Intensified CHOP regimen in aggressive lymphomas: Maximal dose intensity and dose density of doxorubicin and cyclophosphamide

A. Bertuzzi, M. Balzarotti, M. Spina, A. Nozza, M. Roncalli, B. Sarina, E. Morenghi, M. Magagnoli, U. Tirelli, L. Castagna, I. Milan, A. Santoro, C. Ripa, F. Latteri, D. Bernardi

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Following our previous study of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) intensification in non-Hodgkin's lymphoma (NHL), in the present report we attempted to further increase dose intensity by shortening the between-course intervals with the support of growth factors. Patients and methods: A total of 67 patients were enrolled. With a fixed dose of doxorubicin 75 mg/m 2, cyclophosphamide (CTX) was started at a dose of 1750 mg/m 2 and increased by 250 mg/m 2 in consecutive cohorts of patients provided that no dose-limiting toxicity occurred. After the maximal tolerated dose (MTD) had been identified, this was used to treat more patients in order to confirm the feasibility of the regimen on a large scale, with the number of cycles being varied on the basis of disease extension. Results: Twenty-three cases were enrolled in the CTX dose finding phase. Dose-limiting non-hematological toxicity occurred at 2250 mg/m 2. As the intermediate level of 2000 mg/m 2 had a borderline toxicity profile, a CTX dose of 1750 mg/m 2 was defined as the MTD. A total of 53 patients then received the MTD during the course of the study as a whole. At the MTD, toxicity was acceptable. Only 10 of 189 cycles (4%) required hospitalization due to infection or febrile neutropenia. Seventy-four percent of the patients achieved complete remission. Freedom from progression and overall survival at 12 months were 71% and 86% in the whole series, and 58% and 71% for high-risk cases, respectively. Conclusions: This intensified CHOP regimen is feasible on an outpatient basis. It can be safely considered a definitive treatment in patients at low and intermediate risk, and as induction before high-dose consolidation in high-risk cases.

Original languageEnglish
Pages (from-to)1341-1346
Number of pages6
JournalAnnals of Oncology
Volume13
Issue number9
DOIs
Publication statusPublished - Sep 2002

Fingerprint

Doxorubicin
Cyclophosphamide
Lymphoma
Maximum Tolerated Dose
Febrile Neutropenia
Vincristine
Prednisone
VAP-cyclo protocol
Non-Hodgkin's Lymphoma
Intercellular Signaling Peptides and Proteins
Hospitalization
Outpatients
Survival
Infection

Keywords

  • Chemotherapy
  • CHOP
  • Dose finding
  • Dose intensity
  • Non-Hodgkin's lymphoma

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Intensified CHOP regimen in aggressive lymphomas : Maximal dose intensity and dose density of doxorubicin and cyclophosphamide. / Bertuzzi, A.; Balzarotti, M.; Spina, M.; Nozza, A.; Roncalli, M.; Sarina, B.; Morenghi, E.; Magagnoli, M.; Tirelli, U.; Castagna, L.; Milan, I.; Santoro, A.; Ripa, C.; Latteri, F.; Bernardi, D.

In: Annals of Oncology, Vol. 13, No. 9, 09.2002, p. 1341-1346.

Research output: Contribution to journalArticle

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abstract = "Background: Following our previous study of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) intensification in non-Hodgkin's lymphoma (NHL), in the present report we attempted to further increase dose intensity by shortening the between-course intervals with the support of growth factors. Patients and methods: A total of 67 patients were enrolled. With a fixed dose of doxorubicin 75 mg/m 2, cyclophosphamide (CTX) was started at a dose of 1750 mg/m 2 and increased by 250 mg/m 2 in consecutive cohorts of patients provided that no dose-limiting toxicity occurred. After the maximal tolerated dose (MTD) had been identified, this was used to treat more patients in order to confirm the feasibility of the regimen on a large scale, with the number of cycles being varied on the basis of disease extension. Results: Twenty-three cases were enrolled in the CTX dose finding phase. Dose-limiting non-hematological toxicity occurred at 2250 mg/m 2. As the intermediate level of 2000 mg/m 2 had a borderline toxicity profile, a CTX dose of 1750 mg/m 2 was defined as the MTD. A total of 53 patients then received the MTD during the course of the study as a whole. At the MTD, toxicity was acceptable. Only 10 of 189 cycles (4{\%}) required hospitalization due to infection or febrile neutropenia. Seventy-four percent of the patients achieved complete remission. Freedom from progression and overall survival at 12 months were 71{\%} and 86{\%} in the whole series, and 58{\%} and 71{\%} for high-risk cases, respectively. Conclusions: This intensified CHOP regimen is feasible on an outpatient basis. It can be safely considered a definitive treatment in patients at low and intermediate risk, and as induction before high-dose consolidation in high-risk cases.",
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T1 - Intensified CHOP regimen in aggressive lymphomas

