SHORT-TERM WEEKLY CHEMOTHERAPY FOLLOWED BY HIGH-DOSE THERAPY WITH AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR LYMPHOBLASTIC AND BURKITT LYMPHOMAS IN ADULT PATIENTS

被引:32
作者
JOST, LM
JACKY, E
DOMMANNSCHERRER, C
HONEGGER, HP
MAURER, R
SAUTER, C
STAHEL, RA
机构
[1] UNIV ZURICH HOSP, DEPT MED, DIV ONCOL, CH-8091 ZURICH, SWITZERLAND
[2] UNIV ZURICH HOSP, INST CLIN PATHOL, DEPT PATHOL, CH-8091 ZURICH, SWITZERLAND
[3] STADTSPITAL TRIEMLI, INST MED ONCOL, ZURICH, SWITZERLAND
[4] STADTSPITAL TRIEMLI, INST PATHOL, ZURICH, SWITZERLAND
关键词
LYMPHOBLASTIC LYMPHOMA; BURKITTS LYMPHOMA; VACOP-B; MACOP-B; ABMT; FIRST REMISSION;
D O I
10.1093/oxfordjournals.annonc.a059214
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background: Type and duration of treatment for highly aggressive non-Hodgkin's lymphoma has been a matter of debate over the past decade. To determine the therapeutic efficacy of an abbreviated treatment regimen, 26 patients with newly-diagnosed highly aggressive lymphomas, 17 of them belonging to the International Working Formulation (IWF) group I and 9 with Burkitt's lymphoma (IWF J), were entered in a study using short-term weekly chemotherapy followed by high-dose therapy and autologous bone marrow transplantation. Patients and methods: Besides histology, requirements for entry into to the study were age between 16 and 60 years, stage I bulky disease and elevated LDH or stage II to IV disease with or without bulk or elevated LDH, and an absence of HIV infection or CNS involvement at diagnosis. The treatment plan was 12 weeks of MACOP-B or VACOP-B chemotherapy followed by high dose therapy and autologous bone marrow transplantation in first complete remission. Results: Twenty patients (76%), 16 (62%) of those on MACOP-B or VACOP-B, 1 who had received 2 cycles of ProMACE-CytaBOM prior to MACOP-B and 3 after a first salvage reigmen, achieved complete remissions. Seventeen patients (65%) were transplanted in first remission, and 15 (58%) after induction treatment with only MACOP-B or VACOP-B. Reasons for not being given high dose therapy and autologous bone marrow transplantation (ABMT) were failure to achieve complete remission in 6 patients, early relapse in 2 and severe pulmonary toxicity associated with chemotherapy in 1. The median time of follow-up was 45 months. At 3 years, the estimated event-free survival was 31% (CI 14%-50%) and the overall survival 48% (CI 25%-67%). There were no deaths from toxic effects of treatment. Pretreatment factors associated with relapse were stage III or IV disease, age over 30 years and bone marrow involvement. Logrank analysis showed that age was the only factor significantly associated with poor event-free survival. Conclusion: Short-term weekly chemotherapy followed by high-dose therapy with the CBV regimen in first remission is not a highly effective treatment for advanced lymphoblastic and Burkitt's lymphomas. The 30% rate of failure to achieve partial remission after 6 weeks and/or complete response after 12 weeks of MACOP-B or VACOP-B treatment, as well as the 42% failure rate to undergo ABMT in first remission, suggest that more aggressive chemotherapy should be used in the beginning.
引用
收藏
页码:445 / 451
页数:7
相关论文
共 32 条
[1]   LONG-TERM FOLLOW-UP OF PATIENTS TREATED WITH COMP OR LSA2L2 THERAPY FOR CHILDHOOD NON-HODGKINS-LYMPHOMA - A REPORT OF CCG-551 FROM THE CHILDRENS CANCER GROUP [J].
ANDERSON, JR ;
JENKIN, RDT ;
WILSON, JF ;
KJELDSBERG, CR ;
SPOSTO, R ;
CHILCOTE, RR ;
COCCIA, PF ;
EXELBY, PR ;
SIEGEL, S ;
MEADOWS, AT ;
HAMMOND, GD .
JOURNAL OF CLINICAL ONCOLOGY, 1993, 11 (06) :1024-1032
[2]  
BARO J, 1992, BONE MARROW TRANSPL, V10, P33
[3]   COMBINED MODALITY THERAPY FOR ADULTS WITH SMALL NONCLEAVED CELL LYMPHOMA (BURKITTS AND NON-BURKITTS TYPES) [J].
BERNSTEIN, JI ;
COLEMAN, CN ;
STRICKLER, JG ;
DORFMAN, RF ;
ROSENBERG, SA .
JOURNAL OF CLINICAL ONCOLOGY, 1986, 4 (06) :847-858
[4]   AUTOLOGOUS VERSUS ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR NON-HODGKINS-LYMPHOMA - A CASE-CONTROLLED ANALYSIS OF THE EUROPEAN-BONE-MARROW-TRANSPLANT-GROUP REGISTRY DATA [J].
CHOPRA, R ;
GOLDSTONE, AH ;
PEARCE, R ;
PHILIP, T ;
PETERSEN, F ;
APPELBAUM, F ;
DEVOL, E ;
ERNST, P .
JOURNAL OF CLINICAL ONCOLOGY, 1992, 10 (11) :1690-1695
[5]   TREATMENT OF LYMPHOBLASTIC LYMPHOMA IN ADULTS [J].
COLEMAN, CN ;
PICOZZI, VJ ;
COX, RS ;
MCWHIRTER, K ;
WEISS, LM ;
COHEN, JR ;
YU, KP ;
ROSENBERG, SA .
JOURNAL OF CLINICAL ONCOLOGY, 1986, 4 (11) :1628-1637
[6]  
CONNORS JM, 1988, SEMIN HEMATOL, V25, P41
[7]   COMPARISON OF A STANDARD REGIMEN (CHOP) WITH 3 INTENSIVE CHEMOTHERAPY REGIMENS FOR ADVANCED NON-HODGKINS-LYMPHOMA [J].
FISHER, RI ;
GAYNOR, ER ;
DAHLBERG, S ;
OKEN, MM ;
GROGAN, TM ;
MIZE, EM ;
GLICK, JH ;
COLTMAN, CA ;
MILLER, TP .
NEW ENGLAND JOURNAL OF MEDICINE, 1993, 328 (14) :1002-1006
[8]   SAFETY OF STRINGENT PROPHYLACTIC PLATELET TRANSFUSION POLICY FOR PATIENTS WITH ACUTE-LEUKEMIA [J].
GMUR, J ;
BURGER, J ;
SCHANZ, U ;
FEHR, J ;
SCHAFFNER, A .
LANCET, 1991, 338 (8777) :1223-1226
[9]  
HAINSWORTH JD, 1986, CANCER TREAT REP, V70, P953
[10]  
HERBRECHT R, 1989, P AN M AM SOC CLIN, V8, P261