Intensive chemotherapy in the treatment of aggressive diffuse large B-cell lymphoma: malignant lymphoma

The aim of the present study was to evaluate an intensive chemotherapy regimen in patients with diffuse large B-cell lymphoma and poor prognosis, as presence of high- or high-intermediate clinical risk, bulky disease, high levels of beta 2 microgloblin, and more than two extranodal sites of involvement at diagnosis. One hundred previously untreated patients were treated with an intensive CEOP-Bleo regimen with increased doses of cyclophosphamide (1000 mg/m(2)) and epirubicin (120 mg/m(2)) in each cycle. Granulocyte colony-stimulating factors was employed to ameliorate severe granulocytopenia. Complete response was achieved in 79 cases (79%). With a median follow-up of 32.3 mo (range 10-45 mo) only seven patients have relapsed. Thus, actuarial curves at 3 yr, showed that event-free survival was 72%. Five died secondary to tumor progression, actuarial curves at 3-yr for overall survival were 75%. Toxicity was mild, granulocytopenia grade III or IV were observed in the 46% of the cycles; infection-related granulocytopenia was observed in 17%, but no fatality due to therapy was observed. Cardiac toxicity was mild, only seven patients showed a drop in left ejection ventricular function, but no symptomatic heart failure has been observed. The intensive CEOP-Bleo regimen with increasing doses of cyclophosphamide and epirubicin is a useful and well-tolerated regimen in the treatment of poor prognosis diffuse large B-cell lymphoma.