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Chemotherapy for Older Patients with Newly Diagnosed, Advanced-Stage, Aggressive-Histology Non-Hodgkin Lymphoma: A Systematic Review

C. Tom Kouroukis, MD, FRCPC; George P. Browman, MD, MSc, FRCPC; Rosmin Esmail, MSc; and Ralph M. Meyer, MD, FRCPC
[+] Article, Author, and Disclosure Information

From Hamilton Regional Cancer Centre, McMaster University, and Hamilton Health Sciences, Hamilton, Ontario, Canada.

Grant Support: Dr. Kouroukis is a Research Fellow of the National Cancer Institute of Canada supported with funds provided by the Terry Fox Run. The Program in Evidenced-Based Care is funded by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Requests for Single Reprints: Ralph M. Meyer, MD, FRCPC, Hamilton Regional Cancer Centre, 699 Concession Street, Hamilton, Ontario L8V 5C2, Canada; e-mail, ralph.meyer@hrcc.on.ca.

Current Author Addresses: Drs. Kouroukis, Browman, and Meyer: Hamilton Regional Cancer Centre, 699 Concession Street, Hamilton, Ontario L8V 5C2, Canada.

Ms. Esmail: Calgary Regional Health Authority, 1035 7th Avenue SW, Calgary, Alberta T2P 3E9, Canada.

Ann Intern Med. 2002;136(2):144-152. doi:10.7326/0003-4819-136-2-200201150-00012
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Purpose: To conduct a systematic review assessing chemotherapeutic regimens in patients at least 60 years of age with previously untreated, advanced-stage, aggressive-histology non-Hodgkin lymphoma.

Data Sources: Computerized databases were searched for reports from 1966 to April 2000. Relevant journals, textbooks, and reference lists of published articles were hand searched. Abstract reports were not considered.

Study Selection: Randomized trials comparing different chemotherapy regimens were selected. Two independent assessors, who were blinded to authors, institution, and results of the report, reviewed the retrieved citations.

Data Extraction: One author abstracted data on patient characteristics, study quality score, survival, disease response and control, toxicity, and quality of life; pooling was not done because of study heterogeneity.

Data Synthesis: 12 randomized trials that compared chemotherapeutic regimens were reviewed. Progression-free and overall survival were improved when anthracycline-containing regimens, such as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or CTVP (cyclophosphamide, pirarubicin, vincristine, and prednisone), were compared with other regimens.

Conclusions: For treatment of older patients with advanced-stage, aggressive-histology lymphoma who do not have significant comorbid illnesses, an anthracycline-containing regimen, such as CHOP, given in standard doses and schedule, provides for superior outcomes compared with other regimens.





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