scholarly journals Salvage therapy with mitoxantrone, etoposide, bleomycin and dexamethasone for refractory or relapsed aggressive non-Hodgkin’s lymphoma patients with a poor performance status or comorbidity

2014 ◽  
Vol 8 (5) ◽  
pp. 2012-2016 ◽  
Author(s):  
XUEDE LIN ◽  
XI SHI ◽  
WUCHA ZENG ◽  
MIN ZHENG ◽  
LIMING HUANG
Keyword(s):  
Salvage Therapy ◽  
Hodgkin’S Lymphoma ◽  
Performance Status ◽  
Poor Performance ◽  
Hodgkin's Lymphoma ◽  
Poor Performance Status ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

Primary non-Hodgkin's lymphoma of the CNS treated with BVAM or CHOD/BVAM chemotherapy before radiotherapy.

1996 ◽  
Vol 14 (3) ◽  
pp. 945-954 ◽  
Author(s):  
E M Bessell ◽  
F Graus ◽  
J A Punt ◽  
J L Firth ◽  
D T Hope ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Whole Brain Radiotherapy ◽  
Hodgkin's Lymphoma ◽  
World Health ◽  
Poor Performance Status ◽  
Significant Treatment ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

PURPOSE To assess whether chemotherapy that includes drugs that cross the blood-brain barrier improves survival in primary CNS non-Hodgkin's lymphoma (PCNSL) when combined with radiotherapy. PATIENTS AND METHODS Thirty-four patients, with no evidence of human immunodeficiency virus type 1 (HIV-1) infection, were treated with the related chemotherapy regimens of carmustine (BCNU), vincristine, cytarabine, and methotrexate (BVAM; 12 patients), cyclophosphamide, doxorubicin, vincristine, and dexamethasone (CHOD)/BVAM (17 patients) and intensified CHOD/BVAM (five patients) between 1986 and 1994. The median age was 60 years (range, 16 to 73) and 47% had a performance status of 3 or 4 (Eastern Cooperative Oncology Group [ECOG]/World Health Organization [WHO]). Ten patients were treated with BVAM chemotherapy between 1986 and 1989, and subsequently 17 patients were treated with CHOD/BVAM (cytarabine 3 g/m2). Twenty of these 27 patients received whole-brain radiotherapy (craniospinal in four). RESULTS The complete response (CR) rate at the completion of chemotherapy was 63% for BVAM and 67% for CHOD/BVAM; more neutropenia occurred with CHOD/BVAM. The 5-year actuarial probability of survival of all 34 patients was 33% (95% confidence interval [CI], 14% to 52%), with so far only one recurrence after 2 years. Using multivariate analysis, age (P = .0005) and number of tumors at diagnosis (P = .0358) were prognostic factors. All five patients aged > or = 70 years died during or shortly after chemotherapy. Performance status was not an independent variable. CONCLUSION The BVAM or CHOD/BVAM regimens can be delivered despite neutropenia without significant treatment delay or dose reduction in patients less than 70 years of age. Further intensification of this type of chemotherapy is probably not possible with patients of this age, many of whom have a poor performance status.

Incidence and Predictors of Low Chemotherapy Dose-Intensity in Aggressive Non-Hodgkin's Lymphoma: A Nationwide Study

2004 ◽  
Vol 22 (21) ◽  
pp. 4302-4311 ◽  
Author(s):  
Gary H. Lyman ◽  
David C. Dale ◽  
Jonathan Friedberg ◽  
Jeffrey Crawford ◽  
Richard I. Fisher
Keyword(s):  
Risk Factors ◽  
Hodgkin’S Lymphoma ◽  
Performance Status ◽  
Significant Risk ◽  
Dose Intensity ◽  
Hodgkin's Lymphoma ◽  
Disease Stage ◽  
Poor Performance Status ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

