Annals of Oncology Advance Access originally published online on June 2, 2005
Annals of Oncology 2005 16(9):1413-1424; doi:10.1093/annonc/mdi264
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
© 2005 European Society for Medical Oncology
Review |
Chemotherapy dose intensity in non-Hodgkin's lymphoma: is dose intensity an emerging paradigm for better outcomes?
1 Rush University Medical Center, Section of Hematology and Stem Cell Transplantation, Chicago, IL, USA 2 Georg August University, Department of Hematology and Oncology, Göttengen, Germany
* Correspondence to: Dr S. A. Gregory, Rush University Medical Center, 1725 W. Harrison Street, Suite 833, Chicago, IL 60 612, USA. Tel: +1-312-942-5982; Fax: +1-312-563-4101; Email: stephanie_gregory{at}rush.edu
Background: Higher chemotherapy dose intensity has been studied as a way of improving the clinical outcomes in various malignancies, including non-Hodgkin's lymphoma (NHL).
Methods: We reviewed clinical trials that have studied the relation between dose and response in cancer chemotherapy, the theory behind dose-intense chemotherapy, and the clinical results with dose-escalated and dose-dense therapy in aggressive NHL.
Results: Myeloablative high-dose chemotherapy with stem cell transplantation produces higher 5-year survival rates than standard salvage chemotherapy in relapsed aggressive lymphoma, but its role as initial therapy is not yet clear. Nonmyeloablative dose-escalated chemotherapy is feasible with granulocyte colony-stimulating factor (G-CSF) support, but this approach does not improve outcomes. Dose-dense (14-day) CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) with G-CSF support produces better results than 21-day CHOP in patients with previously untreated aggressive lymphoma, without additional toxicity. The addition of etoposide to dose-dense CHOP may provide further benefits in younger patients. The addition of rituximab to G-CSF-supported dose-dense CHOP is feasible. Preliminary data suggest the feasibility of dose-dense chemotherapy for NHL with the once-per-cycle G-CSF, pegfilgrastim.
Conclusion: Dose-dense chemotherapy with G-CSF support produced better clinical outcomes in both younger and older patients. Phase 3 trials of dose-dense CHOP plus rituximab with CSF support are warranted.
Key words: chemotherapy, colony-stimulating factor, filgrastim, neutropenia, non-Hodgkin's lymphoma, pegfilgrastim
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  S.-W. Kim, D. W. Oleksyn, R. M. Rossi, C. T. Jordan, I. Sanz, L. Chen, and J. Zhao Protein kinase C-associated kinase is required for NF-{kappa}B signaling and survival in diffuse large B-cell lymphoma cells Blood, February 1, 2008; 111(3): 1644 - 1653. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. G. Polson, S.-F. Yu, K. Elkins, B. Zheng, S. Clark, G. S. Ingle, D. S. Slaga, L. Giere, C. Du, C. Tan, et al. Antibody-drug conjugates targeted to CD79 for the treatment of non-Hodgkin lymphoma Blood, July 15, 2007; 110(2): 616 - 623. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Vaisheva, G. Delbes, B. F. Hales, and B. Robaire Effects of the Chemotherapeutic Agents for Non-Hodgkin Lymphoma, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (CHOP), on the Male Rat Reproductive System and Progeny Outcome J Androl, July 1, 2007; 28(4): 578 - 587. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Witzens-Harig, C. Heilmann, M. Hensel, M. Kornacker, A. Benner, R. Haas, S. Fruehauf, and A. D. Ho Long-Term Follow-Up of Patients with Non-Hodgkin Lymphoma Following Myeloablative Therapy and Autologous Transplantation of CD34+-Selected Peripheral Blood Progenitor Cells Stem Cells, January 1, 2007; 25(1): 228 - 235. [Abstract] [Full Text] [PDF]
|
|