PALLIATIVE CHEMOTHERAPY USING PREDNISOLONE, ETOPOSIDE, PROCARBAZINE AND CYCLOPHOSPHAMIDE (PEP-C) IS
EFFECTIVE AND TOLERABLE IN FRAIL PATIENTS WITH AGGRESSIVE LYMPHOMA.
S. O. Henderson, C. Arbuthnot, A. G. Borg
Haematology Department, Warwick Hospital, UK
Background: Intensive chemotherapy is not suitable for frail patients with aggressive lymphoma at presentation or relapse. This small single centre
retrospective study analyses the effectiveness and tolerability of PEP-C, a palliative chemotherapy regimen, with or without Rituximab (R).
Methods: Seven lymphoma patients (median age 77 years, range 69-82 years, 6 male/1 female) were treated with PEP-C; two mantle cell, four
diffuse large cell and one angioimmunoblastic. PEP-C consisted of oral 20mg prednisolone, 50mg etoposide, 50mg cyclophosphamide and 50mg
procarbazine given daily alongside supportive medication until disease relapse or two months after complete response (CR). Response and
toxicities were monitored using NCI criteria. PEP-C was scheduled according to protocol and altered with falling counts or paused if the white cells
fell below 3.0x109/L. Results: Three patients received PEP-C (two R-PEP-C) as first line; three patients had PEP-C following relapse after RCHOP/CHOP. PEP-C was given for a median of 246 days (range 30-553 days). One patient withdrew after 3 days and was not included in the
analysis. CR with PEP-C was obtained in 4/6 (66%) patients; 1/6 (17%) had refractory disease and 1/6 (17%) had an initial response but relapsed.
Median overall survival was 333 (range 50-601) days and progression free survival 312 (range 30-569) days. At analysis, 50% were alive in CR.
Toxicities were generally mild but included fatigue, HZV oral ulceration, anaemia, CMV retinitis and neutropaenic sepsis. Conclusions: PEP-C is
tolerated by frail patients with aggressive lymphomas at presentation or relapse and improves both duration and quality of life.

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