MTX-HOPE chemotherapy for patients over 70 with relapsed non-Hodgkin’s lymphoma

This study looked at MTX-HOPE (methotrexate, hydrocortisone, vincristine, sobuzoxane, etoposide) to treat patients over 70 with non-Hodgkin’s lymphoma (NHL) which had returned after previous treatments. It found that MTX-HOPE was an effective and safe treatment for these patients.

NHL is a group of cancers of the lymph nodes. NHL can be treated with chemotherapy and with targeted treatments including rituximab. However, roughly half of NHL cancers will eventually relapse (return) after targeted treatment. Over time, NHL can become resistant to multiple treatments. For elderly patients, it can be more difficult to treat relapsed NHL.

Sobuzoxane (Perazolin) is a chemotherapy medication that interferes with a protein involved in copying DNA (genetic material). Because sobuzoxane acts on a different protein than most other chemotherapy medications, it is effective even when the cancer is resistant to multiple treatments. MTX-HOPE is a chemotherapy regimen based on sobuzoxane. It is unclear whether MTX-HOPE is an effective treatment for patients over 70 with relapsed NHL.

This study included 18 patients with NHL. 16 patients had diffuse large B-cell lymphoma. One patient had follicular lymphoma, and one had T-cell lymphoma. The average age was 79 years. 14 patients (78%) had advanced NHL (stage III or IV). 10 patients (56%) had received at least three previous treatment regimens. Patients were treated with MTX-HOPE chemotherapy in 21-day cycles.

78% of the patients responded to MTX-HOPE treatment. 39% of patients had a complete remission, meaning the cancer could no longer be measured after treatment. The average time before the cancer relapsed was 7 months, and the average overall survival was 10 months.

8 patients were over the age of 80. Among these patients, 7 responded to treatment. The average time before the cancer relapsed was 11 months, and the average overall survival was 19 months for patients over 80.

The most common serious side effect was low white blood cell count (60%). One patient developed a serious infection after MTX-HOPE treatment was begun, and one patient experienced bleeding within the brain.

This paper found that MTX-HOPE chemotherapy is an effective treatment for elderly patients with hard-to-treat NHL. The authors note that these results are better than are typically seen with gemcitabine (Gemzar), which is often used for relapsed NHL.

This is a small study without a control (comparison) group. Further, larger studies are needed.