ProMACE-CytaBOM Combination Chemotherapy in Stage II/III/IV Intermediate- and High-Grade Non-Hodgkin's Lymphoma

Song, Hong Suk; Lee, Chun Sik

Abstract

BACKGROUND: CHOP regimen is four-drug, first-generation combination chemotherapy that has been the standard treatment for patients with aggressive non-Hodgkin's lymphoma for the last 20 years. The second- and third-generation regimens have been developed in an attempt to improve the treatment outcome, but recent randomized studies failed to demonstrate an advantage of these regimens compare to the first-generation CHOP regimen. So, we performed clinical study of 8-drug combination chemotherapy, ProMACE-CytaBOM regimen for patients with non-Hodgkin's lymphoma to evaluate the response rate, overall survival, and toxicity.
METHODS
Between November 1992 and Feb. 1997, previously untreated stage II/III/IV intermediate- and high-grade non-Hodgkin's lymphoma patients were treated with a ProMACE- CytaBOM regimen including cyclophosphamide 650 mg/m2 IV on day 1, adriamycin 25 mg/m2 IV on day 1, etoposide 120 mg/m2 IV on day 1, cytosine arabinoside 300 mg/m2 IV on day 8, bleomycin 5 mg/m2 IV on day 8, vincristine 1.4 mg/m2 IV on day 8, methotrexate 120 mg/m2 IV on day 8, and prednisone 60 mg/m2 PO on day 1 to day 14 with 3 weeks interval.
RESULTS
Twenty eight patients (87.5%) were evaluable. Patient characteristics include: Median age 57.5 years (17-75) and 15 patients were 60 years or old; clinical stage II in 12 patients (37.5%), stage III in 7 patients (21.9%), and stage IV in 13 patients (40.6%). Objective response were 22 CR, 4 PR, 2 PD with 92.8% response rate. The complete response rate was associated with the International Prognostic Index (low risk 100%; low intermediate risk 70%; high and high intermediate risk 50%, P<0.05), but age did not influence the response rate. The median survival time was 23.6 months, and 1-year, 3-year, 5-year total survival and relapse-free survival rate were 75.0% 52.0% 34.7%, 84.4% 84.4% 54.3%, respectively. International Prognostic Index was correlated well with survival time (1-year 3-year 5-year survival : Low risk 91.7% 91.7% 91.7% vs low intermediate risk 80.0% 41.1% 27.4% vs high and high intermediate 33.3% 16.6% 0%, P< 0.005), however age was negatively associated with survival time (1-year 3-year 5-year survival : Below the 60 years 81.3% 75.0% 37.5% vs age greater than 60 years 66.7% 34.3% 22.9%, P<0.05). Grade 3/4 toxicities were anemia in 28.6%, neutropenia in 64.3%, thrombocytopenia in 14.3%, vomiting in 35.7%, oral mucositis in 14.3%, alopecia in 25.0%, increased AST in 3.6% and generation CHOP regimen, with higher treatment-related death due to infection. Therefore, ProMACE-CytaBOM combination chemotherapy is not routinely recommended to treat the patients with non-Hodgkin's lymphoma.
CONCLUSION
These data indicate that IDA+BHAC induction chemotherapy seems to be comparable to other combinations for induction chemotherapy in AML. More longer follow-up period is needed for assessing the impact of BHAC-containing regimen on the outcome of autologous and allogeneic hematopoietic stem cell transplantation.