Chemotherapy for Older Patients with Newly Diagnosed, Advanced-Stage, Aggressive-Histology Non-Hodgkin Lymphoma

A Systematic Review

15 January 2002 | Volume 136 Issue 2 | Pages 144-152

Purpose: To conduct a systematic review assessing chemotherapeutic regimens in patients at least 60 years of age with previously untreated, advanced-stage, aggressive-histology non-Hodgkin lymphoma.

Data Sources: Computerized databases were searched for reports from 1966 to April 2000. Relevant journals, textbooks, and reference lists of published articles were hand searched. Abstract reports were not considered.

Study Selection: Randomized trials comparing different chemotherapy regimens were selected. Two independent assessors, who were blinded to authors, institution, and results of the report, reviewed the retrieved citations.

Data Extraction: One author abstracted data on patient characteristics, study quality score, survival, disease response and control, toxicity, and quality of life; pooling was not done because of study heterogeneity.

Data Synthesis: 12 randomized trials that compared chemotherapeutic regimens were reviewed. Progression-free and overall survival were improved when anthracycline-containing regimens, such as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or CTVP (cyclophosphamide, pirarubicin, vincristine, and prednisone), were compared with other regimens.

Conclusions: For treatment of older patients with advanced-stage, aggressive-histology lymphoma who do not have significant comorbid illnesses, an anthracycline-containing regimen, such as CHOP, given in standard doses and schedule, provides for superior outcomes compared with other regimens.

Author and Article Information

From Hamilton Regional Cancer Centre, McMaster University, and Hamilton Health Sciences, Hamilton, Ontario, Canada.

Grant Support: Dr. Kouroukis is a Research Fellow of the National Cancer Institute of Canada supported with funds provided by the Terry Fox Run. The Program in Evidenced-Based Care is funded by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Requests for Single Reprints: Ralph M. Meyer, MD, FRCPC, Hamilton Regional Cancer Centre, 699 Concession Street, Hamilton, Ontario L8V 5C2, Canada; e-mail, ralph.meyer{at}hrcc.on.ca.

Current Author Addresses: Drs. Kouroukis, Browman, and Meyer: Hamilton Regional Cancer Centre, 699 Concession Street, Hamilton, Ontario L8V 5C2, Canada.

Ms. Esmail: Calgary Regional Health Authority, 1035 7th Avenue SW, Calgary, Alberta T2P 3E9, Canada.