Anderson K C, Skarin A T, Rosenthal D S, MacIntyre J M, Pinkus G S, Case D C, Leonard R C, Canellos G P
Cancer Treat Rep. 1984 Nov;68(11):1343-50.
A combination chemotherapy program using methotrexate, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone (M-BACOD), which resulted in a high complete response rate and prolonged disease-free survival in lymphomas of the unfavorable diffuse histiocytic and diffuse undifferentiated histopathologic subgroups, was administered to 44 patients with advanced favorable and intermediate-prognosis non-Hodgkin's lymphomas, including nodular lymphoma of the poorly differentiated lymphocytic, mixed, and histiocytic subtypes, and diffuse lymphoma of the poorly differentiated lymphocytic or mixed histologic subtypes. High-dose methotrexate (3 g/m2) was given on Day 14 between cycles of bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone, administered every 3 weeks for ten cycles. Leucovorin factor (10 mg/m2) was given iv 24 hours after the methotrexate infusion was completed, and was continued at 10 mg/m2 by mouth every 6 hours for 72 hours. Therapy was well-tolerated, with predictable myelosuppression in the majority of patients. The complete response rate was 57% (25 of 44 patients), including ten of 18 (56%) patients with nodular and 15 of 26 (58%) patients with diffuse lymphomas. Median overall follow-up among living patients is 65 months, 58 months for patients with nodular and 69 months for patients with diffuse histologic subgroups. Overall survival at 5 years was 64% for patients who achieved complete response, 32% for partial responders, and 0% for those patients who did not respond. Disease-free survival of complete responders was 43% at 5 years, with only one disease-related death noted after 36 months. The nodular and diffuse patient subgroups had similar overall and disease-free survivals. Although initial bone marrow involvement was documented in nine of 18 (50%) nodular patients and in 13 of 26 (50%) diffuse patients, CNS relapse occurred in only one complete and two partial responders. The prolonged disease-free survival observed after M-BACOD therapy demonstrates that durable responses can be achieved with intensive chemotherapy.
采用甲氨蝶呤、博来霉素、多柔比星、环磷酰胺、长春新碱和地塞米松（M-BACOD）的联合化疗方案，该方案在预后不良的弥漫性组织细胞型和弥漫性未分化组织病理学亚组淋巴瘤中可产生较高的完全缓解率并延长无病生存期。将此方案应用于44例预后良好和中等的晚期非霍奇金淋巴瘤患者，包括低分化淋巴细胞型、混合型和组织细胞型亚型的结节性淋巴瘤，以及低分化淋巴细胞型或混合组织学亚型的弥漫性淋巴瘤。在每3周进行一次、共十个周期的博来霉素、多柔比星、环磷酰胺、长春新碱和地塞米松化疗周期之间，于第14天给予高剂量甲氨蝶呤（3 g/m²）。在甲氨蝶呤输注完成后24小时静脉给予亚叶酸钙（10 mg/m²），并每6小时口服10 mg/m²，持续72小时。治疗耐受性良好，大多数患者出现可预测的骨髓抑制。完全缓解率为57%（44例患者中的25例），包括18例结节性淋巴瘤患者中的10例（56%）和26例弥漫性淋巴瘤患者中的15例（58%）。存活患者的中位总随访时间为65个月，结节性淋巴瘤患者为58个月，弥漫性组织学亚组患者为69个月。达到完全缓解的患者5年总生存率为64%，部分缓解者为32%，未缓解者为0%。完全缓解者的5年无病生存率为43%，36个月后仅记录到1例与疾病相关的死亡。结节性和弥漫性患者亚组的总生存率和无病生存率相似。虽然18例结节性患者中有9例（50%）和26例弥漫性患者中有13例（50%）最初记录有骨髓受累，但中枢神经系统复发仅发生在1例完全缓解者和2例部分缓解者中。M-BACOD治疗后观察到的无病生存期延长表明，强化化疗可实现持久缓解。