T2 - Maximal dose intensity and dose density of doxorubicin and cyclophosphamide

AU - Bertuzzi, A.

AU - Balzarotti, M.

AU - Spina, M.

AU - Nozza, A.

AU - Roncalli, M.

AU - Sarina, B.

AU - Morenghi, E.

AU - Magagnoli, M.

AU - Tirelli, U.

AU - Castagna, L.

AU - Milan, I.

AU - Santoro, A.

AU - Ripa, C.

AU - Latteri, F.

AU - Bernardi, D.

PY - 2002/9

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N2 - Background: Following our previous study of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) intensification in non-Hodgkin's lymphoma (NHL), in the present report we attempted to further increase dose intensity by shortening the between-course intervals with the support of growth factors. Patients and methods: A total of 67 patients were enrolled. With a fixed dose of doxorubicin 75 mg/m 2, cyclophosphamide (CTX) was started at a dose of 1750 mg/m 2 and increased by 250 mg/m 2 in consecutive cohorts of patients provided that no dose-limiting toxicity occurred. After the maximal tolerated dose (MTD) had been identified, this was used to treat more patients in order to confirm the feasibility of the regimen on a large scale, with the number of cycles being varied on the basis of disease extension. Results: Twenty-three cases were enrolled in the CTX dose finding phase. Dose-limiting non-hematological toxicity occurred at 2250 mg/m 2. As the intermediate level of 2000 mg/m 2 had a borderline toxicity profile, a CTX dose of 1750 mg/m 2 was defined as the MTD. A total of 53 patients then received the MTD during the course of the study as a whole. At the MTD, toxicity was acceptable. Only 10 of 189 cycles (4%) required hospitalization due to infection or febrile neutropenia. Seventy-four percent of the patients achieved complete remission. Freedom from progression and overall survival at 12 months were 71% and 86% in the whole series, and 58% and 71% for high-risk cases, respectively. Conclusions: This intensified CHOP regimen is feasible on an outpatient basis. It can be safely considered a definitive treatment in patients at low and intermediate risk, and as induction before high-dose consolidation in high-risk cases.

AB - Background: Following our previous study of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) intensification in non-Hodgkin's lymphoma (NHL), in the present report we attempted to further increase dose intensity by shortening the between-course intervals with the support of growth factors. Patients and methods: A total of 67 patients were enrolled. With a fixed dose of doxorubicin 75 mg/m 2, cyclophosphamide (CTX) was started at a dose of 1750 mg/m 2 and increased by 250 mg/m 2 in consecutive cohorts of patients provided that no dose-limiting toxicity occurred. After the maximal tolerated dose (MTD) had been identified, this was used to treat more patients in order to confirm the feasibility of the regimen on a large scale, with the number of cycles being varied on the basis of disease extension. Results: Twenty-three cases were enrolled in the CTX dose finding phase. Dose-limiting non-hematological toxicity occurred at 2250 mg/m 2. As the intermediate level of 2000 mg/m 2 had a borderline toxicity profile, a CTX dose of 1750 mg/m 2 was defined as the MTD. A total of 53 patients then received the MTD during the course of the study as a whole. At the MTD, toxicity was acceptable. Only 10 of 189 cycles (4%) required hospitalization due to infection or febrile neutropenia. Seventy-four percent of the patients achieved complete remission. Freedom from progression and overall survival at 12 months were 71% and 86% in the whole series, and 58% and 71% for high-risk cases, respectively. Conclusions: This intensified CHOP regimen is feasible on an outpatient basis. It can be safely considered a definitive treatment in patients at low and intermediate risk, and as induction before high-dose consolidation in high-risk cases.

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KW - Dose intensity

KW - Non-Hodgkin's lymphoma

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