Introduction: Mitoxantrone (M), an anthracenedion, was introduced in the early/mid 1980s as a more tolerable alternative to anthracyclines. This agent has a broad anti-tumour activity including lymphoma with potentially less cardiotoxicity than doxorubicin (D), which may be of particular importance in the elderly patient population. However, an important issue is whether M is as efficacious as D in the treatment of NHL patients.

Methods: Through search of several relevant databases and direct contacts with lymphoma investigators worldwide, we identified seven randomized studies of previously untreated patients comparing CHOP and CNOP chemotherapy in aggressive NHL. In this analysis we included five trials where (D;50mg/m2) was compared with (M;10–12mg/m2; table) and the interval between chemotherapy courses was 3–4 weeks. Patients reported in the Pavlovsky article were included in the Bezwoda report, why analyses were performed separately with either but not both of these reports. Odds ratios of complete remission (CR) and overall survival (OS) were pooled using a fixed effects model.

Results: CHOP was significantly superior to CNOP with regard to both CR rate and OS (figure a–b). No formal testing of side effects could be made. However, myelosuppression was similar with both regimens as was the incidence of infections and neutropenic fever episodes. In addition, clinical evidence of symptomatic congestive heart failure was not more frequent among patients treated with CHOP. In contrast, the incidence of gastrointestinal toxicity and alopecia was significantly higher in this patient group.

Conclusion: CHOP chemotherapy is more efficacious than CNOP at equitoxic (myelosuppression) doses leading to higher CR rates and improved survival. This regimen is, however, also associated with more alopecia and gastrointestinal toxicity.

Table

Randomized trials comparing doxorubicin (CHOP) with mitoxantrone (CNOP) in untreated patients with aggressive NHL

Randomized trials comparing doxorubicin (CHOP) with mitoxantrone (CNOP) in untreated patients with aggressive NHL
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Randomized trials comparing doxorubicin (CHOP) with mitoxantrone (CNOP) in untreated patients with aggressive NHL
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Topics:
chemotherapy regimen, cyclophosphamide, doxorubicin, prednisone, and vincristine, doxorubicin, mitoxantrone, non-hodgkin's lymphoma, aggressive, alopecia, gastrointestinal toxicity, lymphoma, myelosuppression, adverse effects

Disclosure: No relevant conflicts of interest to declare.

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2006, The American Society of Hematology
2006
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