Premium
A prospective study of P‐IMVP‐16/CBDCA: a novel salvage chemotherapy for patients with aggressive non‐Hodgkin's lymphoma who had previously received CHOP therapy as first‐line chemotherapy
Author(s) -
Sawada Michio,
Tsurumi Hisashi,
Yamada Toshiki,
Hara Takeshi,
Fukuno Kenji,
Goto Hideko,
Shimizu Masahito,
Kasahara Senji,
Yoshikawa Takeshi,
Kanemura Nobuhiro,
Oyama Masami,
Takami Tsuyoshi,
Moriwaki Hisataka
Publication year - 2002
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1034/j.1600-0609.2002.01654.x
Subject(s) - medicine , etoposide , ifosfamide , carboplatin , vincristine , chemotherapy , chop , regimen , cyclophosphamide , gastroenterology , salvage therapy , aggressive lymphoma , survival rate , prednisolone , methylprednisolone , surgery , lymphoma , urology , rituximab , cisplatin
The purpose of this study was to determine the efficacy of salvage chemotherapy with, P‐IMVP‐16/CBDCA, consisting of carboplatin (CBDCA), etoposide (VP‐16), ifosfamide (IFM), and methotrexate (MTX), for patients with aggressive non‐Hodgkin's lymphoma (NHL) who had previously received CHOP [a regimen of cyclophosphamide, hydroxydaunomycin, Oncovin (vincristine), and prednisolone], as first‐line chemotherapy. The 45 consecutively enrolled patients received methylprednisolone (mPSL) 1000 mg per body for 3 d (from day 1 to day 3), IFM 1000 mg/m 2 for 5 d (from day 1 to day 5), MTX 30 mg/m 2 on day 3 and day 10, VP‐16 80 mg/m 2 for 3 d (from day 1 to day 3), and CBDCA 300 mg/m 2 on day 1, with granulocyte colony‐stimulating factor every 21 d. Patients 70 yr of age or older were given 75% of the standard dose. The response rate [complete response (CR) plus partial response (PR)] was 55.6% (25/45), including 12 (26.7%) CR and 13 (28.9%) PR. The overall survival rate for the 45 patients was 31.1% at 1 yr and 17.3% at 2 yr. The failure‐free survival rate for the 45 patients was 6.7% at 1 yr and 4.4% at 2 yr. The survival rate for the 25 responders was 48.0% at 1 yr and 24.0% at 2 yr, and the survival rate for the 20 non‐responders was 10.0% at 1 yr ( P <0.001). Multivariate analysis demonstrated that prior chemotherapy (reduced‐dose CHOP for age 70 yr or older) and the number of cases of extranodal involvement (>1) were significant unfavorable factors for overall survival. Although the major toxicity was neutropenia, no patient died of infection related to neutropenia. Non‐hematological adverse effects were predominantly mild and tolerable. Unfortunately, the clinical outcome with P‐IMVP‐16/CBDCA was unfavorable, possibly because the study comprised consecutive patients who had received identified intensive chemotherapy, such as biweekly CHOP. Salvage chemotherapy with P‐IMVP‐16/CBDCA is not sufficient to cure relapsed or refractory aggressive NHL. Aggressive NHL should be cured by first‐line chemotherapy with or without hematopoietic stem cell transplantation.