Combination chemotherapy for intermediate and high grade non-Hodgkin's lymphoma

Dhaliwal, H. S.; Rohatiner, A. Z. S.; Gregory, Walter M.; Richards, MA; Johnson, Paul W.; Whelan, Jeremy; Gallagher, Chris; Matthews, Janet; Ganesan, T. S.; Barnett, Michael J.

doi:10.1038/bjc.1993.425

Cited by 40 publications

(24 citation statements)

References 32 publications

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“…Cut-offs used by others were considered where possible. For instance, Dhaliwal et al (Dhaliwal et al, 1993) analysed albumin in 3 subgroups, namely ≥ 32, 33-39 and ≤ 40. We combined adjacent equivalent groups, thus finding, in this case for albumin, that very low albumin values (≤ 32) predicted for poor response while higher values (≥ 40) predicted for better failure-free survival.…”

Section: Methodsmentioning

confidence: 99%

ChlVPP alternating with PABlOE is superior to PABlOE alone in the initial treatment of advanced Hodgkin's disease: results of a British National Lymphoma Investigation/Central Lymphoma Group randomized controlled trial

et al. 2001

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SummaryThe purpose of this randomized trial was to compare the efficacy of 6 cycles of prednisolone, Adriamycin (doxorubicin), bleomycin, vincristine (Oncovin) and etoposide (PABlOE) with 3 cycles of PABIOE that alternate with 3 cycles of chlorambucil, vinblastine, procarbazine and prednisone (ChlVPP) in patients with advanced Hodgkin's disease. Between October 1992 and April 1996, 679 patients were entered onto the study. 41 of these did not match the protocol requirements on review and were excluded from further analysis, most of these being reclassified as NHL on histological review. Of the remaining 638 patients, 319 were allocated to receive PABIOE and 319 were allocated to receive ChlVPP/PABlOE. The complete remission (CR) rates were 78% and 64%, for ChlVPP/PABlOE and PABIOE respectively after initial chemotherapy (P < 0.0001). 124 patients were re-evaluated subsequently following radiotherapy to residual masses. The CR rates changed from 78% to 88% for ChlVPP/PABlOE and from 64% to 77% for PABlOE when re-evaluated in this manner (treatment difference still significant, P = 0.0002). The treatment associated mortality in the PABlOE arm was 2.2% (7 deaths), while there were no such deaths in the ChlVPP/PABlOE arm (P = 0.015). The failure-free survival was significantly greater in the ChlVPP/PABlOE arm (P < 0.0001) as was the overall survival (P = 0.01). The failure-free and overall survival rates at 3 years were 77% and 91% in the ChlVPP/PABlOE arm, compared with 58% and 85% in the PABIOE arm, respectively. These results indicate that ChlVPP alternating with PABIOE is superior to PABIOE alone as initial treatment for advanced Hodgkin's disease.

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Section: Methodsmentioning

confidence: 99%

ChlVPP alternating with PABlOE is superior to PABlOE alone in the initial treatment of advanced Hodgkin's disease: results of a British National Lymphoma Investigation/Central Lymphoma Group randomized controlled trial

et al. 2001

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“…was identified as a negative prognostic factor in both univariate and multivariate analyses in two of three studies of nonsmall cell lung cancer [16,18,19], two studies of renal cell carcinoma [20,21], and in separate studies of gastric cancer [22,23] and non-Hodgkin's lymphoma [24]. Three large studies explored the prognostic role of hyponatremia at hospital admission ( Table 2).…”

