Combined modality therapy for adults with small noncleaved cell lymphoma (Burkitt's and non-Burkitt's types)

J. I. Bernstein, C. N. Coleman, J. G. Strickler, R. F. Dorfman, S. A. Rosenberg

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Abstract

Between June 1979 and June 1984 18 adult patients with small uncleaved cell lymphoma (SCNL) (diffuse undifferentiated lymphoma, Burkitt's and non-Burkitt's types of the Rappaport classification) were treated with high-dose cyclophosphamide, doxorubicin, vincristine, prednisone, mid-cycle high-dose methotrexate, and intrathecal methotrexate. Early in the course of treatment, hyperfractionated radiotherapy (125 cGy, every two days, for 1,500 to 2,250 centigray [cGy]) was administered to unresected masses >10 cm in their greatest dimension. Chemotherapy was administered every 21 days for six to ten cycles. Treatment was generally well tolerated; however, one patient died of probable tumor lysis syndrome. With a median follow-up of 1.2 years, actuarial survival was 66.8% and relapse-free survival (RFS) was 71.3% for the entire group. All treatment failures and deaths occurred in patients with stage D disease. RFS projected at 2 years was 100% for stages A and AR and 60.6% for stage B, C, and D (P= .13 Gehan). Two-year RFS for patients with stage A, AR, B, or C disease was 100 v 41% for those with stage D disease. Patients with adverse prognostic features (n=7) - unresected bulk measuring > 10 cm, pretreatment serum lactate dehydrogenase (LDH) 500 IU/L (normal, 200) or involvement of CNS or bone marrow - had a projected RFS of 28.6% compared with 100% for those patients without these features (P= .002 Gehan). Too few patients received induction radiotherapy to assert its role in therapy. By using aggressive multiagent therapy, cure can be expected in a high percentage of adults with SNCL. In the subset with adverse prognostic features, more effective therapy is necessary.

Original languageEnglish (US)
Pages (from-to)847-858
Number of pages12
JournalJournal of Clinical Oncology
Volume4
Issue number6
DOIs
StatePublished - Jan 1 1986

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ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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