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KMID : 0366220170520040270
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Korean Journal of Hematology
2017 Volume.52 No. 4 p.270 ~ p.275
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Treatment outcomes of dose-attenuated CHOP chemotherapy in elderly patients with peripheral T cell lymphoma
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Choi Eun-Ji
Hong Jung-Yong
Yoon Dok-Hyun
Kang Ji-Hoon
Park Chan-Sik
Huh Joo-Ryung
Chae Eun-Jin
Lee Yoon-Se
Ryu Jin-Sook
Suh Cheol-Won
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Abstract
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Background: While cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) is the most commonly used chemotherapeutic regimen for patients with peripheral T-cell lym-phomas (PTCLs), elderly patients are more vulnerable to associated toxicities. We eval-uated the efficacy and safety of dose-attenuated CHOP in elderly patients with PTCL.
Methods: Patients with PTCL aged ＞70 years or 65?70-years with comorbidities were treated with dose-attenuated CHOP (cyclophosphamide: 562.5 mg/m2, doxorubicin: 37.5 mg/m2, vin-cristine: 1.4 mg/m2, and prednisolone: 100 mg for five days; 25% reduced dose of cyclo-phosphamide and doxorubicin vs. full-dose CHOP) as first-line therapy were included.
Results: Forty-four patients (median age, 74 yr) were analyzed. The majority (N=42, 95.5%) had advanced stage disease and 36 (81.8%) were classified as high/high-intermediate risk by the international prognostic index. The overall response rate was 61.4%, and 21 patients achieved complete response (47.7%). With median follow-up period of 28.8 months, the estimated two-year progression-free and overall survival rates were 36.7% and 46.6%, respectively. Grade 3/4 neutropenia and thrombocytopenia occurred in 26.9% and 7.4% of 204 total cycles, which affected 76.7% and 25.6% of the patients, respectively. Nineteen patients (44.2%) experienced febrile neutropenia, and six died due to treatment-related toxicities. High lactate dehydrogenase levels and an involvement of ＞1 extranodal sites were prognostic indicators of poor survival.
Conclusion: Dose-attenuated CHOP does not compromise treatment efficacy but retains significant toxicity. Our results suggest that some patients can be effectively treated with dose-atte-nuated CHOP, however a novel therapy for elderly patients with PTCL is required.
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KEYWORD
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Peripheral T cell lymphoma, Elderly, Dose-attenuated CHOP
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