HIGH-DOSE CHOP AS INITIAL THERAPY FOR PATIENTS WITH POOR-PROGNOSIS AGGRESSIVE NON-HODGKINS-LYMPHOMA - A DOSE-FINDING PILOT-STUDY

Purpose: The purpose of this study was to develop a more effective approach to the treatment of patients with poor-prognosis aggressive non-Hodgkin's lymphoma (NHL). Patients and Methods: Thirty newly diagnosed patients with bulky (greater than or equal to 10 cm) advanced-stage aggressive NHL were enrolled onto a pilot study. The study was designed to determine the maximum-tolerated dosages (MTD) of cyclophosphamide and doxorubicin that could be used in a high-dose cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regimen with granulocyte colony-stimulating factor (G-CSF) support and to assess preliminarily the efficacy of the regimen. Results: In the initial dose-finding portion of the study, cumulative thrombocytopenia wets the dose-limiting toxicity. At the MTD, the regimen included four 21-day cycles of cyclophosphamide 4 gm/m(2), doxorubicin 70 mg/m(2), vincristine 2 mg, and prednisone 100 mg for 5 days with mesna and G-CSF support. At the MTD, 65% of treatment cycles were complicated by febrile neutropenia, 84% of patients received at least one platelet transfusion for platelet counts less than 20,000/mu L, and there was one treatment-related death. Nineteen of 22 (86%; 90% confidence interval [CI], 68 to 96) patients treated at the MTD achieved an initial complete response (CR), and 79% (90% CI, 58 to 92) of the complete responders and 69% of all patients remain progression-free with 20 months median follow-up. Conclusion: The high-dose CHOP regimen may be an effective alternative for patients with poor-prognosis aggressive NHL. (C) 1995 by American Society of Clinical Oncology.