Palmieri G, Morabito A, Rea A, Biondi E, Lauria R, Matano E, Pagliarulo C, Montesarchio V, Tagliaferri P, Bianco A R
Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinica, Facolta di Medicina e Chirurgia, Universita Federico II, 80141 Napoli, Italy.
Int J Oncol. 1998 Jul;13(1):121-7. doi: 10.3892/ijo.13.1.121.
Aim of the study was to improve cure rate and survival of aggressive non-Hodgkin's lymphoma (NHL) with a tailored program of therapy based on histologic type, prognostic characteristics of patients and response to therapy, and with the use of differentiating or cytostatic agents such as Ara-C at low doses and alphaIFN. Fifty-four consecutive patients with aggressive NHL were treated in the induction phase with 4 sequential courses of a third generation regimen (modified CODBLAM IV), followed in responsive patients by 1 cycle of doxorubicin and cyclophosphamide and 1 cycle of high dose methotrexate with folinic acid rescue (AC-MTX). Patients who achieved partial response (PR) were treated with the combination of CCNU + vinblastine if affected by high grade NHL, or with low dose Ara-C plus alphaIFN if affected by intermediate grade NHL. Patients who obtained complete response (CR) with basal adverse prognostic factors were treated with alphaIFN as maintenance therapy for two years. Radiotherapy and surgery were effected in selected cases. Thirty-four patients (62.9%) achieved CR and 12 patients (22.2%) showed PR after induction therapy. Among the 12 patients who achieved PR, 6 prolonged CRs were obtained in 7 patients treated with Ara-C at low doses plus alphaIFN and 4 CRs were obtained in 5 patients treated with CCNU + vinblastine. After completion of treatment, 44 patients (81.5%) obtained CR, 2 patients (3.7%) showed PR and 8 patients (14.8%) presented progression of disease (PD). Fifteen patients received alphaIFN as maintenance therapy. The overall survival and failure-free survival rates are 53.7% and 50% respectively, with a median follow-up of 82 months: 27 patients remain alive, disease-free without relapses, and can be considered cured. This tailored program of therapy resulted effective and moderately toxic and may improve the outcome in aggressive NHL.
本研究的目的是通过基于组织学类型、患者预后特征和治疗反应的定制化治疗方案，以及使用低剂量阿糖胞苷（Ara-C）和α干扰素等分化或细胞抑制药物，提高侵袭性非霍奇金淋巴瘤（NHL）的治愈率和生存率。54例连续的侵袭性NHL患者在诱导期接受了4个疗程的第三代方案（改良CODBLAM IV）序贯治疗，反应良好的患者随后接受1个疗程的阿霉素和环磷酰胺治疗以及1个疗程的高剂量甲氨蝶呤联合亚叶酸解救治疗（AC-MTX）。达到部分缓解（PR）的高级别NHL患者接受洛莫司汀（CCNU）+长春碱联合治疗，或达到部分缓解的中级别NHL患者接受低剂量阿糖胞苷+α干扰素联合治疗。具有基础不良预后因素但获得完全缓解（CR）的患者接受α干扰素维持治疗两年。在选定的病例中进行了放疗和手术。诱导治疗后，34例患者（62.9%）达到CR，12例患者（22.2%）显示PR。在达到PR的12例患者中，7例接受低剂量阿糖胞苷+α干扰素治疗的患者中有6例延长了CR，5例接受CCNU+长春碱治疗的患者中有4例获得CR。治疗结束后，44例患者（81.5%）获得CR，2例患者（3.7%）显示PR，8例患者（14.8%）出现疾病进展（PD）。15例患者接受α干扰素维持治疗。总生存率和无失败生存率分别为53.7%和50%，中位随访时间为82个月：27例患者存活，无疾病复发，可视为治愈。这种定制化治疗方案有效且毒性适中，可能改善侵袭性NHL的治疗结果。
