Abstract:
Between 8/82 and 5/90, 26 patients (pts) with SNC lymphoma were treated with an intensive inpatient chemotherapy regimen (mega therapy) which primarily involved two courses of treatment. Course I consisted of cyclophosphamide 1500 mg/m2/day (d) x 2 d and etoposide 400 mg/m2/d x 3 d. Course II began on d 29: cyclophosphamide 1500 mg/m2/d x 1 d, etoposide 100 mg/m2/d x 3 d, doxorubicin 45 mg/m2/d x 2 d. Prednisone 60 mg/m2/d was given during week 1 of each course; vincristine 1.4 mg/m2 and bleomycin 10 U/m2 were given on d 8 and 22 of each course; methotrexate 200 mg/m2 with leucovorin rescue was given on d 15. The median age was 45 yr (range 21-69 yr); M:F ratio was 20:6. Poor prognostic pts included: 18 Stage IV, 15 multiple extranodal sites, 15 B symptoms, 10 LDH greater than 500 IU/L, 9 marrow involvement, 6 HIV+, and 3 CNS involvement. Complete remission (CR) was obtained in 21 (81%) pts; there were 3 (12%) toxic deaths. Neutropenia (WBC less than 1000 cells/mm3) occurred for a median of 11 days. Relapses occurred in 5 pts, all within 18 mo of diagnosis. Two-yr disease-free survival (DFS) was 62% compared to 11% DFS in 36 pts with SNC lymphoma treated at VU or referred after treatment with 1st-3rd generation chemotherapy regimens (p less than 0.005). Features with cure rates less than 30% with mega therapy included: LDH greater than 900 IU/L (2/7), marrow involvement (2/9), and age greater than 60 (1/6). Thirteen of 16 pts between 21-50 yr have had continuous CR. Mega therapy is warranted as initial therapy in pts with SNC lymphoma which has a cure rate of less than 20% with conventional therapy; improvements in therapy are warranted for select groups, including those pts with marrow involvement, LDH greater than 900 IU/L, and over 60 yr.
Keywords: Adult Aged Antineoplastic Agents, Combined/ADVERSE EFFECTS/*THERAPEUTIC USE Drug Administration Schedule Female Human Lymphoma, Small Noncleaved-Cell/*DRUG THERAPY Male Middle Age Prognosis CLINICAL TRIAL ABSTRACT 910930
M9190734
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