title: [First experience with the modified program NHL-BFM-90 application in adult patients with primary diffuse large B-cell gastric lymphosarcoma with unfavourable prognosis].
abstract: OBJECTIVE
  To assess efficacy of a modified program NHL-BFM-90 in adult patients with primary diffuse large B-cell gastric lymphosarcoms (PDLBGL) with unfavourable prognosis.
  
  
  METHODS
  Modified courses of NHL-BFM-90 were conducted in 5 patients aged 27-67 years from January 2004 to September 2005. Four patients received chemotherapy of the first line, in one patient block therapy followed monotherapy with chlorambucil and a CHOEP course. All the patients were in a severe clinical condition and had several initial factors of unfavourable prognosis: size of the tumor more than 10 cm; stage IE and more advanced; B-symptoms; proliferative activity above 70%. The program NHL-BFM-90 was modified because of the patients' age. Chemotherapy was conducted according to the middle arm of the original program NHL-BFM-90, but methotrexate was introduced in a dose 1 g/m2 for 12 hours, while leukovorin was given 18 hours after the start of methotrexate injection. In two cases the blocks were enhanced with rituximab, 2 patients had doxorubicin in block A, in one case block C was enhanced with methotrexate. A total of 23 modified blocks NHL-BFM-90 were performed: one patient was given 6 blocks, two patients--5, one patient--4 blocks and one patient--3 blocks.
  
  
  RESULTS
  Four patients after block 2 and one patient after block 3 of polychemotherapy NHL-BFM-90 achieved remission of the disease of 6 to 22 months duration which still continues. Infectious complications related to hematological toxicity arose more frequently at the latest courses of chemotherapy.
  
  
  CONCLUSIONS
  Treatment according to the modified program NHL-BFM-90 in adult patients with PDLBGL and unfavourable prognosis is highly effective. For a mean follow-up of 10.2 months no recurrences occurred. The number of courses can be reduced to decrease accumulated hematological toxicity and in case of rapid achievement of remission.
authors.forename: E E
authors.initials: EE
authors.lastname: Zvonkov
authors.forename: B B
authors.initials: BB
authors.lastname: Krasil'nikova
authors.forename: V A
authors.initials: VA
authors.lastname: Makhinia
authors.forename: I B
authors.initials: IB
authors.lastname: Kaplanskaia
authors.forename: S K
authors.initials: SK
authors.lastname: Kravchenko
authors.forename: S R
authors.initials: SR
authors.lastname: Karagiulian
authors.forename: A V
authors.initials: AV
authors.lastname: Grzhimolovskiĭ
authors.forename: A N
authors.initials: AN
authors.lastname: Kuznetsov
authors.forename: A U
authors.initials: AU
authors.lastname: Magomedova
authors.forename: I M
authors.initials: IM
authors.lastname: Shukhman
authors.forename: E A
authors.initials: EA
authors.lastname: Bariakh
authors.forename: E A
authors.initials: EA
authors.lastname: Giliazitdinova
authors.forename: A V
authors.initials: AV
authors.lastname: Gubkin
authors.forename: Iu Iu
authors.initials: IuIu
authors.lastname: Lorie
authors.forename: A M
authors.initials: AM
authors.lastname: Kremenetskaia
authors.forename: A I
authors.initials: AI
authors.lastname: Vorob'ev
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D004334:Drug Administration Schedule; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000473:pathology; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology