Significant dose Escalation of Idarubicin in the treatment of aggressive Non- Hodgkin Lymphoma leads to increased hematotoxicity without improvement in efficacy in comparison to standard CHOEP-14: 9-year follow up results of the CIVEP trial of the DSHNHL

摘要: Dose escalation and modification of CHOP has improved the prognosis patients with aggressive lymphoma; even in rituximab era, dose for high-risk is exploited frequently limited by drug toxicity. Idarubicin (Id) a 4-demethoxy anthracycline analogue daunorubicin activity against lymphoma been reported to cause less cardiotoxicity than other anthracylines. The aim this study was replace doxorubicine idarubicin CHOEP regimen find maximum tolerable (MTD) based on hematotoxicity. Between 11/96 09/98, 64 (pts) aged 18–75 yrs (pts. 18–60, LDH not elevated, >60 years all risk groups) newly diagnosed received 6 cycles CIVEP-14 an escalating idarubicin, consisting (11–16 mg/m2 d1) standard doses cyclophosphamide, vincristine, etoposide, prednisone G-CSF support. 55 pts (median age 56 yrs) were evaluable final analysis median observation time 9.3 years. CR-rate 77.4% ; 5 8-year-EFS rates 46.4% (95%CI 32.5-60.3%) 43.5% (29.4-57.6%), respectively, 5- 8 yr OS 64.6% (51.7-77.5%) 59.9% (46.4-73.4%). 14/55 have died due progression, 2/55 (3.6%) treatment related toxicity, 4/55 causes (3 infections, 1 acute heart failure). In matched pair comparing CHOEP-14 CIVEP-14, had higher hematotoxicity no significant differences event free overall survival two regimens. Thus, cannot be used instead doxorubicin if its escalated achieve similar Doxorubicin remains NHL.