***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: One hundred and sixty nine untreated elderly patients ( median age 69 years old ; range 60 - 89 years old ) with high or high-intermediate clinical risk non-Hodgkin 's lymphoma were enrolled in a controlled clinical trial to evaluate escalated doses of epirubicin in a CEOP-Bleo regimen ( cyclophosphamide , vincristine , epirubicin , prednisone and bleomycin ) , compared to escalated doses of idaurubicin in an CIOP-Bleo regimen ( idaurubicin instead of epirubicin ) . Overall , 71 % of the patients in the CEOP-Bleo arm achieved a complete response compared to only 48 % in the CIOP-Bleo regimen ( p < 0.01 ) . At actuarial 3 year , 72 % of the patients treated with the CEOP-Bleo regimen remained alive and free of disease , compared to 34 % in the CIOP-Bleo arm ( p < 0.01 ) . Dose intensity was 0.86 in the epirubicin regimen , similar to 0.82 in the idaurubicin arm . Toxicities were more frequent and severe in the CEOP-Bleo regimen ; however , no death-related treatment was observed in either groups . Cardiac toxicity was also similar in both arms . We conclude that treatment of elderly paitents with aggressive non-Hodgkin 's lymphoma should be considered a curative attempt and not only palliative . The use of full doses of chemotherapy should be contemplated in elderly patients . Epirubicin , in escalating doses , is a drug with mild toxicity and improvement in outcome in this setting is observed . We can not confirm the usefulness of idaurubicin , including escalating doses , in the treatment of patients with aggressive malignant lymphoma , because the complete response rate and survival were worse than other chemotherapy regimens . We feel that the CEOP-Bleo regimen with escalated doses of epirubicin is a useful option in the treatment of elderly patients with aggressive non-Hodgkin 's lymphoma Age is an important prognostic parameter , especially in patients with advanced high- grade non-Hodgkin 's lymphoma ( HG-NHL ) who require more intensive and extensive therapy for any possible chance of cure . We investigated the potential of granulocyte colony-stimulating factor ( G-CSF ) for reducing myelotoxicity , which is the most important dose-limiting factor for chemotherapy . Between March 1993 and June 1995 , 158 previously untreated patients 60 years and older with HG-NHL were included in a cooperative r and omized comparative trial and treated with a combination therapy including VNCOP-B ( cyclophosphamide , mitoxantrone , vincristine , etoposide , bleomycin , and prednisone ) with or without G-CSF . G-CSF was administered at 5 microg/kg/d throughout the treatment starting on day 3 of every week for 5 consecutive days . Of the 158 patients registered for the trial , 149 patients were evaluable : 77 received VNCOP-B plus G-CSF and 72 received VNCOP-B alone . The overall response rate was 81.5 % , with complete response in 59 % : 60 % in the VNCOP-B plus G-CSF group , and 58 % in the VNCOP-B group . At 30 months ( median 24 months ) , 68 % of all complete responders were alive without disease in the G-CSF group and 65 % in the control group . Neutropenia occurred in 18 out of 77 ( 23 % ) of the G-CSF treated patients and in 40 out of 72 ( 55.5 % ) of the controls ( P = .00005 ) . Clinical ly relevant infections occurred in 4 out of 77 ( 5 % ) of the G-CSF group and in 15 out of 72 ( 21 % ) of the controls ( P = .004 ) . The delivered dose intensity was higher in patients receiving G-CSF ( 95 % v 85 % ) , but the difference was not statistically significant . Our data show that VNCOP-B is a feasible and effective regimen in elderly HG-NHL patients , and that the use of G-CSF reduces infection and neutropenia rates without producing any significant modifications to the dose intensity , CR rate , and relapse-free survival curve A r and omized trial was design ed in order to compare the efficacy and feasibility of ProMECE-CytaBOM ( P-C ) and MACOP-B ( M-B ) in patients with advanced , aggressive non Hodgkin 's lymphoma ( NHL ) .  