Jost L M, Jacky E, Dommann-Scherrer C, Honegger H P, Maurer R, Sauter C, Stahel R A
Department of Medicine, University Hospital, Zürich, Switzerland.
Ann Oncol. 1995 May;6(5):445-51. doi: 10.1093/oxfordjournals.annonc.a059214.
Type and duration of treatment for highly aggressive non-Hodgkin's lymphoma has been a matter of debate over the past decade. To determine the therapeutic efficacy of an abbreviated treatment regimen, 26 patients with newly-diagnosed highly aggressive lymphomas, 17 of them belonging to the International Working Formulation (IWF) group I and 9 with Burkitt's lymphoma (IWF J), were entered in a study using short-term weekly chemotherapy followed by high-dose therapy and autologous bone marrow transplantation.
Besides histology, requirements for entry into to the study were age between 16 and 60 years, stage 1 bulky disease and elevated LDH or stage II to IV disease with or without bulk or elevated LDH, and an absence of HIV infection or CNS involvement at diagnosis. The treatment plan was 12 weeks of MACOP-B or VACOP-B chemotherapy followed by high dose therapy and autologous bone marrow transplantation in first complete remission.
Twenty patients (76%), 16 (62%) of those on MACOP-B or VACOP-B, 1 who had received 2 cycles of ProMACE-CytaBOM prior to MACOP-B and 3 after a first salvage regimen, achieved complete remissions. Seventeen patients (65%) were transplanted in first remission, and 15 (58%) after induction treatment with only MACOP-B or VACOP-B. Reasons for not being given high dose therapy and autologous bone marrow transplantation (ABMT) were failure to achieve complete remission in 6 patients, early relapse in 2 and severe pulmonary toxicity associated with chemotherapy in 1. The median time of follow-up was 45 months. At 3 years, the estimated event-free survival was 31% (CI 14%-50%) and the overall survival 48% (CI 25%-67%). There were no deaths from toxic effects of treatment. Pretreatment factors associated with relapse were stage III or IV disease, age over 30 years and bone marrow involvement. Logrank analysis showed that age was the only factor significantly associated with poor event-free survival.
Short-term weekly chemotherapy followed by high-dose therapy with the CBV regimen in first remission is not a higly effective treatment for advanced lymphoblastic and Burkitt's lymphomas. The 30% rate of failure to achieve partial remission after 6 weeks and/or complete response after 12 weeks of MACOP-B or VACOP-B treatment, as well as the 42% failure rate to undergo ABMT in first remission, suggest that more aggressive chemotherapy should be used in the beginning.
在过去十年中，高度侵袭性非霍奇金淋巴瘤的治疗类型和疗程一直存在争议。为了确定简化治疗方案的疗效，26例新诊断的高度侵袭性淋巴瘤患者进入了一项研究，其中17例属于国际工作分类法（IWF）的I组，9例为伯基特淋巴瘤（IWF J组），该研究采用短期每周化疗，随后进行高剂量治疗和自体骨髓移植。
除组织学检查外，进入该研究的要求包括年龄在16至60岁之间、I期有大包块病变且乳酸脱氢酶（LDH）升高，或II至IV期病变，无论有无包块或LDH升高，并且在诊断时无HIV感染或中枢神经系统受累。治疗方案为12周的MACOP - B或VACOP - B化疗，然后在首次完全缓解时进行高剂量治疗和自体骨髓移植。
20例患者（76%）达到完全缓解，其中16例（62%）接受MACOP - B或VACOP - B治疗，1例在MACOP - B之前接受了2个周期的ProMACE - CytaBOM治疗，3例在首次挽救方案后达到完全缓解。17例患者（65%）在首次缓解时接受了移植，15例（58%）仅在接受MACOP - B或VACOP - B诱导治疗后接受移植。未进行高剂量治疗和自体骨髓移植（ABMT）的原因包括6例未达到完全缓解、2例早期复发以及1例与化疗相关的严重肺部毒性。中位随访时间为45个月。3年时，估计无事件生存率为31%（可信区间14% - 50%），总生存率为48%（可信区间25% - 67%）。没有因治疗毒性作用导致的死亡。与复发相关的预处理因素包括III或IV期病变、年龄超过30岁和骨髓受累。对数秩分析显示年龄是与无事件生存率差显著相关的唯一因素。
首次缓解时采用短期每周化疗随后用CBV方案进行高剂量治疗，对于晚期淋巴细胞性和伯基特淋巴瘤并非高度有效的治疗方法。MACOP - B或VACOP - B治疗6周后未达到部分缓解和/或12周后未达到完全缓解的发生率为30%，以及首次缓解时ABMT失败率为42%，提示一开始应采用更积极的化疗。