Purpose To assess the incidence of and risk factors for reduced relative dose-intensity (RDI) in patients treated with chemotherapy for aggressive non-Hodgkin's lymphoma (NHL). Methods A nationwide survey was conducted of 567 oncology practices with data extracted from the records of 4,522 patients with aggressive NHL treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP); CHOP-rituximab (CHOP-R); or cyclophosphamide, mitoxantrone, vincristine, and prednisone (CNOP). The primary outcome was the average RDI for each regimen based on both planned and reference standards. Other assessments included the incidence of febrile neutropenia and patterns of colony-stimulating factor (CSF) use, as well as the average RDI in high-risk subgroups. Results Dose reductions ≥ 15% occurred in 40% of patients and treatment delays ≥ 7 days occurred in 24% of patients, resulting in 53% and 48% of patients receiving an RDI less than 85% of the minimum six-cycle and National Comprehensive Cancer Network guideline standards, respectively. Reduced RDI was more prevalent in older patients, with 60% of patients older than 60 years receiving RDI less than 85%. Multivariate analysis identified several independent predictors for reduced RDI, including age older than 60 years, advanced disease stage, poor performance status, and no prophylactic CSF use. Age was no longer a significant risk factor in patients who received prophylactic CSF. Conclusion Patients with aggressive and potentially curable NHL treated with CHOP, CHOP-R, or CNOP frequently receive reduced RDI. Predictive models based on the risk factors identified for reduced RDI should enable the targeted use of appropriate supportive care, facilitating the delivery of full chemotherapy doses on schedule.

scholarly journals International Prognostic Index for aggressive non-Hodgkin's lymphoma is valid for all malignancy grades

Blood ◽  
1995 ◽  
Vol 86 (4) ◽  
pp. 1460-1463 ◽  
Author(s):  
J Hermans ◽  
AD Krol ◽  
K van Groningen ◽  
PM Kluin ◽  
JC Kluin-Nelemans ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Hodgkin’S Lymphoma ◽  
Performance Status ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Population Based ◽  
Hodgkin's Lymphoma ◽  
Intermediate Grade ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

An International Prognostic Index (IPI) for patients with aggressive non-Hodgkin's lymphoma (NHL) has recently been published. The IPI is based on pretreatment clinical characteristics and developed on clinical trial patients, classified as intermediate grade according to the Working Formulation (WF). We applied this IPI in a population-based registry of NHL patients. This registry does not have the restrictions that usually hold for patients in clinical trials, eg, with respect to age and performance status. Moreover, it covers all the three WF classes (low, intermediate, and high). The IPI turned out to be of prognostic value for response rate and survival in our unselected cohort of 744 patients, as well. In each of the three WF classes separately, the four IPI classes showed going from low to high substantially decreasing response rates and survival percentages. For our cohort of WF intermediate grade patients 5-year survival levels were lower in all four IPI classes (59%, 34%, 14%, and 10%, respectively), probably reflecting the selection of clinical trial patients in the original study (73%, 51%, 43%, and 26%).

scholarly journals ESHAP as Salvage Therapy for Refractory Non-Hodgkin's Lymphoma: Taiwan Experience

1999 ◽  
Vol 29 (1) ◽  
pp. 33-37 ◽  
Author(s):  
W.-S. Wang ◽  
T.-J. Chiou ◽  
J.-H. Liu ◽  
F. S. Fan ◽  
C.-C. Yen ◽  
...  
Keyword(s):  
Salvage Therapy ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

2-Chlorodeoxyadenosine is an active salvage therapy in advanced indolent non-Hodgkin's lymphoma.

1994 ◽  
Vol 12 (4) ◽  
pp. 788-792 ◽  
Author(s):  
M Hoffman ◽  
M S Tallman ◽  
D Hakimian ◽  
D Janson ◽  
D Hogan ◽  
...  
Keyword(s):  
Salvage Therapy ◽  
Hodgkin’S Lymphoma ◽  
Response Rate ◽  
Complete Response ◽  
Hodgkin's Lymphoma ◽  
Chemotherapy Drugs ◽  
Non Hodgkin’S Lymphoma ◽  
Major Toxicity ◽  
Non Hodgkin's Lymphoma ◽  
Pretreated Patients

