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Twenty-two patients with non-Hodgkin's lymphoma were treated with a four-drug combination of mitoxantrone, etoposide, cisplatin and prednisolone (MEPP) after their disease had failed to respond to, or had relapsed after, induction chemotherapy consisting of cyclophosphamide, adriamycin, vincristine and prednisolone with/without bleomycin (CHOP/CHOP-bleo). Of 18 evaluable patients, four (22%) achieved complete remission and six (33%) responded partially. The median duration of response was 29 weeks (range, 9 to 54 weeks). The median survival time was 45 weeks for responders and 22 weeks for non-responders. Gastrointestinal toxicity was common, but well tolerated. Myelosuppression was the major dose-limiting toxicity: 11 patients (61%) experienced a febrile episode during periods of neutropenia and two patients, both of whom had massive bone marrow involvement of the disease, succumbed to infection. Despite the moderate to severe myelotoxicity, these results provide evidence that MEPP is an effective regimen for non-Hodgkin's lymphoma resistant to CHOP or CHOP-bleo.
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