Non-pegylated liposomal doxorubicin in combination with cyclophosphamide, vincristine, prednisone and rituximab for the treatment of non-Hodgkin's lymphoma: Study of 26 patients

Background and objectives: Non-pegylated liposomal doxorubicin is associated with lower cardiac toxicity than conventional doxorubicin, and for that reason it has been used in the treatment of non-Hodgkin's lymphoma (NHL) in old patients or patients with cardiac disease. The objective of this study was to evaluate the efficacy and safety of chemotherapy schedules including non-pegylated liposomal doxorubicin in patients with NHL Patients and methods: Retrospective study of NHL patients treated with non-pegylated liposomal doxorubicin in two hospitals. In each patient demographic data, clinical and biological variables, as well as therapy, response and toxicity were recorded. Results: Twenty-six patients were included, 14 (58%) of them were women. Median age was 76 years (range 42-86). The most frequent histological diagnosis was diffuse large B cell lymphoma (DLBCL, 20 patients). The stage disease at diagnosis was III/IV in 19 (73%) patients whereas 12 (57%) of the 21 patients with DLBCL and grade 3 follicular lymphoma had a high-risk International Prognostic Index. Three patients had a left ventricular ejection fraction lower than 50% at the time of starting treatment. The most frequent cardiovascular risk factor was hypertension (50% of the patients) and 6 (23%) had previous heart disease. In all cases non-pegylated liposomal doxorubicin was administered as part of the R-COMP schedule (rituximab, cyclophosphamide, vincristin, non-pegylated liposomal doxorubicin and prednisone). in 20 cases (73%) as first-line treatment and in the remaining 6 as salvage therapy. Two patients died after the first cycle of chemotherapy (one because of sudden death and the other due to disease progression). Eleven (61%) out of the 18 patients receiving R-COMP as first-line therapy achieved a complete response (CR), 5 (28%) achieved partial response (PR) and 2 showed progression. Only one out of the 6 patients receiving R-COMP as salvage therapy achieved CR, whereas 3 had PR and 2 did not respond. Grade 3 or 4 neutropenia was observed in 11 (46%) patients and febrile neutropenia in 10 (42%), while only one patient developed grade 4 thrombocytopenia. The median overall survival was 50,7 months (95% confidence interval [95% CI] 8-93.3) and the median disease free survival was 18,4 months (95% CI 18.1-18.7). Conclusions: In this cohort of patients, most of them old and with cardiovascular risk factors, the administration of non-pegylated liposomal doxorubicin as part of R-COMP regimen was effective and safe. (C) 2009 Elsevier Espana, S.L. All rights reserved.