PMBL has unique clinical and biologic characteristics that are radically different from those of other types of diffuse large B-cell lymphoma. Although relatively rare, its aggressive growth and its occurrence in young patients increase the clinical relevance of this entity. The consistent recognition and study of PMBL will allow the development of new approaches to its management.
Background: this work aims at determining the efficacy of modified CHOP combination in which Vinorelbine (Navelbine) replaces Vincristine for the treatment of aggressive Non-Hodgkin's Lymphomas (NHL).
Patients and methods: This open label pilot study included 19 patients with aggressive NHL and one patient with low grade NHL who were treated with the new combination which we abbreviated as P-CAN (Prednisolone 100 mg/day PO day 1-5, Cyclophosphamide 750 mg/m2 i.v day 1, Adriamycin (Doxorubicin) 60 mg/m2 i.v day 1, Navelbine (Vinorelbine) 30 mg/m2 i.v day). The patients1 were 13 males and 6 females, mean age 50 years (34-65), performance state 0-2, International Prognostic Index (IPI) 0-3. Seven patients Stage I, one patient Stage II, eight patients Stage III and 3 patients in Stage IV. 14 patients with nodal disease and five patients with extra-nodal disease. They received total of 97 cycles of the chemotherapy (3-7 cycles).
Results: 18 out of 19 patients achieved complete response (CR). In one patient the response could not be assessed, one patient progressed while on treatment. Toxicity was mainly hematological. The 3 years overall survival (OS) and disease free survival (DFS) was 83%.
Conclusion: P-CAN is an effective, well tolerated combination in chemo-naive aggressive NHL. The addition of Vinorelbine to steroid, Adriamycin, and Cyclophosphamide seems improve the response. Further larger trials are needed to study this combination and its impact on longer overall survival.
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