Section: Rationale For Diagnosis and Management Of Hyponatremia In Camentioning

confidence: 99%

Diagnosis and Management of Hyponatremia in Cancer Patients

Castillo

Vincent

Justice³

2012

The Oncologist

205

201

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Hyponatremia, a common electrolyte abnormality in oncology practice, may be a negative prognostic factor in cancer patients based on a systematic analysis of published studies. The largest body of evidence comes from small-cell lung cancer (SCLC), for which hyponatremia was identified as an independent risk factor for poor outcome in six of 13 studies. Hyponatremia in the cancer patient is usually caused by the syndrome of inappropriate antidiuretic hormone (SIADH), which develops more frequently with SCLC than with other malignancies. SIADH may be driven by ectopic production of arginine vasopressin (AVP) by tumors or by effects of anticancer and palliative medications on AVP production or action. Other factors may cause hypovolemic hyponatremia, including diarrhea and vomiting caused by cancer therapy. Hyponatremia may be detected on routine laboratory testing before or during cancer treatment or may be suggested by the presence of mostly neurological symptoms. Treatment depends on several factors, including symptom severity, onset timing, and extracellular volume status. Appropriate diagnosis is important because treatment differs by etiology, and choosing the wrong approach can worsen the electrolyte abnormality. When hyponatremia is caused by SIADH, hypertonic saline is indicated for acute, symptomatic cases, whereas fluid restriction is recommended to achieve a slower rate of correction for chronic asymptomatic hyponatremia. Pharmacological therapy may be necessary when fluid restriction is insufficient. The orally active, selective AVP receptor 2 (V 2 )-receptor antagonist tolvaptan provides a mechanism-based option for correcting hyponatremia caused by SIADH or other conditions with inappropriate AVP elevations. By blocking AVP effects in the renal collecting duct, tolvaptan promotes aquaresis, leading to a controlled increase in serum sodium levels. The Oncologist 2012;17:756 -765

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“…Low serum albumin and low hemoglobin values are associated with a higher death rate during treatment [35,42]. In our study, they showed significance in CR rate, RFS and OS only in univariate analysis.…”

Section: Discussionmentioning

confidence: 49%

Diffuse Large Cell Lymphomas: Identification of Prognostic Factors and Validation of the International Non-Hodgkin’s Lymphoma Prognostic Index

Nicolaides

Fountzilas

Zoumbos³

et al. 1998

Oncology

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Several clinical prognostic factors have been identified that predict treatment outcome in patients with diffuse large cell lymphomas. An International Non-Hodgkin’s Lymphoma Prognostic Index (IPI) has been recently formulated. We tried to identify the clinical prognostic factors that predict treatment outcome in Greek patients with diffuse large cell lymphomas and validated the IPI in these patients. The possible prognostic variables for tumor response, relapse-free (RFS) and overall survival (OS) were analyzed in 239 consecutive patients treated with anthracycline-based chemotherapy regimens. In univariate analysis, factors associated with poor response were stages III–IV, performance status (PS) ≥2, spleen and bone marrow involvement, more than one extranodal site involved, increased lactate dehydrogenase (LDH) value, hemoglobin (Hb) <12 g/dl, albumin <3.5 g/dl, erythrocyte sedimentation rate (ESR) >50 mm/h. Multivariate analysis identified stage, PS, more than one extranodal site involved, increased LDH level, and ESR > 50 mm/h as the factors more predictive of poor response. For RFS, multiple Cox analysis found stages III–IV and bone marrow involvement to be statistically significant. For OS, multiple Cox analysis identified stage III–IV, PS ≥2, bone marrow involvement, more than one extranodal site involved, increased LDH level and ESR > 50 mm/h as negative prognostic factors. Patients stratified in the different risk groups of the IPI had a significantly different outcome regarding complete response (CR) rate, RFS and OS. In conclusion, although age >60 years was not recognized as an adverse factor in this analysis, our patients stratified in the different groups of the IPI had significant differences in CR rate, 2-year RFS and OS verifying the prognostic significance of the index. Bone marrow involvement and ESR > 50 mm/h, parameters that are not included in the IPI, adversely affected survival.

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Combination chemotherapy for intermediate and high grade non-Hodgkin's lymphoma

Cited by 40 publications

References 32 publications

ChlVPP alternating with PABlOE is superior to PABlOE alone in the initial treatment of advanced Hodgkin's disease: results of a British National Lymphoma Investigation/Central Lymphoma Group randomized controlled trial

ChlVPP alternating with PABlOE is superior to PABlOE alone in the initial treatment of advanced Hodgkin's disease: results of a British National Lymphoma Investigation/Central Lymphoma Group randomized controlled trial

Diagnosis and Management of Hyponatremia in Cancer Patients

Diffuse Large Cell Lymphomas: Identification of Prognostic Factors and Validation of the International Non-Hodgkin’s Lymphoma Prognostic Index

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