Treatment of aggressive Non‐Hodgkin's lymphoma in the elderly

Abstract

A nonanthracycline‐containing chemotherapeutic combination for the treatment of intermediate and high‐grade non‐Hodgkin's lymphoma was evaluated. Thirty‐four consecutive and previously untreated patients, with a median age of 75 (range 54‐86) years, with aggressive lymphoma, received daily etoposide (60 mg/m² intravenous infusion [IVI]), cytosine arabinoside (50 mg/m² subcutaneously), and methylprednisolone (60 mg/m² IVI) on each of 5 consecutive days. Individuals with limited disease (stages I and II) (n = 9) received six, 3‐day cycles of the same therapy and involved field radiation (36 Gy in 20 fractions) between the third and fourth courses. Patients with disseminated lymphoma (n = 25) received 10 cycles over 8 months of the same combination, with the addition of methotrexate (200 mg/m² on days 8 and 15), followed by leucovorin rescue (10 mg/m² orally every 6 hr for 8 doses). Of the 34 patients, 44% entered complete remission (CR), and 7 died before completing the first cycle of chemotherapy. Fifty‐six percent of the patients with limited disease and 40% with disseminated lymphoma (P > 0.05) achieved CR. For all patients, median survival was 14 months (range 3 days‐>54 months), this being 12 and 15 months, respectively. For the entire population of responding patients, median survival has not been reached at a median follow‐up of 39 months, while the median CR duration is 21 months. Ten of the 15 responders are alive in unmaintained CR at a median of 41 (range 30‐54) months. Myelotoxicity was the major side effect, leading to adjustments in dose and schedule in two‐thirds of the patients, although treatment changes did not affect outcome. Of the 15 deaths that occurred in this trial, in 53.3% it was unrelated to lymphoma or its therapy. Four patients that had achieved CR died of cardiovascular events (n = 2) or of progressive second malignancies (n = 2). It is concluded that cytosine arabinoside in combination regimens is effective in selected patients; this is particularly relevant in the elderly.