Liposomal daunorubicin (daunoxome) in combination with cyclophosphamide, vincristine and prednisolone (COPA) as salvage therapy in poor-prognosis non-Hodgkins lymphoma

We treated 33 patients with a variant of the standard 3 weekly CHOP regime, replacing doxorubicin with liposomal daunorubicin (DaunoXome, NeXstar Phar maceuticals) 120 mg/m(2) (COP-X). Eighteen subjects had relapsed / refracto ry aggressive NHL and 15 had indolent NHL / CLL. Median number of courses r eceived was 4 (1-8). Thirty-two patients were evaluable for efficacy and 26 (81%) responded. 88% of patients with aggressive NHL responded; three (18% ) patients achieved complete remission (CR), 12 (70%) achieved partial remi ssion (PR), 1 (6%) patient had stable disease (SD) and 1 (6%) patient progr essed through treatment. Median duration of response for patients with aggr essive NHL was 3 months. The response rate in indolent NHL / CLL was 73%. F our (27%) patients achieved CR, 7 (46%) PR and 4 (27%) SD. At two years pos t treatment, 55% of the patients with indolent NHL/CLL remain progression-f ree, although 4 patients have proceeded to consolidation therapy. Twenty-se ven out of 28 (96%) patients developed neutropenia of short duration follow ing one or more of their treatments. Twenty-three patients developed an inf ection at some stage during therapy (all associated with neutropenia) and r equired hospitalisation. There were two toxic deaths (infection) both of wh ich occurred in patients who were neutropenic before starting COP-X. Platel et toxicity was mild in patients with normal platelet counts at the commenc ement of therapy. Alopecia and mucositis were mild. No clinical evidence of myocardial failure was observed. We conclude that the substitution of Daun oXome for doxorubicin in the CHOP regimen to form COP-X provides excellent efficacy against non-Hodgkin's lymphoma. Response durations were short but comparable to those reported with other regimes. COP-X was well tolerated w ith some suggestion of reduced non-haematological toxicity. The regimen sho uld be considered as an alternative to CHOP with potentially less non-haema tological toxicity, particularly cardiac; further studies are required to e valuate the regimen in this context.