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Intensive and sequential combination chemotherapy for aggressive malignant lymphomas (protocol LNH-80).

B Coiffier, P A Bryon, F Berger

    Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
    |February 1, 1986
    PubMed
    Summary

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    An intensive chemotherapy protocol (LNH-80) achieved an 87% complete remission rate in aggressive malignant lymphoma (ML) patients. Despite manageable toxicity, 6% of patients experienced treatment-related mortality.

    Area of Science:

    • Hematology
    • Oncology
    • Clinical Trials

    Background:

    • Aggressive malignant lymphoma (ML) necessitates effective treatment strategies.
    • Advanced stages of ML often present significant therapeutic challenges.

    Purpose of the Study:

    • To evaluate the efficacy and toxicity of the intensive sequential chemotherapy protocol LNH-80 in patients with aggressive malignant lymphoma.
    • To assess complete remission (CR) rates, relapse patterns, and survival outcomes.

    Main Methods:

    • Ninety-seven patients with aggressive ML (intermediate and high-grade) received the LNH-80 protocol, comprising induction, consolidation, and intensification phases.
    • The protocol included cyclophosphamide, doxorubicin, vindesine, methylprednisolone, bleomycin, cytarabine, high-dose methotrexate with folinic acid rescue, and asparaginase.

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  • Central nervous system (CNS) prophylaxis involved methotrexate and consolidation phase drugs, with cranial radiotherapy for initial CNS involvement.

    • Main Results:

    • An 87% complete remission (CR) rate was achieved in 97 patients.
    • Relapse occurred in 21% of patients, predominantly during or shortly after treatment.
    • Median follow-up was 24 months, with a survival plateau above 60%; median survival and disease-free survival were not reached.
    • No significant difference in CR or relapse rates was observed between intermediate-grade and high-grade ML.
    • Treatment toxicity included neutropenia in most patients (57%) and documented infections in 25%, with 6% overall treatment-related mortality.

    Conclusions:

    • The LNH-80 protocol demonstrates high efficacy in achieving complete remission for aggressive malignant lymphoma.
    • The observed toxicity profile is primarily associated with the induction phase, requiring careful monitoring.
    • The treatment shows promising long-term survival outcomes for patients with advanced-stage aggressive ML.