Effective therapy for poor-prognosis non-Hodgkin's lymphoma with 8 weeks of high-dose-intensity combination chemotherapy

Thomas M. Waits, F. Anthony Greco, John P. Greer, David H. Johnson, Steven N. Wolff, Richard S. Stein, Mary L. McMaster, John D. Hainsworth

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Abstract

Purpose: Despite substantial advances in the treatment of aggressive non-Hodgkin's lymphoma, therapeutic results with conventional regimens remain poor in some subsets of patients. In an attempt to improve the prognosis of such patients we used an 8-week, multidrug chemotherapy regimen of high dose-intensity. Patients and Methods: Between April 1986 and April 1991, 70 patients with advanced intermediate- or highgrade non-Hodgkin's lymphoma were treated. The median age was 41 years (range, 18 to 69). Fifty-one patients (73%) had stage IV disease; 37 (53%) were Shipp's category 3; 17 (24%) had small noncleaved-cell lymphoma; 35 (50%) had Eastern Cooperative Oncology Group (ECOG) performance status ≥ 2; 24 (34%) had two or more extranodal sites involved; and 17 (24%) had bone marrow involvement. The 8-week regimen included cyclophosphamide, etoposide, doxorubicin, vincristine, bleomycin, methotrexate with leucovorin rescue, and prednisone. Results: Sixty-two of 70 patients completed the regimen as planned. Fifty-seven patients (81 %) obtained a complete response (CR) and the actuarial 5-year failure-free survival rate is 52%. Thirty-seven patients remain alive and disease-free a median of 35 months (range, 7 to 68) after therapy. Adverse prognostic factors included age more than 50 years, bone marrow involvement, and serum lactic dehydrogenase (LDH) more than 500 IU/L (normal range, 125 to 250). Myelosuppression was responsible for most of the treatment-related toxicity. Severe leukopenia (< 1,000/μL) occurred in all patients and lasted a median of 9 days. Seven patients (10%) died of myelosuppression-related complications; five of these patients were older than 60 years. Conclusion: This brief but intensive therapy was effective in treating poor-prognosis patients with non-Hodgkin's lymphoma. With this therapy, patients with small noncleaved-cell lymphoma or Shipp's category 3 disease had treatment outcome similar to the group as a whole. This therapy was not well tolerated by patients older than 60 years, and should not be given to this subgroup. Verification of these results in a randomized trial setting is indicated.

Original languageEnglish (US)
Pages (from-to)943-949
Number of pages7
JournalJournal of Clinical Oncology
Volume11
Issue number5
StatePublished - 1993

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Combination Drug Therapy
Non-Hodgkin's Lymphoma
Therapeutics
Bone Marrow
Leucovorin
Bleomycin
Leukopenia
Vincristine
Etoposide
Prednisone
Methotrexate
Doxorubicin
Cyclophosphamide
Oxidoreductases
Milk
Reference Values
Survival Rate

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Waits, T. M., Anthony Greco, F., Greer, J. P., Johnson, D. H., Wolff, S. N., Stein, R. S., ... Hainsworth, J. D. (1993). Effective therapy for poor-prognosis non-Hodgkin's lymphoma with 8 weeks of high-dose-intensity combination chemotherapy. Journal of Clinical Oncology, 11(5), 943-949.

Effective therapy for poor-prognosis non-Hodgkin's lymphoma with 8 weeks of high-dose-intensity combination chemotherapy. / Waits, Thomas M.; Anthony Greco, F.; Greer, John P.; Johnson, David H.; Wolff, Steven N.; Stein, Richard S.; McMaster, Mary L.; Hainsworth, John D.

In: Journal of Clinical Oncology, Vol. 11, No. 5, 1993, p. 943-949.

