COPBLAM III: infusional combination chemotherapy for diffuse large-cell lymphoma.

1988 ◽  
Vol 6 (3) ◽  
pp. 425-433 ◽  
Author(s):  
D B Boyd ◽  
M Coleman ◽  
S W Papish ◽  
A Topilow ◽  
S K Kopel ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Combination Chemotherapy ◽  
Cell Lymphoma ◽  
Large Cell ◽  
Complete Response ◽  
The Elderly ◽  
Diffuse Large Cell Lymphoma ◽  
Large Cell Lymphoma ◽  
The Difference

COPBLAM III, a polychemotherapy regimen consisting of cyclophosphamide, infusional vincristine, prednisone, infusional bleomycin, doxorubicin, and procarbazine, was administered to 51 patients with diffuse large-cell lymphoma. Ninety-six percent of patients age 60 or younger achieved a complete response (CR); none have relapsed. Overall, 88% of patients are alive and well and potentially in the survival plateau. For patients greater than 60 years, CR was obtained in 73%, with 42% potentially in the survival plateau, the difference resulting in part from four relapses, three toxic deaths, and one presumed unrelated death. These results in the elderly were paralleled by a relatively reduced ability to tolerate therapy. Toxicity was primarily pulmonary, occurring in 39% of patients, two of whom died. With an overall CR rate of 84%, of which 92% are sustained at a median follow-up of 40 months, COPBLAM III represents a highly effective treatment in a sizeable cohort of patients.

Interpretation of clinical trials in diffuse large-cell lymphoma.

1988 ◽  
Vol 6 (8) ◽  
pp. 1335-1347 ◽  
Author(s):  
J O Armitage ◽  
B D Cheson
Keyword(s):  
Cell Lymphoma ◽  
Large Cell ◽  
Complete Response ◽  
High Rate ◽  
Prolonged Treatment ◽  
Diffuse Large Cell Lymphoma ◽  
Number Of Patients ◽  
Large Cell Lymphoma ◽  
Comparative Trials

Diffuse large-cell lymphoma is one of the neoplasms curable with chemotherapy in an appreciable percentage of patients. However, all patients are not cured and the best combination of agents is not certain. This reflects the lack of completed comparative trials using the regimens that appear most effective. Despite this uncertainty, several principles for the therapy of diffuse large-cell lymphoma can be identified that allow an analysis of the results reported in the literature. These principles include the following: (1) for a regimen to be curative in a substantial number of patients it must achieve a high rate of complete remissions; (2) cure must be accomplished with frontline therapy; (3) drugs must be delivered at curative doses; (4) rapidity of achieving a complete response might be related to chance for cure; (5) prolonged treatment for diffuse large-cell lymphoma is unnecessary; and (6) aggressive therapy is toxic. In analyzing the results with any regimen it is important to have long follow-up since late relapses do occur and initial very positive results tend to decay with greater numbers of patients treated. Applying these principles to the reported chemotherapy studies in patients with diffuse large-cell lymphoma suggest that no one of the new regimens is clearly superior to the others. Also, it is not clear that cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) delivered at full doses to comparable patients is inferior to the newer regimens. The results of ongoing studies comparing these regimens might help resolve these questions.

The m-BACOD combination chemotherapy regimen in large-cell lymphoma: analysis of the completed trial and comparison with the M-BACOD regimen.

1990 ◽  
Vol 8 (1) ◽  
pp. 84-93 ◽  
Author(s):  
M A Shipp ◽  
B Y Yeap ◽  
D P Harrington ◽  
M M Klatt ◽  
G S Pinkus ◽  
...  
Keyword(s):  
Combination Chemotherapy ◽  
Chemotherapy Regimen ◽  
Cell Lymphoma ◽  
Large Cell ◽  
Stage Ii ◽  
Late Relapse ◽  
Dose Methotrexate ◽  
Large Cell Lymphoma ◽  
Combination Chemotherapy Regimen

