Pixantrone (BBR2778) is a novel anthracycline derivative, manufactured by Cell Therapeutics Incorporated, WA, USA. In both preclinical and clinical studies pixantrone exhibited a significantly lower cardiac toxicity and better activity than that observed with alternative anthracyclines, as it is devoid of the putative cardiac toxicity generating 5,8-dihydroxy groups. With single-agent pixantrone, neutropenia was the dose-limiting toxicity. In relapsed aggressive non-Hodgkin lymphomas, weekly single-agent pixantrone 85 mg/m(2) for 3 weeks every 4 weeks was associated with a 27% overall response rate and a 15% complete response rate. When used in combination with chemotherapy regimens overall response rates of 58-74% and complete response rates of 37-57% were achieved.