PURPOSE To determine the response rate to 2-chlorodeoxyadenosine (2-CdA; cladribine) in patients with advanced indolent non-Hodgkin's lymphoma (NHL) who fail to respond to or progress after a response to standard chemotherapy drugs. PATIENTS AND METHODS Twenty-one patients were treated with at least one cycle of 2-CdA 0.1 mg/kg/d by continuous infusion for 5 or 7 days. RESULTS The overall response rate (complete response [CR] and partial response [PR]) was nine of 21 patients (43%; 95% confidence interval, 22% to 64%). Unmaintained durable responses (longest follow-up, 29+ months) have been observed. The treatment was well tolerated by all patients. The major toxicity was related to myelosuppression (predominantly neutropenia) and immunosuppression with infection. CONCLUSION The purine analog 2-CdA is an active salvage therapy in pretreated patients with indolent NHL, and deserves further assessment in untreated patients and in combination with other chemotherapy agents.

Clinical Features and Prognostic Relevance of Ovarian Involvement in Non-Hodgkin's Lymphoma: a Consortium for Improving Survival of Lymphoma (CISL) Report.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4999-4999
Author(s):  
Jina Yoon ◽  
Seok Jin Kim ◽  
Jong Ho Won ◽  
Chul Won Choi ◽  
Hyeon-Seok Eom ◽  
...  
Keyword(s):  
B Cell ◽  
Hodgkin’S Lymphoma ◽  
Cell Lymphoma ◽  
Performance Status ◽  
B Cell Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Disseminated Disease ◽  
Ovarian Involvement

Abstract Abstract 4999 Introduction Ovary can be involved as a primary ovarian lymphoma or secondarily involved by disseminated disease of non-Hodgkin's lymphoma. However, ovarian involvement is an extremely rare event in non-Hodgkin's lymphoma. Thus, it clinical features and prognostic relevance has rarely been addressed, and most publications refer to a single or a few cases. Thus, we retrospectively analyzed patients with ovarian involvement Patients and methods 32 patients with ovarian involvement were assembled from 8 hospitals affiliated with the CISL (Consortium for Improving Survival of Lymphoma), a Korean lymphoma study group. Primary ovarian involvement was defined as a lymphoma confined to ovary with or without involvement of adjacent lymph nodes and contiguous organs. Secondary ovarian lymphoma was defined as a secondary involvement of ovary in disseminated disease of lymphoma at initial diagnosis. Results Twelve patients had primary ovarian lymphoma (37.5%) while twenty patients (62.5%) had secondary ovarian involvement by systemic disease. The clinical manifestations of ovarian involvement were similar to that of other ovarian tumors, namely an abdominal pain (31%), abdominal distension (19%) or lower abdominal palpable mass (16%). Pathological review according to the WHO classification showed that the most common histological subtype was diffuse large B-cell lymphoma (DLBCL, 75.0%, 24/32), and the frequency of other subtypes was as follows: Burkitt lymphoma (BL, 12.5%, 4/32), lymphoblastic lymphoma (6.3%, 2/32), marginal zone B-cell lymphoma (MZL, 3.1%, 1/32), peripheral T-cell lymphoma, unspecified (PTCL-U, 3.1%, 1/32). The median age (43 years, range 18-80) was younger than that of previously reported other organs such as uterus or prostate. The presence of B symptoms was only observed in 31.3%, and the performance status was good (84.4% of patients had less than grade II of ECOG performance status). The cases involving two or more than two extranodal sites were 68.8% while cases with elevated level of serum LDH were 59.4%. Thus, 59.4% of patients had the low or low-intermediate score of IPI score. Bilateral ovarian involvement was found in 12/32 (38%) while unilateral involvement was 20/32 (63%, 9 right and 11 left side. Three patients showed the involvement of central nervous system (CNS) at diagnosis (3/32, 9.4%). These three patients had DLBCL histology and unfavorable parameters including stage IV, high IPI score and bone marrow BM involvement. Thus, the initial CNS involvement might be associated with advanced stage of lymphoma not with ovarian involvement itself. Surgical removal of involved ovary was performed in 20 patients (62%), and then they were treated with systemic chemotherapy. Twelve patients (38%) were treated with chemotherapy alone. The comparison of outcomes according to the treatment modalities showed the outcomes of chemotherapy-based treatment versus surgery-based treatment were not significantly different (2 year overall survival; 66% vs. 68%). With a median follow-up of 25 months (range 3-185), 13 patients (40.6%) relapsed. Two patients were relapsed in single lesion and 11 were relapsed in multiple lesions. The majority relapsed at various extranodal sites (11/13, 84.6%) and only 2 cases relapsed at nodal sites. Most common relapse site was CNS (4 cases among 13 cases of relapse, 31%). All CNS relapsed patients had DLBCL histology. Ovarian relapse observed in one case that had been involved both ovary at the time of diagnosis. The 2 year overall survivals (OS) were 67% (95% CI: 50 to 83%) and the 2 year progression free survivals (PFS) were 61% (95% CI: 44 to 78%). In univariate analysis, high IPI score, 2 or more extranodal sites involvement and elevated LDH level were statistically significant parameters for lower PFS; moreover, 2 or more extranodal sites involvement and elevated LDH level associated with poor OS. Conclusion Ovarian involvement of non-Hodgkin's lymphoma showed a dismal prognosis despite active treatment. Therefore, more optimal treatment strategy should be warranted. Disclosures No relevant conflicts of interest to declare.

