Cyclophosphamide, doxorubicin, vincristine, and prednisone versus intensive chemotherapy in non-Hodgkin's lymphoma
Cyclophosphamide, doxorubicin, vincristine, and prednisone versus intensive chemotherapy in non-Hodgkin's lymphoma
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DOI：
10.1007/s002800051060
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发表时间：
1997-06-01
影响因子：
3
通讯作者：
Fisher, RI
中科院分区：
文献类型：
--
作者：
Fisher, RI
侵袭性非霍奇金淋巴瘤的治疗在过去的25年中经历了重大的演变。第一代联合化疗研究产生了45-53%的完全缓解(CR)率和30%-37%的长期存活率。然后开发了旨在提高CR率的新的治疗方案，假设获得CR的额外患者将成为长期无病幸存者。关于第三代方案的单一机构试点研究的初步报告显示，CR率和存活率分别为68-86%和58-69%；然而，在较长的随访期后，存活率下降。此外，使用这些新方案的验证性国家II期试验仅产生49-65%的CR率和50-61%的存活率。因此，关于这些新方案的疗效的最终结论有待前瞻性随机试验的结果。西南肿瘤组(SWOG)进行了一项随机试验，将标准疗法CHOP与第三代化疗方案m-BACOD、ProMACE-CytaBOM和MACOP-B进行了比较。6年后，CHOP方案和第三代方案在有效率、无进展生存期或总生存期方面没有发现差异。例如，CHOP、m-BACOD、ProMACE-CytaBOM和MACOP-B的6年无进展生存率估计分别为33%、36%、34%和32%(P=0.31)。6年总生存率估计为CHOP 42%，m-BACOD40%，ProMACE-CytaBOM 46%，MACOP-B 41%(P=0.89)。此外，我们还没有确定使用第三代方案治疗的患者中存活时间更长的任何子集，而且新方案的成本和毒性更高。在此基础上
Therapy for aggressive non-Hodgkin's lymphomas has undergone significant evolution in the past 25 years. First-generation combination chemotherapy studies produced complete response (CR) rates of 45-53% together with 30-37% rates of long-term survival. New treatment programs aimed at increasing CR rates were then developed on the assumption that the additional patients who achieved a CR would become long-term disease-free survivors. Initial reports of single-institution pilot studies with third-generation regimens suggested CR and survival rates of 68-86% and 58-69%, respectively; however, after longer follow-up periods, survival rates decreased. Furthermore, confirmatory national phase II trials using these newer regimens produced CR rates of only 49-65% and survival rates of 50-61%. Thus, ultimate conclusions concerning the efficacy of these new regimens awaited the results of prospective randomized trials. The Southwest Oncology Group (SWOG) conducted a randomized trial comparing standard therapy, CHOP, to the third-generation chemotherapy regimens m-BACOD, ProMACE-CytaBOM, and MACOP-B. After 6 years, no difference in the response rate, progression-free survival, or overall survival has been found between CHOP and the third-generation regimens. For example, the 6-year estimates of progression-free survival are CHOP 33%, m-BACOD 36%, ProMACE-CytaBOM 34%, and MACOP-B 32% (P = 0.31). The 6-year overall survival estimates are CHOP 42%, m-BACOD 40%, ProMACE-CytaBOM 46%, and MACOP-B 41% (P = 0.89). Furthermore, we have not identified any subset of patients who survive longer on treatment with the third-generation regimens, and the cost and toxicity of the new regimens are higher. On the basis that