TY - JOUR
T1 - Treatment of lymphoblastic lymphoma in adults
AU - Coleman, C. N.
AU - Picozzi, V. J.
AU - Cox, R. S.
AU - McWhirter, K.
AU - Weiss, L. M.
AU - Cohen, J. R.
AU - Yu, K. P.
AU - Rosenberg, S. A.
PY - 1986
Y1 - 1986
N2 - Forty-four adult patients with lymphoblastic lymphoma (BL) were treated according to one of two protocols. Both included induction with cyclophosphamide, doxorubicin, vincristine, prednisone, and L-asparaginase; CNS prophylaxis; and maintenance therapy with methotrexate (MTX) and 6-mercaptopurine. In the second protocol, CNS prophylaxis began earlier than in the first protocol and included cranial irradiation and intrathecal (IT) MTX rather than simultaneous high-dose systemic and IT MTX. The overall response rate was 100% (95% complete). With a 26-month median follow-up, the 1- and 3-year actuarial freedom from relapse (FFR) for the composite patient group was 70% and 56%, respectively. The incidence of CNS relapse was reduced from 31% in the first protocol to 3% in the second protocol (P = .04, Gehan). Patients can be assigned retrospectively to low (n = 19) and high (n = 25) risk prognostic groups, as indicated by a multivariate analysis of pretreatment prognostic factors. High-risk is defined by Ann Arbor stage IV disease with bone marrow or CNS involvement or initial serum lactate dehydrogenase (LDH) concentration of >300 IU/L (normal, <200). FFR of low- and high-risk groups at 5 years are 94% and 19%, respectively (P = .0006). Low-risk patients are highly curable using this approach to adult LBL. More intensive treatment for high-risk patients is warranted.
AB - Forty-four adult patients with lymphoblastic lymphoma (BL) were treated according to one of two protocols. Both included induction with cyclophosphamide, doxorubicin, vincristine, prednisone, and L-asparaginase; CNS prophylaxis; and maintenance therapy with methotrexate (MTX) and 6-mercaptopurine. In the second protocol, CNS prophylaxis began earlier than in the first protocol and included cranial irradiation and intrathecal (IT) MTX rather than simultaneous high-dose systemic and IT MTX. The overall response rate was 100% (95% complete). With a 26-month median follow-up, the 1- and 3-year actuarial freedom from relapse (FFR) for the composite patient group was 70% and 56%, respectively. The incidence of CNS relapse was reduced from 31% in the first protocol to 3% in the second protocol (P = .04, Gehan). Patients can be assigned retrospectively to low (n = 19) and high (n = 25) risk prognostic groups, as indicated by a multivariate analysis of pretreatment prognostic factors. High-risk is defined by Ann Arbor stage IV disease with bone marrow or CNS involvement or initial serum lactate dehydrogenase (LDH) concentration of >300 IU/L (normal, <200). FFR of low- and high-risk groups at 5 years are 94% and 19%, respectively (P = .0006). Low-risk patients are highly curable using this approach to adult LBL. More intensive treatment for high-risk patients is warranted.
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U2 - 10.1200/JCO.1986.4.11.1628
DO - 10.1200/JCO.1986.4.11.1628
M3 - Article
C2 - 3772416
AN - SCOPUS:0022977175
VL - 4
SP - 1628
EP - 1637
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
SN - 0732-183X
IS - 11
ER -