Avilés A, Nambo M J, Talavera A, Garcia E L, Huerta-Guzman J, Díaz Maqueo J C
Department of Hematology, Oncology Hospital, National Medical Centre, Mexico DF, Mexico.
Anticancer Drugs. 1997 Nov;8(10):937-42. doi: 10.1097/00001813-199711000-00004.
One hundred and sixty nine untreated elderly patients (median age 69 years old; range 60-89 years old) with high or high-intermediate clinical risk non-Hodgkin's lymphoma were enrolled in a controlled clinical trial to evaluate escalated doses of epirubicin in a CEOP-Bleo regimen (cyclophosphamide, vincristine, epirubicin, prednisone and bleomycin), compared to escalated doses of idaurubicin in an CIOP-Bleo regimen (idaurubicin instead of epirubicin). Overall, 71% of the patients in the CEOP-Bleo arm achieved a complete response compared to only 48% in the CIOP-Bleo regimen (p < 0.01). At actuarial 3 year, 72% of the patients treated with the CEOP-Bleo regimen remained alive and free of disease, compared to 34% in the CIOP-Bleo arm (p < 0.01). Dose intensity was 0.86 in the epirubicin regimen, similar to 0.82 in the idaurubicin arm. Toxicities were more frequent and severe in the CEOP-Bleo regimen; however, no death-related treatment was observed in either groups. Cardiac toxicity was also similar in both arms. We conclude that treatment of elderly paitents with aggressive non-Hodgkin's lymphoma should be considered a curative attempt and not only palliative. The use of full doses of chemotherapy should be contemplated in elderly patients. Epirubicin, in escalating doses, is a drug with mild toxicity and improvement in outcome in this setting is observed. We cannot confirm the usefulness of idaurubicin, including escalating doses, in the treatment of patients with aggressive malignant lymphoma, because the complete response rate and survival were worse than other chemotherapy regimens. We feel that the CEOP-Bleo regimen with escalated doses of epirubicin is a useful option in the treatment of elderly patients with aggressive non-Hodgkin's lymphoma.
169例未经治疗的老年患者（中位年龄69岁；范围60 - 89岁），患有高或高中度临床风险的非霍奇金淋巴瘤，被纳入一项对照临床试验，以评估在CEOP - Bleo方案（环磷酰胺、长春新碱、表柔比星、泼尼松和博来霉素）中增加表柔比星剂量的效果，并与CIOP - Bleo方案（去甲柔比星代替表柔比星）中增加去甲柔比星剂量的效果进行比较。总体而言，CEOP - Bleo组71%的患者达到完全缓解，而CIOP - Bleo方案组只有48%（p < 0.01）。在精算3年时，接受CEOP - Bleo方案治疗的患者中有72%存活且无疾病，而CIOP - Bleo组为34%（p < 0.01）。表柔比星方案的剂量强度为0.86，与去甲柔比星组的0.82相似。CEOP - Bleo方案中的毒性反应更频繁且更严重；然而，两组均未观察到与死亡相关的治疗。两组的心脏毒性也相似。我们得出结论，对老年侵袭性非霍奇金淋巴瘤患者的治疗应被视为一种治愈性尝试，而不仅仅是姑息性治疗。应考虑在老年患者中使用全剂量化疗。增加剂量的表柔比星是一种毒性较轻的药物，并且在这种情况下观察到了预后改善。我们无法证实去甲柔比星（包括增加剂量）在治疗侵袭性恶性淋巴瘤患者中的有效性，因为其完全缓解率和生存率比其他化疗方案更差。我们认为增加剂量的表柔比星的CEOP - Bleo方案是治疗老年侵袭性非霍奇金淋巴瘤患者的一个有用选择。
