Blood Res.  2017 Dec;52(4):270-275. 10.5045/br.2017.52.4.270.

Treatment outcomes of dose-attenuated CHOP chemotherapy in elderly patients with peripheral T cell lymphoma

• Choi EJ
• Hong JY
• Yoon DH
• Kang J
• Park CS
• Huh J
• Chae EJ
• Lee Y
• Ryu JS
• Suh C

• KMID: 2405063
• DOI: http://doi.org/10.5045/br.2017.52.4.270

Abstract

BACKGROUND
While cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) is the most commonly used chemotherapeutic regimen for patients with peripheral T-cell lymphomas (PTCLs), elderly patients are more vulnerable to associated toxicities. We evaluated the efficacy and safety of dose-attenuated CHOP in elderly patients with PTCL.
METHODS
Patients with PTCL aged >70 years or 65-70-years with comorbidities were treated with dose-attenuated CHOP (cyclophosphamide: 562.5 mg/m2, doxorubicin: 37.5 mg/m2, vincristine: 1.4 mg/m2, and prednisolone: 100 mg for five days; 25% reduced dose of cyclophosphamide and doxorubicin vs. full-dose CHOP) as first-line therapy were included.
RESULTS
Forty-four patients (median age, 74 yr) were analyzed. The majority (N=42, 95.5%) had advanced stage disease and 36 (81.8%) were classified as high/high-intermediate risk by the international prognostic index. The overall response rate was 61.4%, and 21 patients achieved complete response (47.7%). With median follow-up period of 28.8 months, the estimated two-year progression-free and overall survival rates were 36.7% and 46.6%, respectively. Grade 3/4 neutropenia and thrombocytopenia occurred in 26.9% and 7.4% of 204 total cycles, which affected 76.7% and 25.6% of the patients, respectively. Nineteen patients (44.2%) experienced febrile neutropenia, and six died due to treatment-related toxicities. High lactate dehydrogenase levels and an involvement of >1 extranodal sites were prognostic indicators of poor survival.
CONCLUSION
Dose-attenuated CHOP does not compromise treatment efficacy but retains significant toxicity. Our results suggest that some patients can be effectively treated with dose-attenuated CHOP, however a novel therapy for elderly patients with PTCL is required.

Keyword

Peripheral T cell lymphoma; Elderly; Dose-attenuated CHOP

MeSH Terms

Aged*
Comorbidity
Cyclophosphamide
Doxorubicin
Drug Therapy*
Febrile Neutropenia
Follow-Up Studies
Humans
L-Lactate Dehydrogenase
Lymphoma, T-Cell, Peripheral*
Neutropenia
Prednisolone
Survival Rate
Thrombocytopenia
Treatment Outcome
Vincristine
Cyclophosphamide
Doxorubicin
L-Lactate Dehydrogenase
Prednisolone
Vincristine

Figure

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  Fig. 1 Survival curves. (A) The estimated two-year progression-free survival rate was 36.7% and (B) the two-year overall survival rate was 46.6%.

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