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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36 Scopus citations

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 high-grade 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
DOIs
StatePublished - Jan 1 1993

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Waits, T. M., Anthony Greco, F., Greer, J. P., Johnson, D. H., Wolff, S. N., Stein, R. S., McMaster, M. L., & 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. https://doi.org/10.1200/JCO.1993.11.5.943