Pfreundschuh Michael, Trümper Lorenz, Kloess Marita, Schmits Rudolf, Feller Alfred C, Rübe Christian, Rudolph Christian, Reiser Marcel, Hossfeld Dieter K, Eimermacher Hartmut, Hasenclever Dirk, Schmitz Norbert, Loeffler Markus
Saarland University Medical School, Homburg/Saar, Germany.
Blood. 2004 Aug 1;104(3):634-41. doi: 10.1182/blood-2003-06-2095. Epub 2004 Mar 11.
Cyclophosphamide, doxorubicin, vincristine, and prednisone, given every 3 weeks (CHOP-21), is standard chemotherapy for aggressive lymphomas. To determine whether biweekly CHOP (CHOP-14) with or without etoposide is more effective than CHOP-21, 689 patients ages 61 to 75 years were randomized to 6 cycles of CHOP-21, CHOP-14, CHOEP-21 (CHOP plus etoposide 100 mg/m2 days 1-3), or CHOEP-14. Patients in the 2-weekly regimens received granulocyte colony-stimulating factor (G-CSF) starting from day 4. Patients received radiotherapy (36 Gy) to sites of initial bulky disease and extranodal disease. Complete remission rates were 60.1% (CHOP-21), 70.0% (CHOEP-21), 76.1% (CHOP-14), and 71.6% (CHOEP-14). Five-year event-free and overall survival rates were 32.5% and 40.6%, respectively, for CHOP-21 and 43.8% and 53.3%, respectively, for CHOP-14. In a multivariate analysis, the relative risk reduction was 0.66 (P =.003) for event-free and 0.58 (P <.001) for overall survival after CHOP-14 compared with CHOP-21. Toxicity of CHOP-14 and CHOP-21 was similar, but CHOEP-21 and in particular CHOEP-14 were more toxic. Due to its favorable efficacy and toxicity profile, CHOP-14 should be considered the new standard chemotherapy regimen for patients ages 60 or older with aggressive lymphoma.
环磷酰胺、多柔比星、长春新碱和泼尼松，每3周给药一次（CHOP-21），是侵袭性淋巴瘤的标准化疗方案。为了确定每两周一次的CHOP（CHOP-14）加或不加依托泊苷是否比CHOP-21更有效，689名年龄在61至75岁的患者被随机分为接受6个周期的CHOP-21、CHOP-14、CHOEP-21（CHOP加依托泊苷100mg/m²，第1 - 3天）或CHOEP-14治疗。接受两周方案治疗的患者从第4天开始接受粒细胞集落刺激因子（G-CSF）。患者对初始大块病灶和结外病灶部位接受放射治疗（36Gy）。完全缓解率分别为：CHOP-21为60.1%，CHOEP-21为70.0%，CHOP-14为76.1%，CHOEP-14为71.6%。CHOP-21的5年无事件生存率和总生存率分别为32.5%和40.6%，CHOP-14分别为43.8%和53.3%。在多变量分析中，与CHOP-21相比，CHOP-14后无事件生存的相对风险降低为0.66（P = 0.003），总生存的相对风险降低为0.58（P < 0.001）。CHOP-14和CHOP-21的毒性相似，但CHOEP-21尤其是CHOEP-14毒性更大。由于其良好的疗效和毒性特征，CHOP-14应被视为60岁及以上侵袭性淋巴瘤患者的新标准化疗方案。
