Improved prognosis of diffuse histiocytic and undifferentiated lymphoma by use of high dose methotrexate alternating with standard agents (M-BACOD).

Abstract

A new combination chemotherapy program (M-BACOD) was administered to 101 patients with advanced diffuse histiocytic and diffuse undifferentiated lymphoma (DHL and DUL). High dose methotrexate (M) 3 g/m2 with leucovorin factor rescue was given on day 14 between cycles of bleomycin (B), adriamycin (A), cyclophosphamide (C), oncovin (O), and dexamethasone (D) administered every 3 weeks for 10 cycles. The complete remission rate (CR) was 72% in all 101 patients or 77% in 95 evaluable patients. The median follow-up is 3 yr 2 mo with one-third of CR patients followed beyond 4 yr. Twenty-six percent of CR patients have relapsed with a projected 5-yr survival rate of 80% (5-yr disease-free rate 65%). The overall survival of all 101 study patients reaches a plateau at 59% projected out to 5 yr. Patients with prior therapy had a significantly lower CR rate than those without prior treatment (p = 0.001); however, no other unfavorable prognostic characteristics could be identified. Relapse in the central nervous system CNS occurred in only 5.4% of CR patients. M-BACOD results in prolonged survival and possible cure in a high proportion of all patients with DHL and DUL.

β-2 microglobulin: a prognostic factor in diffuse aggressive non-Hodgkin's lymphomas

“…The use of anthracycline-based four-drug chemotherapy regimens such as CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) has resulted in long-term diseasefree survival for a substantial minority of patients (McKelvey et al, 1975;Coltman et al, 1986), whilst more complex and toxic regimens using larger numbers of drugs have been apparently more effective when judged against historical controls (Schein et al, 1976;Laurence et al, 1982;Fisher et al, 1983;Skarin et al, 1983;Klimo & Connors, 1985). The results with such regimens used at different institutions have however rarely matched those of their originators (Schneider et al, 1990;Weick et al, 1991) and phase III trials of direct comparison have failed to demonstrate a clear advantage for the more complex treatments (O'Connell et al, 1984;Gordon et al, 1989).…”

“…In almost two decades since the initial reports of long-term disease free survival after chemotherapy for the diffuse aggressive lymphomas (Levitt et al, 1972;De Vita et al, 1975) a variety of newer, more complex and more toxic regimens have been described which are said to improve remission rates and survival (Schein et al, 1976;Laurence et al, 1982;Fisher et al, 1983;Skarin et al, 1983;Klimo & Connors, 1985). The evaluation of such claims is however made difficult by the heterogeneity of the patient populations studied and lack of a well recognised set of prognostic factors.…”

A critical analysis of prognostic factors for survival in intermediate and high grade non-Hodgkin's lymphoma

“…Optimistic reviews of NHL therapy have summarised the apparent progress due to the application of increasingly complex chemotherapy DeVita et al, 1988). ProMACE-MOPP, ProMACE-CytaBOM, M-BACOD, m-BACOD, COP-BLAM and its refinements, and MACOP-B are all contemporary variations on this theme 80 ll lll (Fisher et al, 1983;Fisher et al, 1987;Skarin et al, 1983;Canellos et al, 1987;Laurence et al, 1982;Boyd et al, 1988;Klimo & Connors, 1987). However response and survival 60 15 XL were significantly related to several patient and disease characteristics (Fisher et al, 1977;Cabanillas et al, 1978;Lenhard et al, 1978;Stein et al, 1979;Fisher et al, 1981;Armitage et al, 1982;Trump & Mann, 1982;Leonard et al, 40 1983;Sullivan et al, 1983;Al-Katib et al, 1984;Steward et al, 1984;Horning et al, 1984).…”

Non-Hodgkin's Lymphoma A four-drug regimen suitable for elderly patients with advanced disease

“…Elderly patients, and those with poor performance status, do not tolerate the doxorubicin-containing combinations well, and the presence of significant ischaemic heart disease is a contraindiction to their use. Similar arguments apply to the more intensive regimens such as COMLA ( 5 ) , OPAL (6), ProMACE/MOPP (7), M-BACOD (8) and MACOP-B (9) which have claimed higher response and survival at a cost of increased toxicity.…”