title: Alternating triple therapy for the treatment of intermediate grade and immunoblastic lymphoma.
abstract: BACKGROUND
  CHOP is currently considered the gold standard of treatment for intermediate grade lymphomas. We designed a new regimen known as 'ATT' (alternating triple therapy) which uses three non-cross resistant combinations in alternating sequence for nine cycles.
  
  
  METHODS
  This is a phase II clinical trial with comparison to CHOP/CMED historical controls using prognostic factors. The tumor score system was used to evaluate the results of this trial. Two hundred sixty-eight eligible patients who had one or more of the following adverse features: bulky disease, elevated LDH or > 1 extranodal site were analyzed. Outcome measures consist of survival and failure free survival.
  
  
  RESULTS
  At a median follow-up of 32 months, there was no statistically significant difference in survival for those with favorable prognostic factors (tumor score < or = 2). However, there was a statistically significant difference in favor of ATT for those with unfavorable tumor scores. When we examined the failure-free survival of those with unfavorable tumor scores, we again observed a superiority for the ATT regimen over CHOP/CMED but the opposite was true for those with favorable tumor scores. We also found a statistically significant difference in favor of the ATT regimen when compared with CHOP/CMED for patients < or = 60 years old with a tumor score > or = 3, while no advantage was found for those > 60 years.
  
  
  CONCLUSIONS
  ATT appears more effective but only for patients < 60 years old with unfavorable tumor scores. In those older than 60 years with favorable tumor score, CHOP/CMED appears superior. ATT might be an adequate regimen for young patients with poor prognostic features while CHOP/CMED might be a better choice for those with good prognosis irrespective of age. For those > 60 years with unfavorable tumor scores neither ATT or CHOP/CMED were adequate treatment. Because of the phase II nature of this study, these conclusions should be considered as hypotheses which require prospective testing.
authors.affiliation: Department of Lymphoma-Myeloma, University of Texas M.D. Anderson Cancer Center, Houston, USA. fcabanil@notes.mdacc.tmc.edu
authors.forename: F
authors.initials: F
authors.lastname: Cabanillas
authors.forename: J
authors.initials: J
authors.lastname: Rodriguez-Diaz Pavón
authors.forename: F B
authors.initials: FB
authors.lastname: Hagemeister
authors.forename: P
authors.initials: P
authors.lastname: McLaughlin
authors.forename: M A
authors.initials: MA
authors.lastname: Rodriguez
authors.forename: J E
authors.initials: JE
authors.lastname: Romaguera
authors.forename: K
authors.initials: K
authors.lastname: Dong
authors.forename: T
authors.initials: T
authors.lastname: Moon
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D016400:Lymphoma, Large-Cell, Immunoblastic / Q000188:drug therapy* / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D015080:Mesna / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage; D008776:Methylprednisolone Hemisuccinate / Q000008:administration & dosage; D008875:Middle Aged; D008942:Mitoxantrone / Q000008:administration & dosage; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D003561:Cytarabine; D001761:Bleomycin; D008776:Methylprednisolone Hemisuccinate; D014750:Vincristine; D005047:Etoposide; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D008942:Mitoxantrone; D015080:Mesna; D002945:Cisplatin; D007069:Ifosfamide; D011241:Prednisone; D008727:Methotrexate