High-Dose Chemotherapy with Vandervilt Regimen and CSF Support for High-Risk Aggressive Non-Hodgkin's Lymphoma.
- Author:
Bong Seog KIM
1
;
Jeong Hoon YANG
;
Kyung Tae KIM
;
Baek Yeol RYOO
;
Tae You KIM
;
Young Hyuck IM
;
Jhin Oh LEE
;
Tae Woong KANG
;
Yoon Koo KANG
Author Information
1. Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
High-dose chemotherapy;
CSF;
High-risk non-Hodgkins lymphoma
- MeSH:
Cranial Irradiation;
Drug Therapy*;
Follow-Up Studies;
Humans;
Leukopenia;
Lymphoma, Non-Hodgkin*;
Methotrexate;
Precursor Cell Lymphoblastic Leukemia-Lymphoma;
Sepsis
- From:Journal of the Korean Cancer Association
1998;30(1):137-149
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To detennine the therapeutic effect and toxicities of high-dose chemotherapy with Vanderbilt regimen and colany-stimulating factors(CSF) support for high-risk aggressive non-Hodgkin's lymphoma(NHL). MATERIALS AND METHODS: Between Aug. 1995 and Mar. 1997, 40 patients with high-risk aggressive NHLs were treated with high-dose chemotherapy with Vandebilt regimen and CSF support. If the complete response(CR) was induced, four cycles of CHOP were administered for the maintenance of response. In cases of lymphoblastic lymphomas, CNS prophyiaxis with cranial irradiation and intrathecal methotrexate was done after CR. RESULTS: CR was achieved after Vanderbilt regimen in 62.5%(25/40) of the total patients. CR rste in refractory group(12.5%: 1/8) was significantly lower than in other groups (75%: 24/32)(p=0.001). With a median follow-up of 14 months, the failure free survival (FFS) was 0~18+ months(median 6.1 months). The overall FFS rate at one year was 31.7%. The 1-year FFS rate in refractory group(0%) was significantly lower than in other patients groups(41%)(p=0.001). The range of survival time was 0.5~18+ months, and median survival time was 6.2 months. Grade 4 leukopenia was observed in 100% of chemotherapy cycles and its median duration was 7 days. However, only one patient died due to treatment-relate sepsis. Non-hematological toxicities were tolerable and all reversible. CONCLUSION: High-dose chemotherapy with Vanderbilt regimen was effcctive for induction of CR in high-risk aggressive NHL patients and safe with the CSF support. However, poor CR rate in reftactory group and poor FFS in other groups indicate that a new, more intensive approach is needed for the induction of CR in refractory group and for the maintenance of CR in other high-risk patient groups.