P-C and M-B were chosen due to their association with a very high complete remission rate when compared to other published protocol s. The study was conducted on 210 patients with intermediate or high- grade NHL in stage I bulky , or stages II-IV , r and omized to receive either 6 courses of P-C delivered every 28 days ( 106 patients ) , or 12 weeks of M-B chemotherapy ( 104 patients ) . In both regimens doxorubicin was replaced by a 20 % higher dose of epidoxorubicin ( i.e. 30 mg/m2 of the analog ) . At the end of induction therapy patients could receive additional radiotherapy to residual masses or to sites of previous bulky disease . The two groups of patients were compared for response rates , number and severity of therapy related side effects , overall survival , disease-free survival , and time to treatment failure . Sixty-five patients ( 62 % ) treated with P-C and 69 patients ( 67 % ) treated with M-B achieved a complete remission , with no significant differences between the two treatment arms ( P = 0.13 ) . The overall objective response rate ( complete + partial remission ) was 74 % for patients treated with P-C , and 81 % for patients treated with M-B , respectively . The 4-year relapse-free survival rate was 59 % for P-C and 69 % for M-B , respectively ( P = 0.11 ) . ( ABSTRACT TRUNCATED AT 250 WORDS To determine the effect of a chemotherapy regimen containing pirarubicin , a multicenter clinical trial was performed in naive patients > or = 65 years with malignant lymphoma , between January 1990 and December 1992 . The total number of patients was 37 ( median age 74.2 years ) . One of three different types of chemotherapy regimens , which was administered every 3 to 5 weeks , was chosen for each patient at r and om . Regimen A ( THP-COP ) included pirarubicin ( 30 mg/m2 ; day 1 ) , cyclophosphamide ( 500 mg/m2 ; day 1 ) , vincristine ( 1 mg/m2 ; day 1 ) and prednisolone ( 30 mg/m2 ; days 1 - 5 ) , regimen B , modified " CHOP " , included doxorubicin ( 30 mg/m2 ; day 1 ) , cyclophosphamide ( 500 mg/m2 ; day 1 ) vincristine ( 1 mg/m2 ; day 1 ) and prednisolone ( 30 mg/m2 ; days 1 - 5 ) ; regimen C ( THP-COPE ) included etoposide ( 80 mg/m2 ; day 1 ) in addition to regimen A. The complete response ( CR ) rate was 60.0 % , 45.5 % and 62.5 % with regimen A , B and C. The partial response ( PR ) rate with regimen A was 20.0 % , 18.2 % with B and 25.0 % with C. The 50 % survival period with regimen A was more than 1,000 days , with C 643 days but it was only 365 days with B. The adverse effects related to these treatments occurred more frequently in regimen B than A and C showing a statistically significant difference . We concluded that chemotherapy regimens containing pirarubicin are useful and safe for the elderly patients with malignant lymphoma PURPOSE To determine whether modifying the st and ard regimen of cyclophosphamide , doxorubicin , vincristine , and prednisone ( CHOP ) from full doses given every 3 weeks to one-third doses given weekly ( chop ) increases the received chemotherapy dose-intensity in elderly patients with advanced-stage intermediate- grade lymphoma . PATIENTS AND METHODS Consenting patients , age > or = 65 years who had acceptable cardiac , renal , and liver function and an Eastern Cooperative Oncology Group ( ECOG ) performance status less than 4 , were stratified by bone marrow and performance status and r and omized to receive st and ard CHOP or weekly chop . Drug doses were attenuated or escalated according to a defined dose-modification schedule . The primary outcome was average relative received dose-intensity . Secondary outcomes included response , progression-free and overall survival , toxicity , and performance status . RESULTS Nineteen patients were allocated to each group . No difference in received dose-intensity was seen . When dose-intensity was calculated for the first six cycles of therapy , average relative received dose-intensity was .92 with CHOP versus .89 with weekly chop ( P = .5 ) ; when calculated for the first 18 weeks of therapy , values were .88 with CHOP