Treatment of localized aggressive lymphomas with combination chemotherapy followed by involved-field radiation therapy.

Abstract

Localized lymphomas of diffuse and aggressive histology sometimes undergo early hematogenous dissemination such that local therapies (surgery alone or followed by radiation therapy) are not curative in 100% of cases. We have treated 47 clinical stage I or IE patients with aggressive lymphoma histologies (diffuse large-cell, diffuse mixed, diffuse immunoblastic, follicular large-cell, diffuse small-non-cleaved cell) with four monthly cycles of an eight-drug combination chemotherapy program consisting of cyclophosphamide, etoposide, doxorubicin, nitrogen mustard (mechlorethamine), procarbazine, high-dose methotrexate with leucovorin rescue, and prednisone (Pro-MACE-MOPP) administered systemically followed by 40 Gy involved-field radiation therapy. Forty-five (96%) patients achieved a complete remission and no patient has relapsed with a median follow-up time of 42 months (range, 8 to 90). Both patients failing to achieve a complete remission died of lymphoma, and one patient died free of lymphoma 45 months after diagnosis during coronary artery bypass surgery unrelated to lymphoma or its treatment. Hospital admissions were necessary to manage complications on nine of 188 (5%) cycles of treatment. There were no treatment-related deaths. ProMACE-MOPP plus involved-field radiation therapy is safe and effective treatment for localized aggressive lymphoma.

High-Grade Non-Hodgkin's Lymphoma Stage I: A retrospective study of treatment, outcome and prognostic factors in 213 patients

“…In the present study the s-LDH level was the only important pretreatment prognostic factor besides age. Elevated values of s-LDH were uncommon in some other materials and therefore not helpful as a prognostic marker (9,18). In our material s-LDH above normal significantly predicted a worse prognosis, especially for those treated with radiotherapy alone.…”

Localized radiation increases morbidity and mortality after TBI-containing autologous stem cell transplantation in patients with lymphoma

“…Risk of radiation prior to autoSCT C Emmanouilides et al approaches in an effort to cytoreduce an inadequate response to chemotherapy or consolidate a lesion thought to be of high risk for relapse. 9 Consolidation radiation therapy is commonly used following chemotherapy in patients with early-stage or bulky HL, or patients with early-stage aggressive NHL. 10,11 Upon relapse, radiation therapy is usually employed in an effort to achieve maximal cytoreduction in a patient, hoping to render autologous transplant more successful.…”

Should involved-field radiation therapy be used as an adjunct to lymphoma autotransplantation?

“…In localized, early stage NHL, IFRT used in conjunction with chemotherapy has been shown to improve both event-free survival (EFS) and overall survival (OS). Longo and colleagues 10 treated 47 stage I/IE aggressive NHL patients using four cycles of ProMACE-MOPP (cyclophosphamide, etoposide, doxorubicin, nitrogen mustard, procarbazine, vincristine and high- Table 1 Randomized studies addressing the impact of IFRT on event-free and overall survival in conventional therapy for NHL Bleo/DA C ϩ P Ͻ 0.01 P Ͻ 0.01 IFRT NHL ϭ non-Hodgkin's lymphoma; HD ϭ Hodgkin's disease; IFRT ϭ involved-field radiation therapy; EFS ϭ event-free survival; OS ϭ overall survival; CHOP ϭ cyclophosphamide, adriamycin, vincristine, prednisone; CEOP-Bleo/DAC ϭ cyclophosphamide, epirubicin, vincristine, prednisone, bleomycin alternating with dexamethasone, cytosine arabinoside and cisplatin. dose methotrexate) followed by 4000 cGy IFRT.…”