Related Experiment Videos
Methotrexate-leucovorin factor rescue regimens in diffuse large cell lymphoma
1Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115.
NCI Monographs : a Publication of the National Cancer Institute
|January 1, 1987
Summary
High-dose methotrexate (MTX)-leucovorin (LV) and moderate-dose MTX-LV regimens show similar efficacy in treating diffuse large cell lymphoma (DLCL). Further trials are needed to define optimal MTX-LV use in DLCL therapy.
Area of Science:
- Oncology
- Pharmacology
- Hematology
Background:
- Methotrexate (MTX) and leucovorin (LV) rescue have been studied for non-Hodgkin's lymphoma (NHL).
- High-dose MTX (HDMTX) with LV rescue was investigated in early phase II studies for diffuse large cell lymphoma (DLCL).
- The M-BACOD regimen (HDMTX, bleomycin, doxorubicin, cyclophosphamide, vincristine, dexamethasone) was developed to reduce relapse and CNS involvement.
Purpose of the Study:
- To review early studies of MTX in NHL and the rationale for HDMTX-LV rescue.
- To evaluate the efficacy and feasibility of HDMTX-LV and moderate-dose MTX-LV regimens in DLCL.
- To identify prognostic factors and guide future therapeutic strategies for DLCL.
Main Methods:
- Phase II studies of HDMTX-LV (1-7.5 g/m2) in 12 DLCL patients failing prior chemotherapy.
- Evaluation of the M-BACOD regimen in 101 DLCL patients.
- Preliminary analysis of the m-BACOD regimen (moderate-dose MTX-LV) in 80 DLCL patients.
Main Results:
- HDMTX-LV showed a 24% response rate, including 2 complete remissions (CR), in early studies.
- M-BACOD achieved 72% CR in 101 patients, with a projected 5-year survival of 59%.
- m-BACOD showed a 75% CR in 80 patients, with a 2-year survival of 70% and projected 4-year survival of 60%; CNS relapse rates were similar (~5%) for both protocols.
Conclusions:
- Both HDMTX-LV and moderate-dose MTX-LV regimens demonstrate comparable efficacy in DLCL treatment.
- The m-BACOD regimen offers potential for improved feasibility, reduced toxicity, and lower cost.
- Multivariate analysis identified 3 prognostic groups, necessitating prospective randomized trials to determine optimal MTX-LV dose and schedule in DLCL.