Results of treatment with high intensity, brief duration chemotherapy in poor prognosis non‐hodgkin's lymphoma
Results of treatment with high intensity, brief duration chemotherapy in poor prognosis non‐hodgkin's lymphoma
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高强度、短时间化疗治疗预后不良的非霍奇金淋巴瘤的结果
作者：
M. McMaster;J. Greer;S. Wolff;David H. Johnson;F. Greco;J. Hainsworth;R. Stein;J. M. Flexner;J. Cousar
设计了一种新的化疗方法，用于治疗中高级别组织学非霍奇金淋巴瘤，在住院患者中使用频繁的增加（但亚移植）剂量的化疗。对于该方案的初步评估，预后不良的患者接受标准治疗，预计长期生存率低于25%。在1982年3月至1988年5月期间，56名先前未接受治疗的患者进入了这项研究；所有患者要么为高级别组织学（20例），要么主要为大细胞淋巴瘤（36例）。中位年龄为41.5岁（18 - 69岁）。不良预后特征包括：IV期，71%；绩效状况不佳（东部肿瘤合作集团评分，2 ~ 4分），55%；结外多发病变，52%；乳酸脱氢酶升高（> 300 IU/I） 43%；体积大（10 ~ 10厘米）的肿瘤肿块占30%。56例患者中有33例（59%）属于Shipp的3类。在为期6年的研究中，化疗方案被修改，试图提高疗效和降低毒性。然而，大多数患者接受2个月的疗程如下：环磷酰胺1500mg /m2静脉注射（IV），第1、2和29天；依托泊苷IV 400 mg/m2（第1、2、3天）和100 mg/m2（第29、30、31天）；阿霉素45mg /m2 IV，第29、30天；长春新碱1.4 mg/m2 IV，第8、22、36、50天；博莱霉素10单位/m2 IV，第8、22、36和50天；甲氨蝶呤200 mg/m2 IV，第15和43天，24小时后，亚叶酸素15 mg/m2 IV，每6小时一次，共6剂；强的松60mg /m2口服，第1 ~ 7天和第29 ~ 35天。完全缓解（CR）率为77%（95%置信区间，64% ~ 86%）。有10例复发，其中1例发生在随访18个月后。总无事件生存率（EFS）为52%(95%可信区间，36% - 68%)，中位随访时间为36个月。13例小型非裂性淋巴瘤中11例出现CR；精算EFS在该亚组为61%。所有患者均出现骨髓抑制，严重白细胞减少（< 1000/μl）持续时间中位数为12天（范围3 ~ 29天）；5例患者中毒性死亡（9%；95%可信区间，4%至19%）。这种强化治疗方法提高了极低风险非霍奇金淋巴瘤患者的疗效和生存率。
A novel chemotherapeutic approach was designed for the treatment of intermediate and high‐grade histology non‐Hodgkin's lymphoma using augmented (but subtransplantation) doses of chemotherapy administered at frequent intervals in the inpatient setting. For the initial evaluation of this regimen, poor prognosis patients were treated with a projected long‐term survival rate of less than 25% in response to standard therapy. Between March 1982 and May 1988, 56 previously untreated patients were entered into this study; all patients had either high‐grade histology (20 patients) or predominantly large cell lymphoma (36 patients). Median age was 41.5 years (range, 18 to 69 years). Poor prognosis features included: Stage IV, 71%; poor performance status (Eastern Cooperative Oncology Group scale, 2 to 4), 55%; multiple extranodal sites of disease, 52%; elevated lactic dehydrogenase (> 300 IU/I), 43%; and bulky (> 10 cm) tumor masses, 30%. Thirty‐three of 56 patients (59%) were in Shipp's Category 3. During the 6‐year study, the chemotherapy regimen was modified in an attempt to improve efficacy and reduce toxicity. However, most patients received a 2‐month course of therapy as follows: cyclophosphamide 1500 mg/m2 intravenously (IV) on days 1, 2, and 29; etoposide 400 mg/m2 IV on days 1, 2, and 3 and 100 mg/m2 on days 29, 30, 31; doxorubicin 45 mg/m2 IV on days 29, 30; vincristine 1.4 mg/m2 IV on days 8, 22, 36, and 50; bleomycin 10 units/m2 IV on days 8, 22, 36, and 50; methotrexate 200 mg/m2 IV on days 15 and 43 followed 24 hours later by leucovorin 15 mg/m2 IV every 6 hours for six doses; and prednisone 60 mg/m2 orally on days 1 to 7 and 29 to 35. The complete response (CR) rate was 77% (95% confidence interval, 64% to 86%). There were ten relapses, only one of which occurred after 18 months of follow‐up. Overall event‐free survival (EFS) was 52% (95% confidence interval, 36% to 68%), with a median follow‐up of 36 months. Eleven of 13 patients with small noncleaved lymphoma had CR; actuarial EFS in this subgroup was 61%. Myelosuppression occurred in all patients, with severe leukopenia (< 1000/μl) lasting a median of 12 days (range, 3 to 29 days); toxic deaths occurred in five patients (9%; 95% confidence interval, 4% to 19%). This intensive approach improved the response and survival of very poor risk non‐Hodgkin's lymphoma patients.
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识别接受 m-BACOD 或 M-BACOD 治疗的大细胞淋巴瘤患者的主要预后亚组。
影响因子：
39.2
作者：
Shipp,MA;Harrington,DP;Klatt,MM;Jochelson,MS;Pinkus,GS;Marshall,JL;Rosenthal,DS;Skarin,AT;Canellos,GP
通讯作者：
Canellos,GP
影响因子：
11.2
作者：
P. Carbone;H. Kaplan;K. Musshoff;D. Smithers;M. Tubiana
通讯作者：
P. Carbone;H. Kaplan;K. Musshoff;D. Smithers;M. Tubiana
成人淋巴母细胞淋巴瘤：试点方案的结果。
影响因子：
20.3
作者：
Coleman,CN;Cohen,JR;Burke,JS;Rosenberg,SA
通讯作者：
Rosenberg,SA
晚期弥漫性组织细胞淋巴瘤与六药 COP-BLAM 方案的联合化疗。
影响因子：
39.2
作者：
Laurence,J;Coleman,M;Allen,SL;Silver,RT;Pasmantier,M
通讯作者：
Pasmantier,M
自体骨髓移植治疗预后不良的淋巴瘤患者。
DOI：
10.1200/jco.1988.6.8.1303
发表时间：
1988
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
--
作者：
Gulati,SC;Shank,B;Black,P;Yopp,J;Koziner,B;Straus,D;Filippa,D;Kempin,S;Castro-Malaspina,H;Cunningham,I
通讯作者：
Cunningham,I