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CHOP Compared With CHOP Plus Granulocyte Colony-Stimulating Factor in Elderly Patients With Aggressive Non-Hodgkin’s Lymphoma

J.K. Doorduijn, B. van der Holt, G.W. van Imhoff, K.G. van der Hem, M.H.H. Kramer, M.H.J. van Oers, G.J. Ossenkoppele, M.R. Schaafsma, L.F. Verdonck, G.E.G. Verhoef, M.M.C. Steijaert, I. Buijt, C.A. Uyl-de Groot, M. van Agthoven, A.H. Mulder, P. Sonneveld

From the For the Dutch-Belgian Hemato-Oncology Cooperative Group (HOVON), Erasmus, Rotterdam, the Netherlands.

Address reprint requests to J.K. Doorduijn, MD, Department of Hematology, Erasmus Medisch Centrum Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands; email: j.doorduijn{at}erasmusmc.nl.

Purpose: To investigate whether the relative dose-intensity of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy could be improved by prophylactic administration of granulocyte colony-stimulating factor (G-CSF) in elderly patients with aggressive non-Hodgkin’s lymphoma (NHL).

Patients and Methods: Patients aged 65 to 90 years (median, 72 years) with stage II to IV aggressive NHL were randomly assigned to receive standard CHOP every 3 weeks or CHOP plus G-CSF every 3 weeks on days 2 to 11 of each cycle.

Results: In 389 eligible patients, the relative dose intensities (RDIs) of cyclophosphamide (median, 96.3% v 93.9%; P = .01) and doxorubicin (median, 95.4% v 93.3%; P = .04) were higher in patients treated with CHOP plus G-CSF. The complete response rates were 55% and 52% for CHOP and CHOP plus G-CSF, respectively (P = .63). The actuarial overall survival at 5 years was 22% with CHOP alone, compared with 24% with CHOP plus G-CSF (P = .76), with a median follow-up of 33 months. Patients treated with CHOP plus G-CSF had an identical incidence of infections, with World Health Organization grade 3 to 4 (34 of 1,191 cycles v 36 of 1,195 cycles). Only the cumulative days with antibiotics were fewer with CHOP plus G-CSF (median, 0 v 6 days; P = .006) than with CHOP alone. The number of hospital admissions and the number of days in hospital were not different.

Conclusion: In elderly patients, G-CSF improved the RDI of CHOP, but this did not lead to a higher complete response rate or better overall survival. G-CSF did not prevent serious infections.

Supported by the Dutch National Health Council, the Hague, the Netherlands.

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