Annals of Hematology

, Volume 87, Issue 9, pp 717–726

Equitoxicity of bolus and infusional etoposide: results of a multicenter randomised trial of the German High-Grade Non-Hodgkins Lymphoma Study Group (DSHNHL) in elderly patients with refractory or relapsing aggressive non-Hodgkin lymphoma using the CEMP regimen (cisplatinum, etoposide, mitoxantrone and prednisone)


  • Carsten Zwick
    • Innere Medizin IUniversitätskliniken des Saarlandes
  • Josef Birkmann
    • Medizinische Klinik VKlinikum Nürnberg
  • Norma Peter
    • Carl-Thiem-Klinikum Cottbus
  • Heinrich Bodenstein
    • Abteilung HämatologieKlinikum Minden
  • Roland Fuchs
    • St. Antonius-Hospital Eschweiler
  • Mathias Hänel
    • Klinikum Chemnitz
  • Marcel Reiser
    • Klinik für Innere MedizinUniversitätsklinikum Köln
  • Manfred Hensel
    • Innere Medizin IVUniversitätsklinikum Heidelberg
  • Michael Clemens
    • OnkologieMütterhaus
  • Samira Zeynalova
    • IMISELeipzig University
  • Marita Ziepert
    • IMISELeipzig University
    • Innere Medizin IUniversitätskliniken des Saarlandes
    • DSHNHL Secretariat
Original Article

DOI: 10.1007/s00277-008-0500-1

Cite this article as:
Zwick, C., Birkmann, J., Peter, N. et al. Ann Hematol (2008) 87: 717. doi:10.1007/s00277-008-0500-1


To compare toxicity of etoposide bolus with continuous infusion and to assess the efficacy of the CEMP (cisplatinum, etoposide, mitoxantrone, prednisone) regimen, 47 patients with refractory or relapsed aggressive non-Hodgkin’s lymphoma older than 60 years (n = 43) or not qualifying for high-dose chemotherapy (n = 4) received five four-weekly CEMP cycles. Patients were randomised to start with bolus or continuous-infusion etoposide and then received bolus and infusional etoposide in an alternating fashion. The primary objective was the comparison of differences in the course of leukocytopenia and thrombocytopenia between the two application schedules. CEMP was well tolerated with little organ and moderate haematotoxicity. There was no difference in toxicity between bolus and continuous-infusion etoposide. Complete remission rate was 44% in patients relapsing ≥1 year, 27% in patients relapsing within the first year after achieving complete remission and 5% in primary refractory patients. Median event-free and overall survivals for all patients were 3 and 10 months, respectively. The observed equitoxicity and the more challenging logistics of a 60-h infusion make bolus injection the preferred application of etoposide. As the CEMP regimen is well tolerated and efficacious in elderly patients with relapsed or refractory aggressive non-Hodgkin’s lymphoma for whom more aggressive therapies are not feasible, a three-weekly modification of CEMP should be tested in combination with rituximab.


Aggressive lymphomaChemotherapyContinuous infusionRelapse

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© Springer-Verlag 2008