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Annals of Oncology 7:1037-1041, 1996
© 1996 European Society for Medical Oncology

research-article

Dose escalation of high-dose cyclophosphamide and etoposide with high-dose doxorubicin (CDE) and filgrastim for poor-risk non-Hodgkin's lymphoma

G. Juliusson1, and J. Liliemark2

1Departments of Hematology, University Hospital, Linköping, and Huddinge Hospital Linköping; Huddinge and Stockholm, Sweden
2Departments of Clinical Oncology, Karolinska Hospital Linköping; Huddinge and Stockholm, Sweden

Correspondence to: Dr. Gunnar Juliusson Department of Hematology University Hospital S-581 85 Linköping Sweden

PURPOSE:: To identify the highest possible dose of cyclophosphamide (C) and etoposide (E) to be given with high-dose doxorubicin (D) and filgrastim (G-CSF) but without stem cell support in high-risk non-Hodgkin's lymphoma.

PATIENTS AND METHODS:: High-dose CDE was given to 18 evaluable patients, 5 had previous chemotherapy. All patients received D 90 mg/sqm and G-CSF 20 µg/kg/day. The first cohort had C 1800 mg/sqm and E 450 mg/sqm. Chemotherapy was given in equally divided doses over three days. Dose escalation was performed thrice up to C 3900 mg/sqm and E 975 mg/sqm. One to four courses were given.

RESULTS:: The median number of days (quartile values) with neutrophils <0.5 x 109/l was 9 days (7–10), untransfused platelets <20 x 109/l 6 days (3–7), fever i38.0°C 5 days (3–8), intravenous antibiotics 10 days (9–12), with packed red cell transfusion 1 day (0–2), and with platelet transfusion 2 days (1–3). Six patients had complete remission and 11 partial remission from first course. There was no difference in toxicity according to dose level. A second course was given to 15 patients, resulting in fewer days with neutropenia (mean 7.2), and intravenous antibiotics (mean 6.3). Mucositis was the main non-hematologic toxicity.

CONCLUSIONS:: Very high-dose CDE with G-CSF but without stem cell support is feasible as primary therapy. The toxicity was similar to that of standard autologous stem cell transplantation programs.

dose escalation, G-CSF, high-dose chemotherapy, non-Hodgkin's lymphoma, toxicity


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