One hundred thirty-four assessable patients with stage II-IV large-cell lymphoma (LCL) were treated with the combination chemotherapy regimen methotrexate with leucovorin, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone (m-BACOD) between July 1981 and May 1986. The m-BACOD regimen substituted moderate-dose methotrexate (200 mg/m2 x 2) for the high-dose methotrexate used in the preceding M-BACOD regimen; all other drugs were administered as with m-BACOD. Eighty-two patients (61%) in the completed m-BACOD trial achieved a complete response (CR). With a median follow-up of 3.6 years, 62 patients (76%) continue in CR. Predicted survivals of 1, 3, and 5 years for the entire m-BACOD group are 80%, 63%, and 60%, respectively, with a 5-year disease-free survival (DFS) of 74% for the patients who achieve CR. The results obtained with m-BACOD are comparable with those obtained in the preceding M-BACOD trial, which now has a median follow-up of 8.0 years. The reduction in methotrexate dosage in m-BACOD patients was not associated with an increased incidence of CNS relapse. Long-term follow-up of the 215 M/m-BACOD patients indicates that the regimens are not associated with an increased incidence of secondary malignancy. Prolonged follow-up also indicates that advanced-stage patients have a persistent rate of late relapse of about 7.0% per year for years 2 to 5 of their follow-up and that stage II patients have an approximate 2.1% per year rate of late relapse. Application of the previously described prognostic factor model to the 215 M/m-BACOD patients from the completed trials identifies a high-risk group of patients with a CR rate and predicted 5-year survival (38% and 24%, respectively) that are significantly worse than those of the group as a whole (65% and 57%, respectively).

Chemotherapy for diffuse large-cell lymphoma--rapidly responding patients have more durable remissions.

1986 ◽  
Vol 4 (2) ◽  
pp. 160-164 ◽  
Author(s):  
J O Armitage ◽  
D D Weisenburger ◽  
M Hutchins ◽  
D F Moravec ◽  
M Dowling ◽  
...  
Keyword(s):  
Complete Remission ◽  
Combination Chemotherapy ◽  
Chemotherapy Regimen ◽  
Cell Lymphoma ◽  
Large Cell ◽  
Diffuse Large Cell Lymphoma ◽  
Persistent Disease ◽  
Large Cell Lymphoma ◽  
Combination Chemotherapy Regimen ◽  
Better Than

Fifty-one patients with diffuse large-cell lymphoma (DLCL) were treated with a six-drug combination chemotherapy regimen including cyclophosphamide, doxorubicin, procarbazine, bleomycin, vincristine, and prednisone. The patients were restaged after three cycles of therapy, and restaging was repeated at 2-month intervals in patients who had persistent disease. Responding patients received two cycles of therapy after documentation of complete remission (CR). With all patients considered evaluable, 73% of the patients achieved a CR. Twenty-six of the 37 CRs (70%) achieved remission in the first three treatment cycles. The durability of remission in the rapidly responding patients was significantly better than for patients who required five cycles to achieve CR (80% v 40% at 2 years, P = .02) despite the latter patients having received two more cycles of therapy. Rapidly responding patients with DLCL do not require prolonged therapy and have a better prognosis than patients achieving a CR more slowly.

Long-term follow-up and analysis for prognostic factors for patients with limited-stage diffuse large-cell lymphoma treated with initial chemotherapy with or without adjuvant radiotherapy.

1989 ◽  
Vol 7 (9) ◽  
pp. 1186-1191 ◽  
Author(s):  
S E Jones ◽  
T P Miller ◽  
J M Connors
Keyword(s):  
Prognostic Factors ◽  
Cell Lymphoma ◽  
Large Cell ◽  
Diffuse Large Cell Lymphoma ◽  
Relapse Free Survival ◽  
Bulky Disease ◽  
Free Survival ◽  
Large Cell Lymphoma

In order to assess long-term outcome of patients with localized (stage I or II) diffuse large-cell lymphoma treated with initial combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with or without involved-field radiotherapy following chemotherapy, we combined data from two prospective trials in Tucson (64 patients) and Vancouver (78 patients). Follow-up on 142 patients was updated and a variety of potential pretreatment prognostic factors were analyzed for impact on outcome. One hundred forty patients (99%) achieved a complete remission and there were no differences in outcome between institutions. Twenty-three patients have relapsed and 22 have died from lymphoma at a median follow-up of 4.4 years, resulting in an overall relapse-free survival of 82% at 5 years. There was no treatment-related mortality and were no instances of late cardiac toxicity or leukemia. Of the following potential pretreatment prognostic factors (age, stage, "B" symptoms, extranodal disease, gastrointestinal tract involvement, bulky disease, or disease above or below the diaphragm), only stage affected relapse-free survival (RFS) (P = .16) and survival (.003). Among 34% of patients over age 65, outcome was similar to younger patients. RFS for 108 patients treated with CHOP plus radiotherapy was not significantly superior to the use of CHOP alone in 34 patients (P = .2).