versus .89 with weekly chop ( P = .8 ) . The complete response rate was 68 % with CHOP versus 74 % with weekly chop ( P = .9 ) . At 2 years , the progression-free survival rate was 57 % with CHOP versus 46 % with weekly chop ( P = .16 ) and the survival rate was 74 % with CHOP versus 51 % with weekly chop ( p = .05 ) . More myelotoxicity was seen with CHOP . CONCLUSION We conclude that CHOP can be given in sufficient doses to elderly patients and that weekly chop does not increase received dose-intensity . Progression-free and overall survival are unlikely to be superior with weekly chop , and may be worse . CHOP should remain the st and ard against which new therapies for elderly patients with intermediate- grade lymphoma are compared BACKGROUND In 1984 , the Eastern Cooperative Oncology Group began a r and omized controlled clinical trial of patients with advanced ( stage III or IV ) diffuse mixed or diffuse large-cell lymphoma to determine whether complete-remission rates , survival , and toxicity differed when patients were treated with a chemotherapeutic regimen containing cyclophosphamide , doxorubicin , vincristine , and prednisone ( CHOP ) , as compared with a regimen containing bleomycin , doxorubicin , cyclophosphamide , vincristine , dexamethasone , methotrexate , and leucovorin ( m-BACOD ) . METHODS From July 1984 through January 1988 , 392 patients were enrolled , 325 of whom ( 83 percent ) were eligible for the analysis and capable of being evaluated . The extent of disease was defined according to st and ard staging techniques , including bilateral bone-core biopsies in 88 percent of patients . R and omization was stratified according to age ( < 60 or > or = 60 years ) , performance status ( 0 , 1 , or other ) , stage ( III or IV ) , and histologic presentation ( diffuse mixed or diffuse large-cell lymphoma ) . RESULTS After a median follow-up of four years , there were no significant differences in rates of complete remission , time to treatment failure , disease-free survival , or overall survival in the patients treated with CHOP as compared with those treated with m-BACOD . However , there was more severe and life-threatening pulmonary , infectious , and hematologic toxicity associated with the m-BACOD regimen . In an attempt to measure the importance of dose intensity in the 325 patients who could be analyzed , we retrospectively calculated dose intensity ( measured in milligrams per square meter of body-surface area per week ) and normalized dose intensity ( defined as a percentage of the prescribed dose ) for all drugs . The median normalized dose intensity for both cyclophosphamide and doxorubicin was found to be greater in the patients treated with CHOP than in those treated with m-BACOD . CONCLUSIONS For patients with stage III or IV diffuse mixed or diffuse large-cell lymphoma , CHOP is superior to m-BACOD , but the role of dose intensity is not yet clear Sixty consecutive previously untreated patients with non-Hodgkin ’s lymphomas ( intermediate or high grade and /or bulky disease and /or presence of constitutional symptoms ) , were r and omized to receive either CHOP-B or CEOP-B ( 31 and 29 patients , respectively ) to compare the therapeutic activity and toxicity . Complete response was observed in 65 % of the patients treated with CHOP-B and 62 % with CEOP-B ;  relapse of the disease occurred , respectively , in 5/20 ( 25 % ) and 6/18 ( 33 % ) of CR . Relapse-free survival and overall survival at 5 yr result ed in both groups ( RFS 68 % and 62 % and overall survival 62 % and 62 % , respectively).In addition , increasing the dosage of epirubicin did not result in an increase in the haematologic toxicity or percent of CR . The haematologic toxicity was slightly lower 
    Output:
    
In comparison with patients receiving CNOP , patients receiving CHOP had a superior median and 3-year overall survival , but no difference was detected in the rate of 3-year disease-free survival .
These results favoring doxorubicin are consistent with those seen in younger patients ( 34 ) .