title: Chlorambucil, vincristine and cytarabine (COA) treatment of low grade lymphomas.
abstract: Forty-five patients with stage III-IV low grade non-Hodgkin's lymphoma (NHL) were treated with a non-intensive polychemotherapy regimen including chlorambucil-vincristine and cytarabine (Ara-C), termed COA, for a total of 366 courses, beginning in June 1986. Grade 4 myelotoxicity occurred in only 4/45 patients. No treatment related death was observed. All patients were evaluable for response. Overall, 38 (84%) objective responses, including 31 (69%) complete responses (CR), were observed. At a median follow-up of 57 (21-84+) months, only 8 deaths occurred. Twenty-seven (60%) patients are still disease-free. All disease-free patients were in their first CR. The seven-year estimated survival is 71% and the estimated 7-year progression-free survival (PFS) was 48%. The estimated probability of complete responders to be disease-free at 6 years is 78%. Pretreatment laboratory parameters (serum levels of thymidine kinase, LDH and TNF-alpha showed a good prognostic relevance at using univariate analysis. At multivariate analysis, only the pretreatment serum levels of TNF-alpha were significantly associated with a higher CR achievement probability (p = 0.02) and a longer PFS (p = 0.02). We established a risk model for clinical outcome based on these 3 parameters. Patients having all parameters within the normal range at diagnosis, showed a very good prognosis (100% 7-year PFS and survival), while patients with all parameters increased had a very poor prognosis (0% 7-year PFS and 22% 7-year survival). In conclusion, COA treatment appears to be a non-toxic and very effective treatment for low-grade non-Hodgkin's lymphomas.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Cattedra di Oncologia Medica, Facoltà di Medicina, Università di Cagliari, Napoli, Italia.
authors.forename: R V
authors.initials: RV
authors.lastname: Iaffaioli
authors.forename: G
authors.initials: G
authors.lastname: Frasci
authors.forename: G
authors.initials: G
authors.lastname: Palmieri
authors.forename: P
authors.initials: P
authors.lastname: Tagliaferri
authors.forename: V
authors.initials: V
authors.lastname: Montesarchio
authors.forename: C
authors.initials: C
authors.lastname: Pagliarulo
authors.forename: A
authors.initials: A
authors.lastname: Tortoriello
authors.forename: G
authors.initials: G
authors.lastname: Facchini
authors.forename: E
authors.initials: E
authors.lastname: Matano
authors.forename: R
authors.initials: R
authors.lastname: Lauria
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D002699:Chlorambucil / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011788:Quality of Life; D013937:Thymidine Kinase / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014408:Biomarkers, Tumor; D014409:Tumor Necrosis Factor-alpha; D003561:Cytarabine; D002699:Chlorambucil; D014750:Vincristine; D013937:Thymidine Kinase