Treatment of poor prognosis non-Hodgkin's lymphoma with intensive, inpatient combination chemotherapy of brief duration: long-term followup.
Between 1982 and 1990, we treated patients with poor prognosis non-Hodgkin's lymphoma (NHL) with inpatient, dose-intensive multidrug chemotherapy. Dose intensity was approximately 2.6 times that of the standard CHOP regimen. All patients had intermediate or high grade NHL, as well as one or more clinical features predictive of poor prognosis. Initial results were previously reported in a group of 56 patients, and in a subgroup of 20 patients with small noncleaved cell lymphoma. In this report, we present long-term followup of the patients previously reported. Median follow up is now 75 months (range 48-122 months). Since our initial reports, the survival curves have remained essentially unchanged, with an actuarial 5 year survival of 48% for the entire group and 60% for the patients with small noncleaved cell lymphoma. Disease-free survival is 42% for patients in Shipp's category 3. Three late relapses occurred, all > 36 months after treatment. No late toxicities or second malignancies have been observed. Intensive, short duration therapy is feasible and effective, and may provide particular advantage to patients with small noncleaved cell histology or other poor prognostic features. Exploration of the importance of dose intensity in lymphoma treatment should continue; comparison of this regimen with standard CHOP is indicated.
Waits
T M
TM
Department of Medicine, Vanderbilt University, Nashville, Tennessee.
Greco
F A
FA
Greer
J P
JP
Hainsworth
J D
JD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D011239:Prednisolone / Q000008:administration & dosage; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D016019:Survival Analysis; D014750:Vincristine / Q000008:administration & dosage
D003561:Cytarabine; D001761:Bleomycin; D014750:Vincristine; D005047:Etoposide; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D002955:Leucovorin; D011241:Prednisone; D008727:Methotrexate