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  • A phase III randomized trial of high-dose CEOP + filgrastim versus standard-dose CEOP in patients with non-Hodgkin lymphoma: 10-year follow-up data: Australasian Leukaemia and Lymphoma Group (ALLG) NHL07 trial

    Author(s)
    Hertzberg, Mark
    Matthews, Jane Palfrey
    Stone, Janey Malka
    Dubosq, Ming-Celine
    Grigg, Andrew
    Ellis, David
    Benson, Warwick
    Browett, Peter
    Horvath, Noemi
    Januszewicz, Henry
    Abdi, Ehtesham
    Green, Michael
    Bonaventura, Anthony
    Marlton, Paula
    Cannell, Paul
    Wolf, Max
    Griffith University Author(s)
    Abdi, Ehtesham
    Year published
    2014
    Metadata
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    Abstract
    Increasing dose intensity (DI) of chemotherapy for patients with aggressive non-Hodgkin lymphoma (NHL) may improve outcomes at the cost of increased toxicity. This issue was addressed in a randomized trial aiming to double the DI of myelosuppressive drugs. Between 1994 and 1999, 250 patients with previously untreated aggressive NHL were randomized to treatment with six cycles of 3-weekly standard (s) or intensive (i) chemotherapy: s-CEOP-cyclophosphamide 750, epirubicin 75, vincristine 1.4 mg/m2 all on day 1, and prednisolone 100 mg days 1-5; i-CEOP-cyclophosphamide 1,500, epirubicin 150, vincristine 1.4 mg/m2 all on day 1, ...
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    Increasing dose intensity (DI) of chemotherapy for patients with aggressive non-Hodgkin lymphoma (NHL) may improve outcomes at the cost of increased toxicity. This issue was addressed in a randomized trial aiming to double the DI of myelosuppressive drugs. Between 1994 and 1999, 250 patients with previously untreated aggressive NHL were randomized to treatment with six cycles of 3-weekly standard (s) or intensive (i) chemotherapy: s-CEOP-cyclophosphamide 750, epirubicin 75, vincristine 1.4 mg/m2 all on day 1, and prednisolone 100 mg days 1-5; i-CEOP-cyclophosphamide 1,500, epirubicin 150, vincristine 1.4 mg/m2 all on day 1, and prednisolone 100 mg days 1-5. Primary endpoint was 5-year overall survival (OS). Relative to s-CEOP patients, i-CEOP patients achieved a 78% increase in the DI of cyclophosphamide and epirubicin. Despite this, there was no significant difference in any outcome: 5-year OS (56.7% i-CEOP; 55.1% s-CEOP; P?=?0.80), 5-year progression free survival (PFS; 41% i-CEOP; 43% s-CEOP; P?=?0.73), 5-year time to progression (TTP; 44% i-CEOP; 47% s-CEOP; P?=?0.72), or complete remission (CR)?+?unconfirmed CR (CRu) rates (53% i-CEOP; 59% s-CEOP; P?=?0.64). Long-term follow up at 10 years also showed no significant differences in OS, PFS, or TTP. The i-CEOP arm had higher rates of febrile neutropenia (70 vs. 26%), hospitalisations, blood product utilisation, haematological and gastrointestinal toxicities, and lower quality of life scores during treatment, although without significant differences 6-month later. In the treatment of aggressive NHL in the prerituximab era, increasing DI did not result in improved outcomes, while at the same time lead to increased toxicity.
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    Journal Title
    American Journal of Hematology
    Volume
    89
    Issue
    5
    DOI
    https://doi.org/10.1002/ajh.23684
    Subject
    Cardiovascular medicine and haematology
    Publication URI
    http://hdl.handle.net/10072/65636
    Collection
    • Journal articles

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