RESUMO
We report a series of 57 adults patients with lymphoblastic lymphoma treated at our Institution between 1975 and 1987. Mediastinal involvement was seen in 74% (42 cases); extranodal involvement (not including bone marrow) in 24% (14 cases); stage IV in 84% (48 patients) and leukemic phase in 19% (11 patients). In 15 cases immunologic studies were performed 14 proved to be of T type and the other one lack both T and B markers. Survival and duration of remission was better when the patients were treated with aggressive chemotherapy that included maintenance and central nervous system prophylaxis. In the multivariable analysis we observed that mediastinal mass, attainment of a complete remission and high levels of lactic dehidrogenase were associated with a worse prognosis. We believe that patients with lymphoblastic lymphoma have an aggressive disease and that the treatment should be more aggressive than in other non-Hodgkin's lymphomas, and include central nervous system prophylaxis.
Assuntos
Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Adolescente , Adulto , Feminino , Humanos , Masculino , Análise Multivariada , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , PrognósticoRESUMO
Between January 1983 and December 1984, 83 patients with advanced Hodgkin's disease were entered in a prospective randomized trial comparing MOPP (mechlorethamine, vincristine, procarbazine and prednisone) with a regimen containing chlorambucil (Leukeran), vincristine, prednisone and procarbazine (LOPP). Both groups were comparable for the variables of age, stage, symptoms, histology and sites of involvement. Seventy percent of LOPP-treated patients achieved a complete remission compared to 65% of the MOPP-treated group. After a median follow-up of greater than 48 months, there is no statistical difference between the two treatment groups in survival or relapse free-survival. The LOPP combination was better tolerated with significantly less side effects. The drug regimen LOPP appears to be as effective as MOPP in producing complete remission and long term survival in patients with advanced Hodgkin's disease.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doença de Hodgkin/tratamento farmacológico , Análise Atuarial , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Clorambucila/administração & dosagem , Clorambucila/efeitos adversos , Feminino , Doença de Hodgkin/mortalidade , Doença de Hodgkin/patologia , Humanos , Masculino , Mecloretamina/administração & dosagem , Mecloretamina/efeitos adversos , Prednisolona/administração & dosagem , Prednisolona/efeitos adversos , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Procarbazina/administração & dosagem , Procarbazina/efeitos adversos , Estudos Prospectivos , Indução de Remissão , Taxa de Sobrevida , Vincristina/administração & dosagem , Vincristina/efeitos adversosRESUMO
Two hundred and sixty-four patients with Hodgkin's disease (HD) forming the basis of our 15 year experience are retrospectively analyzed. Three therapeutic periods are recognizable. 1. The 1974-76 period was characterized by the increasing knowledge of staging procedures and therapeutic approaches. The 81 patients treated in this period experience 67 and 60% survival at 5 and 10 years, respectively. 2. The 1977-80 period was characterized by a large combination of MOPP and radiotherapy. The 87 patients who entered this period experienced 75 and 72% survival at 5 and 10 years, respectively. 3. The last therapeutic period 1981-84 is characterized by the increasing relevance of prognostic factors and alternating the use of MOPP and ABVD as non-cross resistant regimen. The 96 patients who entered this period showed 96% survival at 4 years. Both survival and disease-free survival were positively influenced by the change of therapeutic strategies during the three periods (p less than .005). Although better results have been recorded moving from one to the next therapeutic period, the present policy has been also based on the recognition of a high number of late complications due to therapy. Preliminary results about the present therapeutic experience seem to indicate both a good remission rate and low incidence of complications.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doença de Hodgkin/terapia , Análise Atuarial , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bleomicina/administração & dosagem , Bleomicina/efeitos adversos , Doenças da Medula Óssea/etiologia , Terapia Combinada/efeitos adversos , Dacarbazina/administração & dosagem , Dacarbazina/efeitos adversos , Diagnóstico por Imagem , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Feminino , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/mortalidade , Doença de Hodgkin/patologia , Doença de Hodgkin/radioterapia , Humanos , Laparotomia , Irradiação Linfática/efeitos adversos , Masculino , Mecloretamina/administração & dosagem , Mecloretamina/efeitos adversos , México/epidemiologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Segunda Neoplasia Primária/etiologia , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Procarbazina/administração & dosagem , Procarbazina/efeitos adversos , Fibrose Pulmonar/etiologia , Indução de Remissão , Estudos Retrospectivos , Esplenectomia , Taxa de Sobrevida , Vimblastina , Vincristina/administração & dosagem , Vincristina/efeitos adversosRESUMO
