantrone and prednisone, a salvage regimen with low toxicity for refractory or relapsed non-Hodgkin's lymphoma

Background and Objectives. Relapsed non-Hodgkin's lymphoma (NHL) is prefera bly treated with high-dose therapy and stem cell support. However, not all patients qualify for intensive chemotherapy. We evaluated the efficacy and toxicity of a new salvage chemotherapy regimen designed for patients with r elapsed or refractory NHL who are not appropriate candidates for high-dose therapy (HDT). Design and Methods. Seventy-nine patients received a regimen consisting of etoposide (350 mg/m(2) i.v. day 1), mitoxantrone (14 mg/m(2) i.v. day I) an d prednisone (80 mg/m(2) p.o. days 1-5) (EMP). The majority had aggressive NHL. Twenty-one patients were elderly, i.e. >60 years of age. Results. The overall response rate in the 79 patients was 38% as compared t o 67% in the elderly. The progression-free survival was 54% and 30% at 12 m onths and 24 months, respectively. The toxicity of the regimen was relative ly tow. No toxic deaths have occurred. In 28 of 231 cycles (12%) a CTC-grad e 24 infection was encountered. Twenty-one hospital admissions were necessa ry because of infection or fever. Other toxicity was rare. Toxicity was not greater in the elderly patients. WHO performance,status 2-4 and elevated s erum lactate dehydrogenase (LDH) concentrationv were adverse prognostic fac tors for response as well as for overall survival. Another adverse prognost ic factor for response was age <60 years. Interpretation and Conclusions. EMP is a new salvage regimen with a relativ ely low toxicity. it should be considered for patients with relapsed or ref ractory NHL who are not candidates for standard reinduction therapy and ste m cell transplantation. (C)2000, Ferrata Storti Foundation.