Advanced age is an unfavourable prognostic factor for Hodgkin's disease (HD). However HD is uncommon in later life and there are so far only few data on chemotherapy regimens designed for the elderly. AIM OF THE WORK. To present the preliminary results of a new regimen (VEPEMB) devised for elderly HD patients (pts). PATIENTS AND METHODS. From 1996 to 1999, 75 HD pts over 65 years were treated at diagnosis with the VEPEMB chemoherapy regimen: vinblastine 6 mg/sqm i.v. on day 1, cyclophosphamide 500 mg/sqm i.v. on day 1, procarbazine 100 mg/sqm p.o. days 1 through 5, prednisone 30 mg/sqm p.o. days 1 through 5, etoposide 60 mg/sqm p.o. days 15 through 19, mitoxantrone 6 mg/sqm i.v. on day 15,bleomycin 10 mg/sqm i.v. on day 15. The regimen was scheduled every 28 days. The treatment was tailored according to stage as follows: a) low risk pts (stage IA and IIA) received 3 courses of VEPEMB, followed by involved field irradiation; b) high risk pts (advanced stage) underwent ocourses of VEPEMB with radiotherapy limited to areas bulky disease. RESULTS. Mean age was 71 years (range 66-83). An age related comorbidity requiring drug therapy was present in 19 pts (25%). 14 pts (19%) were in stage I; 28 (37%) in stage II: 18 (24%) in stage III; 15 (20%) in stage IV. Systemic symptoms were present in 28 pts (37%). 36 pts (48%) were at the low risk (IA and IIA) and 39 pts (52%) at high risk. The tolerance to the first 3 courses of VEPEMB was good and an interruption was necessary in only one case. An interruption for toxicity was required from course forth to sixth in four more cases (11%). The mean relative dose intensity of drugs was 86% for the first 3 courses and 81 % for six courses. All pts treated with six courses experienced at least one episode of grade 3-4 neutropenia, but hospitalization for fever was seldom required and no toxic death was observed. Fifty nine pts (30 low risk and 29 high risk) are so far valuable for response. CR rate was 100% for low risk pts and no relapse as so far occurred with a mean follow-up of 27 months. The response rate for advanced stage pts was as follows: CR 18 (62%), PR 3 ( 10%), non response or progression 8 (28%). The advanced stage patients who entered CR are so far alive and disease-free with a mean follow up of 22 months. CONCLUSIONS. VEPEMB is a well tolerated regimen. Preliminary results are good in stage IA and IIA. In more advanced stage the CR rate is less good, however it compares favorably with historical data and no relapse has so far occurred.
Preliminary results of a new chemotherapy regimen (vepemb) devised for elderly hodgkin's disease patients
LIBERATI, Anna Marina;
2000
Abstract
Advanced age is an unfavourable prognostic factor for Hodgkin's disease (HD). However HD is uncommon in later life and there are so far only few data on chemotherapy regimens designed for the elderly. AIM OF THE WORK. To present the preliminary results of a new regimen (VEPEMB) devised for elderly HD patients (pts). PATIENTS AND METHODS. From 1996 to 1999, 75 HD pts over 65 years were treated at diagnosis with the VEPEMB chemoherapy regimen: vinblastine 6 mg/sqm i.v. on day 1, cyclophosphamide 500 mg/sqm i.v. on day 1, procarbazine 100 mg/sqm p.o. days 1 through 5, prednisone 30 mg/sqm p.o. days 1 through 5, etoposide 60 mg/sqm p.o. days 15 through 19, mitoxantrone 6 mg/sqm i.v. on day 15,bleomycin 10 mg/sqm i.v. on day 15. The regimen was scheduled every 28 days. The treatment was tailored according to stage as follows: a) low risk pts (stage IA and IIA) received 3 courses of VEPEMB, followed by involved field irradiation; b) high risk pts (advanced stage) underwent ocourses of VEPEMB with radiotherapy limited to areas bulky disease. RESULTS. Mean age was 71 years (range 66-83). An age related comorbidity requiring drug therapy was present in 19 pts (25%). 14 pts (19%) were in stage I; 28 (37%) in stage II: 18 (24%) in stage III; 15 (20%) in stage IV. Systemic symptoms were present in 28 pts (37%). 36 pts (48%) were at the low risk (IA and IIA) and 39 pts (52%) at high risk. The tolerance to the first 3 courses of VEPEMB was good and an interruption was necessary in only one case. An interruption for toxicity was required from course forth to sixth in four more cases (11%). The mean relative dose intensity of drugs was 86% for the first 3 courses and 81 % for six courses. All pts treated with six courses experienced at least one episode of grade 3-4 neutropenia, but hospitalization for fever was seldom required and no toxic death was observed. Fifty nine pts (30 low risk and 29 high risk) are so far valuable for response. CR rate was 100% for low risk pts and no relapse as so far occurred with a mean follow-up of 27 months. The response rate for advanced stage pts was as follows: CR 18 (62%), PR 3 ( 10%), non response or progression 8 (28%). The advanced stage patients who entered CR are so far alive and disease-free with a mean follow up of 22 months. CONCLUSIONS. VEPEMB is a well tolerated regimen. Preliminary results are good in stage IA and IIA. In more advanced stage the CR rate is less good, however it compares favorably with historical data and no relapse has so far occurred.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
