Effective treatment of small-noncleaved-cell lymphoma with high-intensity, brief-duration chemotherapy.

Abstract

Small-noncleaved-cell (SNC) lymphoma is a high-grade, biologically aggressive neoplasm notable for poor response to therapy, high relapse rate, and less than a 20% long-term survival. We treated 20 patients with SNC lymphoma with a novel chemotherapeutic regimen using intensive doses of chemotherapy at frequent intervals in the inpatient setting. All patients were previously untreated. Sixteen patients (80%) had stage IV disease. Most patients (95%) had at least one other characteristic associated with poor prognosis (bulky [greater than 10 cm] disease, multiple extranodal sites, poor performance status), and 85% had two or more characteristics associated with poor prognosis. Seventeen patients (85%) achieved a complete response (CR) to therapy, including all three patients with human immunodeficiency virus (HIV)-associated disease. There have been three relapses, all occurring less than 18 months after treatment, and two of three relapses occurred in patients who were unable to complete therapy. At a median follow-up of 29 months, 13 patients (65%) remain disease-free; the calculated 5-year actuarial disease-free survival is 60%. Toxicity, chiefly myelosuppression, was severe but manageable. There were two treatment-related deaths, both in elderly patients with poor performance status and advanced-stage disease. These data suggest that such a dose-intensive approach improves the response and survival of patients with SNC lymphoma.

Intensive chemotherapy with cyclophosphamide, doxorubicin, high‐dose methotrexate/ifosfamide, etoposide, and high‐dose cytarabine (CODOX‐M/IVAC) for human immunodeficiency virus–associated Burkitt lymphoma

“…37 The relatively good immune function possessed by patients with HIV-associated BL (independent of HAART) further suggests that this subset of patients may benefit from aggressive chemotherapy regimens that have acceptable toxicities. 6,27,28,31 Cortes et al 38 recently reported a retrospective study of 13 HIV-positive adult patients with BL who received intensive chemotherapy with hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper CVAD) alternating with high dose methatrexate and Ara-C from 1995 to 2000. Although they demonstrated an overall response rate of 92%, the median survival period was only 12 months.…”

“…Of the 24 HIVnegative patients with BL, 13 received CODOX-M/ IVAC. 9 Ten HIV-negative patients received other firstline chemotherapy including CHOP 23 (six patients), L-20 24 (two patients), the Vanderbilt regimen 27 (one patient), doxorubicin and cyclophosphamide (one patient), and a pediatric Burkitt regimen (one patient).…”

Primary Burkitt Lymphoma of the Chest Wall

“…In the absence of CNS involvement, CNS chemoprophylaxis is very important. Without prophylaxis, 30-50% of patients will relapse compared to 6-11% who received prophylaxis [19]. With aggressive chemotherapy, complete remission rates are 75-90% and overall longterm survival rate reaches 50-70% in adults [4].…”

Short intensive sequential therapy followed by autologous stem cell transplantation in adult Burkitt, Burkitt-like and lymphoblastic lymphoma

“…[32][33][34][35][36] However, this treatment approach is not sufficient in patients with high-risk disease, that is, more extensive and extranodal disease, especially in the presence of extensive bone marrow and/or CNS involvement. 9 Remarkable improvements in the outcome of patients with high-risk disease, even in those with overt leukemic BL or CNS involvement, have been attributed to the addition of high-dose intravenous MTX and Ara-C to the treatment in children 3,4,6 as well as in adults.…”