Etoposide and idarubicin in a modified CHOP-like regimen (VICED) for aggressive non-Hodgkin's lymphomas.

The superiority of intensive versus standard chemotherapy for aggressive (I: intermediate; H: high grade) NHL is still debated; increased antitumor activity may be counterbalanced by increased toxicity. We have designed a first-line five-drug regimen (vincristine, idarubicin, cyclophosphamide, etoposide and deflazacort), with the aim of potentiating the CHOP protocol without losing tolerability and ease of administration. Seventy-one patients (33\% aged > or = 65) entered the study. CR was obtained in 66.7\% of patients (I: 74\%; H: 56\%), PR in 19.7\%: overall response rate was 86.4\%. Six patients were resistant, two died during treatment. With a median follow up of two years, relapse has occurred in 14 patients (8 I, 6 H). At 3 years, overall survival was projected to be 62.5\% (I 73.5\%; H 31.4\%), disease free survival 66\% (I 71\%, H 56.3\%). No organ toxicity occurred. Myelosuppression was moderate, with a nadir on the 14th day. Febrile episodes occurred in 16\% of courses, dose delay in 19\% of courses; dose reduction in 3\% of patients. No patient required hospitalization. G-CSF was only occasionally used. This regimen has shown a potent antitumor effect with an excellent tolerance, even in elderly patients.