Results of treatment with high intensity, brief duration chemotherapy in poor prognosis non-Hodgkin's lymphoma

Article Abstract:

Intermediate and high-grade non-Hodgkin's lymphomas still pose a serious problem for the clinician. Prior to 1965, these tumors were virtually incurable. Although improvements in treatment have been made in the following years, only one-half of the patients treated experienced long-term survival. Furthermore, the effective treatments at present are so toxic that more intensive treatments are not possible without bone marrow transplantation. A study was conducted to determine if delivering high intensity chemotherapy for only a brief period would be any better. For this type of preliminary evaluation, the only patients selected for the experimental treatment were those estimated to have less than 25 percent chance of responding to conventional treatment. A total of 56 such patients were treated with a high-intensity chemotherapeutic protocol including cyclophosphamide, etoposide, doxorubicin, vincristine, and bleomycin, as well as methotrexate, leucovorin, and prednisone. The toxicity of the treatment was high, resulting in five patient deaths. However, the complete response rate was 77 percent, and these responses were long-lived for many patients. After a median follow-up of three years, 52 percent of the patients were alive without relapse of disease. The results indicate that the intensive treatment improves the survival of patients with poor-prognosis non-Hodgkin's lymphomas. The high rate of toxicity of the treatment protocol, which killed 9 percent of the patients, is alarming. However, many of the patients included in the study were severely ill to begin with, which may account for at least a part of this high mortality. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Non-Hodgkin's lymphomas

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A brief-duration combination chemotherapy for elderly patients with poor-prognosis non-Hodgkin's lymphoma

Article Abstract:

Significant advances in chemotherapy for non-Hodgkin's lymphomas have improved long-term survival, and have resulted in cure for some patients. However, elderly patients do not easily tolerate the side effects of chemotherapy, which strongly suppresses the bone marrow. A modification of the chemotherapeutic approach to non-Hodgkin's lymphoma, designed to limit the toxic side effects, was used in the treatment of 26 elderly patients 65 years or older; the median age was 75 years. In addition to advanced age, several indicators of poor prognosis were present in many of the patients. Twenty-one patients had advanced Stage III or Stage IV disease, and 22 patients had tumors larger than 10 centimeters, tumors in multiple sites other than lymph nodes, or some other poor prognostic factor. The eight-week schedule of BECALM, or bleomycin, etoposide, cyclophosphamide, adriamycin, and methotrexate with leucovorin, resulted in four treatment-related deaths. Thirteen patients achieved complete responses; five of these have subsequently relapsed. One patient died of other causes, and the remaining seven patients have sustained their remission for a median follow-up of 37.5 months. The results indicate that the BECALM protocol displays effectiveness against aggressive non-Hodgkin's lymphomas, and seems to be superior to other protocols reported in the literature for the treatment of elderly patients. The BECALM protocol also avoided some of the toxic side effects that are associated with bleomycin and anthracycline chemotherapeutic drugs. Nevertheless, moderate toxicity was still observed among the patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Prognosis, Demographic aspects, Lymphomas, Chemotherapy, Combination, Combination chemotherapy

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