Research output: Contribution to journalArticle

Waits, TM, Anthony Greco, F, Greer, JP, Johnson, DH, Wolff, SN, Stein, RS, McMaster, ML & Hainsworth, JD 1993, 'Effective therapy for poor-prognosis non-Hodgkin's lymphoma with 8 weeks of high-dose-intensity combination chemotherapy', Journal of Clinical Oncology, vol. 11, no. 5, pp. 943-949.
Waits, Thomas M. ; Anthony Greco, F. ; Greer, John P. ; Johnson, David H. ; Wolff, Steven N. ; Stein, Richard S. ; McMaster, Mary L. ; Hainsworth, John D. / Effective therapy for poor-prognosis non-Hodgkin's lymphoma with 8 weeks of high-dose-intensity combination chemotherapy. In: Journal of Clinical Oncology. 1993 ; Vol. 11, No. 5. pp. 943-949.
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title = "Effective therapy for poor-prognosis non-Hodgkin's lymphoma with 8 weeks of high-dose-intensity combination chemotherapy",
abstract = "Purpose: Despite substantial advances in the treatment of aggressive non-Hodgkin's lymphoma, therapeutic results with conventional regimens remain poor in some subsets of patients. In an attempt to improve the prognosis of such patients we used an 8-week, multidrug chemotherapy regimen of high dose-intensity. Patients and Methods: Between April 1986 and April 1991, 70 patients with advanced intermediate- or highgrade non-Hodgkin's lymphoma were treated. The median age was 41 years (range, 18 to 69). Fifty-one patients (73{\%}) had stage IV disease; 37 (53{\%}) were Shipp's category 3; 17 (24{\%}) had small noncleaved-cell lymphoma; 35 (50{\%}) had Eastern Cooperative Oncology Group (ECOG) performance status ≥ 2; 24 (34{\%}) had two or more extranodal sites involved; and 17 (24{\%}) had bone marrow involvement. The 8-week regimen included cyclophosphamide, etoposide, doxorubicin, vincristine, bleomycin, methotrexate with leucovorin rescue, and prednisone. Results: Sixty-two of 70 patients completed the regimen as planned. Fifty-seven patients (81 {\%}) obtained a complete response (CR) and the actuarial 5-year failure-free survival rate is 52{\%}. Thirty-seven patients remain alive and disease-free a median of 35 months (range, 7 to 68) after therapy. Adverse prognostic factors included age more than 50 years, bone marrow involvement, and serum lactic dehydrogenase (LDH) more than 500 IU/L (normal range, 125 to 250). Myelosuppression was responsible for most of the treatment-related toxicity. Severe leukopenia (< 1,000/μL) occurred in all patients and lasted a median of 9 days. Seven patients (10{\%}) died of myelosuppression-related complications; five of these patients were older than 60 years. Conclusion: This brief but intensive therapy was effective in treating poor-prognosis patients with non-Hodgkin's lymphoma. With this therapy, patients with small noncleaved-cell lymphoma or Shipp's category 3 disease had treatment outcome similar to the group as a whole. This therapy was not well tolerated by patients older than 60 years, and should not be given to this subgroup. Verification of these results in a randomized trial setting is indicated.",
author = "Waits, {Thomas M.} and {Anthony Greco}, F. and Greer, {John P.} and Johnson, {David H.} and Wolff, {Steven N.} and Stein, {Richard S.} and McMaster, {Mary L.} and Hainsworth, {John D.}",
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T1 - Effective therapy for poor-prognosis non-Hodgkin's lymphoma with 8 weeks of high-dose-intensity combination chemotherapy

AU - Waits, Thomas M.

AU - Anthony Greco, F.

AU - Greer, John P.

AU - Johnson, David H.

AU - Wolff, Steven N.

AU - Stein, Richard S.

AU - McMaster, Mary L.

AU - Hainsworth, John D.

