Rituximab–CHOP or two-weekly CHOP + G-CSF in aggressive lymphoma of the elderly?

G. Todeschini*,1, S. Gelio2 and C. Tecchio1

1 Dipartimento di Medicina Clinica e Sperimentale, Sezione di Ematologia, 2 Dipartimento di Farmacologia, University of Verona, Verona, Italy

*E-mail: giuseppe.todeschini1@libero.it, cristina.tecchio@univr.it

The growing incidence of lymphomas and the increasing age of the population in western countries prompt clinicians to face more and more frequently the treatment of elderly aggressive lymphomas. Moreover, once an accurate geriatric assessment has been carried out and the patient is willing and able to receive a curative-intent therapy, the clinician has to choose among different therapeutic regimens.

In 2002, two important new achievements were reached in the treatment of aggressive lymphoma in the elderly. First, the combination Rituximab + CHOP (R-CHOP) [1] has been demonstrated to increase significantly the overall survival (OS) and event-free survival (EFS) as compared to CHOP alone. Second, the combination granulocyte colony-stimulating factor (G-CSF) + 2-weekly CHOP allows the clinician to increase dose intensity by delivering chemotherapy every 14 days and decreases the infectious complications, which elderly patients are more exposed to [2]. Two-weekly CHOP + G-CSF significantly improves the complete response and EFS when compared to the traditional CHOP (every 21 days) or to other more complex regimens. As shown in Table 1, there are no significant differences in the results achieved with R-CHOP or with 2-weekly CHOP + G-CSF.


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Table 1.
 
Although the results are comparable, 2-weekly CHOP + G-CSF shows a reduced toxic death rate and a shorter duration of the treatment. As shown in Table 1, we calculated and compared the cost of these two treatments at our institution, finding a significantly lower cost in 2-weekly CHOP + G-CSF. Of note, in R-CHOP cost-assessment, we have not included the additional expense for the G-CSF eventually delivered during this treatment (employed in more than one-third of patients) [1].

Waiting for the ongoing trials comparing these two approaches, the current data in the literature and the estimate of expenses seem to suggest the use of 2-weekly CHOP + G-CSF in the treatment of aggressive lymphomas in the elderly.

REFERENCES

1. Coiffier B, Lepage E, Briere J et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 2002; 346: 235–242.[Abstract/Free Full Text]

2. Pfreundschuh M, Trumper I, Kloess M et al. Two-weekly CHOP: the new standard regimen for patients with aggressive non-Hodgkin’s lymphoma (NHL). Ann Oncol 2002; 13 (Suppl 2): 27.