Results of treatment with high intensity, brief duration chemotherapy in poor prognosis non-Hodgkin's lymphoma

Intermediate and high-grade non-Hodgkin's lymphomas still pose a serious problem for the clinician. Prior to 1965, these tumors were virtually incurable. Although improvements in treatment have been made in the following years, only one-half of the patients treated experienced long-term survival. Furthermore, the effective treatments at present are so toxic that more intensive treatments are not possible without bone marrow transplantation. A study was conducted to determine if delivering high intensity chemotherapy for only a brief period would be any better. For this type of preliminary evaluation, the only patients selected for the experimental treatment were those estimated to have less than 25 percent chance of responding to conventional treatment. A total of 56 such patients were treated with a high-intensity chemotherapeutic protocol including cyclophosphamide, etoposide, doxorubicin, vincristine, and bleomycin, as well as methotrexate, leucovorin, and prednisone. The toxicity of the treatment was high, resulting in five patient deaths. However, the complete response rate was 77 percent, and these responses were long-lived for many patients. After a median follow-up of three years, 52 percent of the patients were alive without relapse of disease. The results indicate that the intensive treatment improves the survival of patients with poor-prognosis non-Hodgkin's lymphomas. The high rate of toxicity of the treatment protocol, which killed 9 percent of the patients, is alarming. However, many of the patients included in the study were severely ill to begin with, which may account for at least a part of this high mortality. (Consumer Summary produced by Reliance Medical Information, Inc.)