Studies on chemotherapy for malignant lymphoma

Twenty six patients with non-Hodgkin's lymphoma (NHL), who failed to achieve complete remission or had relapsed after conventional chemotherapy (CHOP or CHOP-Bleo) were treated with a four-drug combination of mitoxantrone, etoposide, cisplatin and prednisolone (MEPP). Of 24 patients evaluated, five (21%) achieved complete remission and seven (29%) responded partially. The median duration of remission was 25 weeks, 38 weeks for complete responders (CRs), 24 weeks for partial responders (PRs). The median survival time after initiation of therapy was 93 weeks for CRs, 50 weeks for PRs and 25 weeks for non-responders (NRs). The difference in survival time between CRs and NRs was statistically significant. Myelosuppression was the major dose-limiting toxicity; WBC nadir below 1, 000/μl occurred in 66.2% of evaluable courses. Two patients with bone marrow involvement died of infection due to granulocytopenia. Renal toxicity of cisplatin was moderate and there was no cardiotoxicity of mitoxantrone detected. Despite severe myelotoxicity, these results indicate that MEPP regimen is useful as a salvage therapy for relapsed or refractory NHL.