PY - 1993

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N2 - Purpose: Despite substantial advances in the treatment of aggressive non-Hodgkin's lymphoma, therapeutic results with conventional regimens remain poor in some subsets of patients. In an attempt to improve the prognosis of such patients we used an 8-week, multidrug chemotherapy regimen of high dose-intensity. Patients and Methods: Between April 1986 and April 1991, 70 patients with advanced intermediate- or highgrade non-Hodgkin's lymphoma were treated. The median age was 41 years (range, 18 to 69). Fifty-one patients (73%) had stage IV disease; 37 (53%) were Shipp's category 3; 17 (24%) had small noncleaved-cell lymphoma; 35 (50%) had Eastern Cooperative Oncology Group (ECOG) performance status ≥ 2; 24 (34%) had two or more extranodal sites involved; and 17 (24%) had bone marrow involvement. The 8-week regimen included cyclophosphamide, etoposide, doxorubicin, vincristine, bleomycin, methotrexate with leucovorin rescue, and prednisone. Results: Sixty-two of 70 patients completed the regimen as planned. Fifty-seven patients (81 %) obtained a complete response (CR) and the actuarial 5-year failure-free survival rate is 52%. Thirty-seven patients remain alive and disease-free a median of 35 months (range, 7 to 68) after therapy. Adverse prognostic factors included age more than 50 years, bone marrow involvement, and serum lactic dehydrogenase (LDH) more than 500 IU/L (normal range, 125 to 250). Myelosuppression was responsible for most of the treatment-related toxicity. Severe leukopenia (< 1,000/μL) occurred in all patients and lasted a median of 9 days. Seven patients (10%) died of myelosuppression-related complications; five of these patients were older than 60 years. Conclusion: This brief but intensive therapy was effective in treating poor-prognosis patients with non-Hodgkin's lymphoma. With this therapy, patients with small noncleaved-cell lymphoma or Shipp's category 3 disease had treatment outcome similar to the group as a whole. This therapy was not well tolerated by patients older than 60 years, and should not be given to this subgroup. Verification of these results in a randomized trial setting is indicated.

AB - Purpose: Despite substantial advances in the treatment of aggressive non-Hodgkin's lymphoma, therapeutic results with conventional regimens remain poor in some subsets of patients. In an attempt to improve the prognosis of such patients we used an 8-week, multidrug chemotherapy regimen of high dose-intensity. Patients and Methods: Between April 1986 and April 1991, 70 patients with advanced intermediate- or highgrade non-Hodgkin's lymphoma were treated. The median age was 41 years (range, 18 to 69). Fifty-one patients (73%) had stage IV disease; 37 (53%) were Shipp's category 3; 17 (24%) had small noncleaved-cell lymphoma; 35 (50%) had Eastern Cooperative Oncology Group (ECOG) performance status ≥ 2; 24 (34%) had two or more extranodal sites involved; and 17 (24%) had bone marrow involvement. The 8-week regimen included cyclophosphamide, etoposide, doxorubicin, vincristine, bleomycin, methotrexate with leucovorin rescue, and prednisone. Results: Sixty-two of 70 patients completed the regimen as planned. Fifty-seven patients (81 %) obtained a complete response (CR) and the actuarial 5-year failure-free survival rate is 52%. Thirty-seven patients remain alive and disease-free a median of 35 months (range, 7 to 68) after therapy. Adverse prognostic factors included age more than 50 years, bone marrow involvement, and serum lactic dehydrogenase (LDH) more than 500 IU/L (normal range, 125 to 250). Myelosuppression was responsible for most of the treatment-related toxicity. Severe leukopenia (< 1,000/μL) occurred in all patients and lasted a median of 9 days. Seven patients (10%) died of myelosuppression-related complications; five of these patients were older than 60 years. Conclusion: This brief but intensive therapy was effective in treating poor-prognosis patients with non-Hodgkin's lymphoma. With this therapy, patients with small noncleaved-cell lymphoma or Shipp's category 3 disease had treatment outcome similar to the group as a whole. This therapy was not well tolerated by patients older than 60 years, and should not be given to this subgroup. Verification of these results in a randomized trial setting is indicated.

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