Response to Re-Treatment with Rituximab Plus Salvage-Chemotherapy in Refractory or Relapsed Aggressive Non-Hodgkin’s Lymphoma.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4720-4720 ◽  
Author(s):  
Andrea Borgerding ◽  
Justin Hasenkamp ◽  
Bjoern Chapuy ◽  
Lorenz Truemper ◽  
Gerald Wulf ◽  
...  
Keyword(s):  
Salvage Therapy ◽  
Hodgkin’S Lymphoma ◽  
Progressive Disease ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Salvage Chemotherapy ◽  
Hodgkin's Lymphoma ◽  
Autologous Graft ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

Abstract The efficacy of re-therapy with rituximab immuno-chemotherapy was analysed in 20 consecutive patients with relapsed or progressive aggressive Non Hodgkin’s lymphoma after initial treatment with rituximab plus chemotherapy. Ten patients had a diffuse large B-cell lymphoma, seven had a mantle cell lymphoma and three a grade III follicular lymphoma. At primary diagnosis, the IPI was high-intermediate or high in 75% of the patients and the median age was 55 years (range 36–72 years). The overall response rate of primary immuno-chemotherapy was 75% (15/20 patients) with a complete remission in 8/20 patients (40%). After relapse, 53 % of these patients (8/15) responded again to immunochemotherapy: two patients had a second complete and six a second partial remission. None of the five patients with primary progressive disease responded to a conventional immuno-chemo salvage therapy. After re-therapy with rituximab plus salvage chemotherapy, ten patients received at least one cycle of high dose chemotherapy followed by SCT. One patient did receive HD-chemotherapy and an autologous graft solely, two patients did receive HD-radio-immunotherapy followed by an autologous graft and seven patients finally received HDT and an allogeneic transplant. Allogeneic SCT resulted in a CR in 6 out of 7 patients. One of these ten patients relapsed after HDT consolidation. Six out of ten patients without HDT consolidation after immuno-chemotherapy progressed after secondary treatment, 4 patients are alive without progression (SD, PR) but follow up is short (7, 10, 13 and 16 months). Conclusion: A substantial proportion (53%) of patients with relapse after rituximab immuno-chemotherapy did response to rituximab containing salvage therapy. Patients with progressive disease under immuno-chemotherapy did not respond to such salvage therapy. Without additional consolidation by HDT the risk of progression after successful salvage with rituximab and salvage-chemotherapy is high.

Salvage therapy for non-Hodgkin's lymphoma with a combination of dexamethasone, etoposide, ifosfamide, and cisplatin

1992 ◽  
Vol 30 (3) ◽  
pp. 243-244 ◽  
Author(s):  
Nissim Haim ◽  
Edward Rosenblatt ◽  
Mira Wollner ◽  
Menachem Ben-Shahar ◽  
Ron Epelbaum ◽  
...  
Keyword(s):  
Salvage Therapy ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma
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