Universität zu Köln

Hohloch, Karin, Zwick, Carsten, Ziepert, Marita, Hasenclever, Dirk, Kaiser, Ulrich, Engert, Andreas, Hoeffkes, Heinz-Gert, Kroschinsky, Frank, Mesters, Rolf, Feller, Andreas C., Loeffler, Markus, Truemper, Lorenz and Pfreundschuh, Michael (2014). 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. SpringerPlus, 3. CHAM: SPRINGER INTERNATIONAL PUBLISHING AG. ISSN 2193-1801

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Abstract

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

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Hohloch, Karin UNSPECIFIED UNSPECIFIED UNSPECIFIED Zwick, Carsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Ziepert, Marita UNSPECIFIED UNSPECIFIED UNSPECIFIED Hasenclever, Dirk UNSPECIFIED UNSPECIFIED UNSPECIFIED Kaiser, Ulrich UNSPECIFIED UNSPECIFIED UNSPECIFIED Engert, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoeffkes, Heinz-Gert UNSPECIFIED UNSPECIFIED UNSPECIFIED Kroschinsky, Frank UNSPECIFIED UNSPECIFIED UNSPECIFIED Mesters, Rolf UNSPECIFIED UNSPECIFIED UNSPECIFIED Feller, Andreas C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Loeffler, Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED Truemper, Lorenz UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfreundschuh, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-448739
DOI:	10.1186/2193-1801-3-5
Journal or Publication Title:	SpringerPlus
Volume:	3
Date:	2014
Publisher:	SPRINGER INTERNATIONAL PUBLISHING AG
Place of Publication:	CHAM
ISSN:	2193-1801
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language B-CELL LYMPHOMA; 3-WEEKLY CHOP CHEMOTHERAPY; DETUDE-DES-LYMPHOMES; ELDERLY-PATIENTS; PHASE-II; YOUNGER PATIENTS; PLUS RITUXIMAB; DOXORUBICIN; ETOPOSIDE; REGIMEN Multiple languages Multidisciplinary Sciences Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/44873