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Combined chemotherapy with carmustine, doxorubicin, etoposide, vincristine, and cyclophosphamide plus mitoxantrone, cytarabine and methotrexate with citrovorum factor for the treatment of aggressive non‐Hodgkin lymphoma
Author(s) -
Rigacci Luigi,
Carrai Valentina,
Nassi Luca,
Alterini Renato,
Longo Giovanni,
Bernardi Franco,
Bosi Alberto
Publication year - 2005
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.20891
Subject(s) - medicine , mitoxantrone , vincristine , regimen , etoposide , cytarabine , carmustine , cyclophosphamide , surgery , gastroenterology , chemotherapy , lomustine , oncology
BACKGROUND The standard treatment for patients with aggressive non‐Hodgkin lymphoma (NHL) is cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Since 1989, the authors have used a new chemotherapy regimen with combined carmustine, doxorubicin, etoposide, vincristine, and cyclophosphamide plus mitoxantrone, cytarabine and methotrexate with citrovorum factor called BAVEC‐MiMA. The objective of the current study was to explore, after a long follow‐up period, the impact of this third‐generation regimen for the treatment of aggressive NHL. METHODS One hundred and one consecutive patients (median age, 41 years) with either B‐cell ( n = 94 patients) or non‐B‐cell ( n = 7 patients), aggressive lymphoma were diagnosed and treated between 1989 and 1999 with the BAVEC‐MiMA regimen. RESULTS The complete response rate was 74%, and the overall response rate was 89%. Eleven patients with refractory disease died rapidly after a median period of 5 months. The major toxicity was Grade 4 neutropenia (according to World Health Organization criteria), which was observed in 15 patients (15%). There were four toxicity‐related deaths. The overall survival rate was 63% at 9 years. In multivariate analysis, factors that were associated with advantage in overall survival were response to induction therapy, bulky disease, and high score on the International Prognostic Index (IPI). The disease‐free survival rate was 77% at 9 years. In multivariate analysis, the IPI was the most important variable for the definition of disease‐free survival. CONCLUSIONS The BAVEC‐MiMA regimen was feasible on an outpatient basis, it was tolerated well, and it showed a low toxicity‐related mortality. The long follow‐up in patients with NHL, which is a rapidly fatal disease, led the authors to observe that, with this regimen, a cure was obtained in > 50% of patients who had low‐risk or low‐to‐intermediate‐risk, aggressive NHL. Cancer 2005. © 2005 American Cancer Society.