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Annals of Oncology Advance Access published online on October 22, 2009
Annals of Oncology, doi:10.1093/annonc/mdp425
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

High dose intensity doxorubicin in aggressive non-Hodgkin's lymphoma: a literature-based meta-analysis

H.A. Azim1, L. Santoro2, R.G. Bociek3, S. Gandini2, R.A. Malek1 and H.A. Azim, Jr4,*

1 Department of Clinical Oncology, Cairo University Hospital, Cairo, Egypt
2 Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
3 Department of Internal Medicine, Section of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE, USA
4 Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt

* Correspondence to: Dr H. A. Azim Jr, Department of Medical Oncology, National Cancer Institute, Cairo University, 55 Abdel Monem Riad Street, Mohandeseen, Cairo, Egypt. Tel: +202-33026814; Fax: +202-33028656; E-mail: hatemazim{at}cairocure.com

Background: Aggressive non-Hodgkin's lymphoma (NHL) represents ~60% of lymphomas in the West and even more in the developing world. cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) is recognized as the standard chemotherapy regimen and the addition of rituximab to B-cell subtypes has been shown to significantly improve treatment outcomes. Nevertheless, still a significant fraction of patients is not offered rituximab due to economic reasons. Thus, CHOP is still offered to these patients as well as those with T-cell subtypes. Data from the early 1990s have indicated that the dose intensity (DI) of doxorubicin is a key factor in predicting survival.

Methods: A Medline and Cochrane library search was carried out using the search terms ‘CHOP’, ‘lymphoma’ and ‘randomized trials’. Eligible trials had CHOP as a control arm and any regimen administering doxorubicin at a higher DI (16.6 mg/m2/week) as the investigational arm. Pooling of data was carried out using the mixed effect model.

Results: Eight trials were eligible. Patients receiving DI doxorubicin-based regimens had a significantly better overall survival [summary hazard ratio (SHR) 0.82; 95% confidence interval (CI) 0.71–0.96], event-free survival (SHR 0.86; 95% CI 0.75–0.99) and higher complete response rate (summary odds ratio 0.91; 95% CI 0.67–0.97).

Conclusion: High DI doxorubicin based should be considered in patients with aggressive NHL.

chemotherapy, CHOP, dose intensity, doxorubicin, non-Hodgkin's lymphoma

Received for publication February 27, 2009. Revision received July 12, 2009. Accepted for publication August 3, 2009.


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