Intensive weekly combination chemotherapy for patients with intermediate- grade and high-grade non-Hodgkin's lymphoma

J. W. Sweetenham, G. M. Mead, J. M.A. Whitehouse

Research output: Contribution to journalArticle

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Abstract

High response and overall survival rates have been reported for second- and third-generation combination chemotherapy regimens used in the treatment of advanced intermediate- and high-grade non-Hodgkin's lymphoma (NHL). Results with methotrexate with leucovorin, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin (MACOP-B) chemotherapy have been particularly impressive, although this regimen produces considerable toxicity. We have devised a similar regimen, which differs from previously reported weekly regimens in that it includes etoposide given at 14-day intervals. The doses of methotrexate and prednisolone were lower in our regimen than those used in MACOP-B. Alternating cycles of cyclophosphamide, doxorubicin, and etoposide (week 1) and methotrexate, bleomycin, and vincristine (week 2) were given for a total of 12 weeks, with continuous oral prednisolone and prophylactic antibiotics. We report here the first 61 patients entered onto this study. The overall response rate is 84% (57% complete remission [CR], 27% partial remission [PR]). With a median follow-up of 32 months for surviving patients, the actuarial overall survival at 3 years is 47%, and the failure-free survival is 45%. The dose-limiting toxicity of this regimen was mucositis. Five deaths occurred during chemotherapy, two of which were due to sepsis. The dose intensities of cyclophosphamide and doxorubicin in this regimen are considerably lower than those in MACOP-B. However, because of the inclusion of etoposide, the projected average relative dose intensity for our regimen is higher than that for MACOP-B. Our regimen has produced inferior results to those reported for MACOP-B. This may be because the addition of etoposide has failed to compensate for the lower doses of doxorubicin and cyclophosphamide. Alternatively, it may reflect differences in the presenting features of the patient populations.

Original languageEnglish (US)
Pages (from-to)2202-2209
Number of pages8
JournalJournal of Clinical Oncology
Volume9
Issue number12
DOIs
StatePublished - Jan 1 1991
Externally publishedYes

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Etoposide
Combination Drug Therapy
Non-Hodgkin's Lymphoma
Doxorubicin
Cyclophosphamide
Methotrexate
Bleomycin
Vincristine
Prednisolone
Drug Therapy
Mucositis
Survival
Leucovorin
Prednisone
Sepsis
Survival Rate
Anti-Bacterial Agents
Population
Therapeutics

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Intensive weekly combination chemotherapy for patients with intermediate- grade and high-grade non-Hodgkin's lymphoma. / Sweetenham, J. W.; Mead, G. M.; Whitehouse, J. M.A.

In: Journal of Clinical Oncology, Vol. 9, No. 12, 01.01.1991, p. 2202-2209.

Research output: Contribution to journalArticle

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abstract = "High response and overall survival rates have been reported for second- and third-generation combination chemotherapy regimens used in the treatment of advanced intermediate- and high-grade non-Hodgkin's lymphoma (NHL). Results with methotrexate with leucovorin, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin (MACOP-B) chemotherapy have been particularly impressive, although this regimen produces considerable toxicity. We have devised a similar regimen, which differs from previously reported weekly regimens in that it includes etoposide given at 14-day intervals. The doses of methotrexate and prednisolone were lower in our regimen than those used in MACOP-B. Alternating cycles of cyclophosphamide, doxorubicin, and etoposide (week 1) and methotrexate, bleomycin, and vincristine (week 2) were given for a total of 12 weeks, with continuous oral prednisolone and prophylactic antibiotics. We report here the first 61 patients entered onto this study. The overall response rate is 84{\%} (57{\%} complete remission [CR], 27{\%} partial remission [PR]). With a median follow-up of 32 months for surviving patients, the actuarial overall survival at 3 years is 47{\%}, and the failure-free survival is 45{\%}. The dose-limiting toxicity of this regimen was mucositis. Five deaths occurred during chemotherapy, two of which were due to sepsis. The dose intensities of cyclophosphamide and doxorubicin in this regimen are considerably lower than those in MACOP-B. However, because of the inclusion of etoposide, the projected average relative dose intensity for our regimen is higher than that for MACOP-B. Our regimen has produced inferior results to those reported for MACOP-B. This may be because the addition of etoposide has failed to compensate for the lower doses of doxorubicin and cyclophosphamide. Alternatively, it may reflect differences in the presenting features of the patient populations.",
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