Treatment of diffuse poorly differentiated lymphocytic lymphoma an analysis of prognostic variables

Abstract

Forty patients with diffuse poorly differentiated lymphocytic lymphoma (DPDL) Stages II‐IV were treated with three different and successive combination chemotherapy protocols. Seventeen patients were treated with the cyclophosphamide (CTX) L2 protocol which included maintenance chemotherapy for 3 years. Only three patients were treated with the NHL‐3 (non‐Hodgkin's lymphoma) protocol, and 20 patients received the NHL‐5 program. All protocols included radiotherapy (1500–4800 rad) to areas of initial bulky disease or persistent tumor, as well as central nervous system (CNS) prophylaxis with intrathecal methotrexate in patients with bone marrow involvement. Seventy‐eight percent of local recurrences occurred in previously irradiated areas. Two‐year survival rates were 55% and 70% for the CTX‐L2 and NHL‐5 protocols, respectively. Median disease‐free survival for 24 complete response (CR) patients was 16.5 months. of the 40 patients, 37 were evaluable for response to therapy. The CTX‐L2 produced an 80% total response (TR) rate, a 60% CR, and a 20% partial response (PR). The patients on the NHL‐5 achieved a TR rate of 95%, 74% CR, and 21% PR. Differences in TR and CR between the two protocols were not significant. Only 1 of 3 patients on the NHL‐3 protocol achieved a CR. There was a trend for age >50 years to lessen the chances of CR (P = 0.091); however, sex, symptoms, stage of disease, and LDH level were not significantly related to CR rate. Response to treatment (CR versus PR versus failure) was the most important factor influencing survival (P <0.001); age (>50 years) was also significant (P = 0.008). Lactate dehydrogenase (LDH) was of borderline significance (P = 0.06). Cox regression model showed age (>50 versus <50 years, P = 0.001), LDH (>500 versus≦500 U/L, P = 0.019) and symptoms (A or B) to be the best predictors of survival.

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

“…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). The patients treated at different centres often differed widely as a result of selection 20 pressures occurring in the referral process.…”

“…Shipp, who also noted fitness as an important determinant of response and survival, drew attention to the well recognised importance of fitness in prognosis of solid tumours, and the lack of data concerning fitness as a prognostic factor in NHL (Shipp et al, 1986). Other multivariate analyses have detected age as an important prognostic feature (Danieu et al, 1986;Al-Katib et al, 1984;Homing et al, 1984;Lenhard et al, 1978;Kaminski et al, 1986). Armitage has recently noted that many trials select patients on the basis of age and fitness, though often descriptions of fitness do not appear in treatment reports (Armitage & Cheson, 1988).…”

Non‐hodgkin's lymphoma of unfavourable histology: A multivariate analysis of factors predicting the response to chop

“…Several authors have recently analysed the pretreatment factors that allow prediction of the response to current chemotherapy in previously untreated patients (Al-Katib et al, 1984, Jaganath et al, 1986Koziner et al, 1982;Shipp et al, 1986). There is a general agreement on the poor prognosis associated with older age, poor performance status, constitutional symptoms, extensive extranodal involvement, large tumoural masses and high LDH levels, the differences being explained by diversity in patients' characteristics, case inclusion criteria or treatment modalities.…”

Primary gastrointestinal lymphoma: 30‐year experience at the cancer institute, madras, india

“…The favorable impact of complete remission on survival in primary GI-NHL has also been reported by other studies [ 1 1-13 [83], systemic B symptoms [33,101], hemoglobin levels [33], and erythrocyte sedimentation rate [37], these factors were not significant for overall survival in our series. The worse prognosis of intestinal …”