Diffuse Large-Cell Lymphoma in the Elderly: Does a Clinically Indolent Subset Exist?

1991 ◽  
Vol 4 (3) ◽  
pp. 205-209 ◽  
Author(s):  
M. Lishner ◽  
D. Amato ◽  
B. J. Fernandes ◽  
R. Burkes
Keyword(s):  
Cell Lymphoma ◽  
Large Cell ◽  
The Elderly ◽  
Diffuse Large Cell Lymphoma ◽  
Large Cell Lymphoma

Prognostic variables in patients with diffuse large-cell lymphoma treated with MACOP-B.

1991 ◽  
Vol 9 (2) ◽  
pp. 220-226 ◽  
Author(s):  
P J Hoskins ◽  
V Ng ◽  
J J Spinelli ◽  
P Klimo ◽  
J M Connors
Keyword(s):  
Multivariate Analyses ◽  
Cell Lymphoma ◽  
Large Cell ◽  
Complete Response ◽  
Tumor Burden ◽  
Diffuse Large Cell Lymphoma ◽  
Prognostic Variables ◽  
Predictive Variables ◽  
Large Cell Lymphoma ◽  
Approximate Percentage

One hundred twenty-six patients with diffuse large-cell lymphoma were treated with methotrexate with leucovorin, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin (MACOP-B) between April 1981 and June 1986. Univariate and multivariate analyses were performed using overall survival as of September 1989 as the end point. Four independent negative predictors of survival were identified: presence of B symptoms; more than two involved lymph node sites; more than one extranodal site (variables related to tumor burden), and age older than 60, a variable related to the patient's ability to tolerate treatment. Each variable contributed the same relative risk of dying and, accordingly, this simple predictive formula was developed empirically: (4-N) x 30 = the approximate percentage of chance of survival at 5 years. "N" is the number of predictive variables present. The same four predictors were also found to be significant by multivariate analysis when only those patients achieving a complete response were analyzed.

A 10-year update of CHOP-Bleo in the treatment of diffuse large-cell lymphoma.

1986 ◽  
Vol 4 (10) ◽  
pp. 1455-1461 ◽  
Author(s):  
R Lee ◽  
F Cabanillas ◽  
G P Bodey ◽  
E J Freireich
Keyword(s):  
Cell Lymphoma ◽  
Large Cell ◽  
High Dose ◽  
Diffuse Large Cell Lymphoma ◽  
Actuarial Survival ◽  
Conventional Dose ◽  
Long Term Follow Up ◽  
Large Cell Lymphoma

Long-term follow-up results of two studies using cyclophosphamide, doxorubicin, vincristine, and prednisone plus bleomycin (CHOP-Bleo) for the treatment of diffuse large-cell lymphoma are presented. Twenty-eight patients were treated with conventional-dose CHOP-Bleo and 36 patients with maximally tolerated doses of CHOP-Bleo. The maximal duration of follow-up was 10.5 years. The minimum follow-up was 5.7 years. Seventy-five percent of the conventional-dose group achieved a complete remission (CR) with a 10-year actuarial survival of 53% and a corresponding relapse-free survival (RFS) of 69% for CRs. Eighty-one percent of the high-dose group achieved CR, and the 10-year actuarial survival for all patients and RFS for CRs were 48% and 63%, respectively. The combined actuarial survival and RFS for both groups were 51% and 66%, respectively, at 10 years. For 11 patients with stage III disease, 91% achieved CR, 52% survived at 10 years, and the RFS was 67% for CRs. Seventy-five percent of 44 patients with stage IV disease achieved CR, 50% survived at 10 years, and the RFS was 67% for CRs. Three of the 16 relapses occurred late, between 30 to 65 months after initiation of therapy. Neuropathy occurred in 14 patients (22%). Five patients (8%) died of complications related to treatment. Five (8%) had clinically apparent, but nonfatal cardiopulmonary complications. The CHOP-Bleo regimen is an effective treatment for diffuse large-cell lymphoma, and is moderately well tolerated. The use of high-dose CHOP-Bleo for induction therapy did not result in any advantage after long-term follow-up.

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