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Long-term Results of a Multicenter Randomized, Comparative Trial of Modified CHOP versus THP-COP versus THP-COPE Regimens in Elderly Patients with Non-Hodgkin’s Lymphoma

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Abstract

In treating elderly non-Hodgkin’s lymphoma (NHL) patients, it is particularly important to use drugs that have a low incidence of adverse events and high efficacy. In this multicenter study, THP (pirarubicin)-COP (cyclophosphamide, vincristine, and prednisolone) was compared to two thirds dosage of full CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) regimen with regard to both adverse events and efficacy. For a third group, etoposide (E) was added to the THP-COP regimen (THP-COPE) in order to achieve high dose-intensity. Subjects were 486 previously untreated patients, aged 65 or older (range, 65–92 years; median, 74 years), with NHL. Subjects were randomly assigned to receive THP-COP, two thirds CHOP, or THP-COPE. Four hundred and forty-three patients were assessed for response and followed for 8 years after the last subject registered. The complete remission rates for the THP-COP, CHOP, and THP-COPE groups were 42.5%, 41.4%, and 48.0%, respectively. There was no difference in overall survival or progression-free survival among these 3 groups. In aggressive lymphoma, there was also no difference in complete response (CR) rate (45.3% in THP-COP, 44.9% in CHOP, 48.0% in THP-COPE), overall survival, and progression-free survival among these groups. The 5- and 8-year survival rates for all patients were 29.4% and 18.7%, respectively. The 5- and 8-year survival rates for patients with aggressive lymphoma were 27.4% and 17.4%, respectively. Although long-term survival for patients with aggressive lymphoma on our regimens was not worse compared to previous reports, the CR rate was lower. Because severe adverse events were not observed, higher dose chemotherapy may be directed to achieve better CR rates. In patients with T-cell-type lymphoma, the CR rate was greater after treatment with THP-COP (51.4%) or THP-COPE (57.7%) compared to treatment with CHOP (19.4%). Pirarubicin may be more useful for T-cell lymphoma than doxorubicin. Because adverse cardiac events were reported only in CHOP, adverse cardiac events might be low in the THP group.

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Authors and Affiliations

  1. Department of Hematology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi-ku, 173-0015, Tokyo, Japan

    Mayumi Mori

  2. Third Department of Internal Medicine, University of Tokyo, Tokyo, Japan

    Kiyoshi Kitamura

  3. Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan

    Michihiko Masuda & Hideaki Mizoguchi

  4. Third Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan

    Tomomitsu Hotta

  5. Third Department of Internal Medicine, Hokkaido University School of Medicine, Hokkaido, Japan

    Tamotsu Miyazaki

  6. Third Department of Internal Medicine, Akita University School of Medicine, Akita, Japan

    Akira B. Miura

  7. First Department of Internal Medicine, Niigata University School of Medicine, Niigata, Japan

    Akira Shibata

  8. First Department of Internal Medicine, Nagoya University School of Medicine, Nagoya, Japan

    Hidehiko Saito

  9. Third Department of Internal Medicine, Kanazawa University School of Medicine, Ishikawa, Japan

    Tamotsu Matsuda

  10. Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

    Toru Masaoka

  11. First Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan

    Mine Harada & Yoshiyuki Niho

  12. Jichi Medical School, Togichi, Japan

    Fumimaro Takaku

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  1. Mayumi Mori
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The Japanese Clinical Study Group of THP Lymphomas in the Elderly (JGTLE)

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Correspondence to Mayumi Mori.

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Mori, M., Kitamura, K., Masuda, M. et al. Long-term Results of a Multicenter Randomized, Comparative Trial of Modified CHOP versus THP-COP versus THP-COPE Regimens in Elderly Patients with Non-Hodgkin’s Lymphoma. Int J Hematol 81, 246–254 (2005). https://doi.org/10.1532/IJH97.03147

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