Hainsworth J D, Wolff S N, Stein R S, Greer J P, Cousar J B, Greco F A
Cancer Treat Rep. 1986 Aug;70(8):953-8.
Treatment results remain very poor for some clinical and histopathologic subsets of patients with aggressive non-Hodgkin's lymphoma. We treated 21 such patients with a high-dose combination chemotherapy regimen [Mega-COMLA (cyclophosphamide, cytarabine, vincristine, and methotrexate followed by leucovorin and prednisone) + CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)] in an attempt to improve disease-free survival. Neoplasms were classified using the Lukes-Collins system. Eight patients had T-cell lymphomas (convoluted lymphocytic lymphoma, four patients; T-cell lymphoma/leukemia, one; and peripheral T-cell lymphoma, three), eight had B-cell lymphomas (immunoblastic sarcoma, five patients; small noncleaved follicular center cell, one; and large noncleaved follicular center cell, two), and five had nontypable large noncleaved cell lymphomas. All patients were previously untreated; 18 of 21 patients had clinical stage III or IV disease. Following induction therapy (4-8 weeks' duration), 16 patients (76%) achieved complete remission, while three had partial remission. Two patients died of sepsis during induction therapy. Eleven of 16 complete responders (69%) remain in complete remission after a median follow-up of 35 months. The actuarial 3-year survival rate is 51% for the entire group. Myelosuppression with this regimen was severe and prolonged, with a median duration of neutropenia (less than 500 cells/microliter) of 14 days. Seven patients (33%) developed severe neuropathy following induction treatment. High-dose induction therapy with this regimen resulted in a high complete remission rate with manageable toxicity. Survival results are encouraging when compared retrospectively to our patients with similar poor-prognosis histologies treated with standard combination chemotherapy. However, the value of this intensive therapy, relative to newer ("third-generation") regimens, can only be established by prospective randomized studies.
对于侵袭性非霍奇金淋巴瘤患者的某些临床和组织病理学亚组，治疗效果仍然很差。我们采用大剂量联合化疗方案[Mega-COMLA（环磷酰胺、阿糖胞苷、长春新碱和甲氨蝶呤，随后是亚叶酸钙和泼尼松）+CHOP（环磷酰胺、多柔比星、长春新碱和泼尼松）]治疗了21例此类患者，试图提高无病生存率。肿瘤采用卢克斯-柯林斯系统进行分类。8例患者为T细胞淋巴瘤（卷曲淋巴细胞淋巴瘤，4例；T细胞淋巴瘤/白血病，1例；外周T细胞淋巴瘤，3例），8例为B细胞淋巴瘤（免疫母细胞肉瘤，5例；小无裂滤泡中心细胞，1例；大无裂滤泡中心细胞，2例），5例为无法分型的大无裂细胞淋巴瘤。所有患者均未接受过先前治疗；21例患者中有18例处于临床III期或IV期。诱导治疗（持续4 - 8周）后，16例患者（76%）达到完全缓解，3例部分缓解。2例患者在诱导治疗期间死于败血症。16例完全缓解者中有11例（69%）在中位随访35个月后仍处于完全缓解状态。整个组的3年精算生存率为51%。该方案的骨髓抑制严重且持续时间长，中性粒细胞减少（低于500个细胞/微升）的中位持续时间为14天。7例患者（33%）在诱导治疗后出现严重神经病变。该方案的大剂量诱导治疗导致高完全缓解率且毒性可控。与我们采用标准联合化疗治疗的组织病理学预后相似的患者进行回顾性比较时，生存结果令人鼓舞。然而，相对于更新的（“第三代”）方案，这种强化治疗的价值只能通过前瞻性随机研究来确定。