Fifty-six patients with Hodgkin's disease in advanced stages (III-IV) were entered in a study aimed to compare standard doses (28 cases) with low doses (28 cases) ABVD regimen. Both groups had similar clinico-pathological features. The group receiving standard doses chemotherapy achieved complete remission rate of 89% versus 85% for the low-doses group. The number of relapses was, respectively, 8 and 9, and the duration of remission was 66 and 57 months, respectively. Presently, 24 patients have died, 11 of the standard doses group and 13 of the reduced doses group. Toxicity was notably higher in the group receiving standard dosage, where fatal myelosuppression was present in two instances. Those data appear to suggest that chemotherapy with reduced doses for Hodgkin's disease can attain similar response rate and survival than those achieved with standard treatment, with the advantages of a lower toxicity.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Doença de Hodgkin/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bleomicina/administração & dosagem , Bleomicina/efeitos adversos , Doenças da Medula Óssea/induzido quimicamente , Doenças da Medula Óssea/mortalidade , Dacarbazina/administração & dosagem , Dacarbazina/efeitos adversos , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Doença de Hodgkin/mortalidade , Humanos , Tábuas de Vida , México/epidemiologia , Indução de Remissão , Taxa de Sobrevida , Vimblastina , Vincristina/administração & dosagem , Vincristina/efeitos adversosRESUMO
An analysis is presented of the results attained in 115 cases of advanced non-Hodgkin's lymphoma (stages III and IV) with high or intermediate grade histology (with exception of lymphoblastic lymphoma) which had received no previous treatment. The patients were distributed at random into two groups, A and B. Patients in group A received the classical CHOP-Bleo regimen, and they were given six courses at three-week intervals. The patients of group B received alternate chemotherapy consisting of two CHOP-Bleo courses, two CMED (cyclophosphamide, methotrexate, etoposide, dexamethasone) courses, and two CHOP-Bleo courses. The complete remission rates were 68% for patients of group A and 70% for patients of group B (p = 0.81); the duration of complete remission was 36 and 45 months, respectively (p = 0.73). Nineteen cases in group A (34%) and 18 in group B (30%) relapsed. Disease-free survival at five years was 34% for group A and 40% for group B (p = 0.67). No differences were found in toxicity of chemotherapy between the two groups. It was concluded that the alternate chemotherapy regimen CHOP-Bleo/CMED shows similar effects than the classical CHOP-Bleo treatment, and provides a lesser amount of adriamycin, which makes it feasible to use this or other anthracycline drugs in case of relapse; the use of this regimen must be borne in mind when the patient is carrying a myocardiopathy.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Linfoma não Hodgkin/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bleomicina/administração & dosagem , Ciclofosfamida/administração & dosagem , Dexametasona/administração & dosagem , Doxorrubicina/administração & dosagem , Esquema de Medicação , Etoposídeo/administração & dosagem , Humanos , Tábuas de Vida , Linfoma não Hodgkin/mortalidade , Metotrexato/administração & dosagem , México/epidemiologia , Prednisona/administração & dosagem , Indução de Remissão , Taxa de Sobrevida , Vincristina/administração & dosagemRESUMO
Chemotherapy and obstetric care of 16 pregnant patients with non-Hodgkin's lymphoma are reported in this paper. All patients received chemotherapy during the various trimesters of pregnancy, including 8 cases during the first trimester, and there was no evidence of congenital malformations in any offspring. Fifteen babies are alive, healthy, and at a normal level of growth 3 to 11 years after birth. Eight mothers who achieved complete remission are alive and free of disease, 4 to 9 years after delivery, without maintenance treatment and would be considered cured. On the basis of the present study it was concluded that pregnancy is not a contraindication for treatment of non-Hodgkin's lymphomas, cytotoxic drugs do not necessarily cause congenital malformations, and long-term remission can be achieved in these mothers.
Assuntos
Linfoma não Hodgkin , Complicações Neoplásicas na Gravidez , Criança , Desenvolvimento Infantil , Pré-Escolar , Feminino , Seguimentos , Humanos , Linfoma não Hodgkin/terapia , Gravidez , Resultado da Gravidez , Indução de RemissãoRESUMO
Eighteen patients with advanced malignant lymphoma resistant to previous chemotherapy were treated with combination chemotherapy consisting of cisplatinum, vinblastine and bleomycin. Ten patients (55%) responded (two complete remissions and eight partial). The median survivaL time of patients responding was 15 weeks which was better that the one in patients with no response (3 weeks). Toxicity was mild. We believe that the use of cisplatinum could be useful in patients with refractory malignant lymphoma in combination with other drugs.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma/tratamento farmacológico , Bleomicina/administração & dosagem , Cisplatino/administração & dosagem , Avaliação de Medicamentos , Humanos , Recidiva Local de Neoplasia , Indução de Remissão , Vimblastina/administração & dosagemRESUMO
Between 1980 and 1982, 162 patients with non-Hodgkin's lymphoma were treated with cyclophosphamide, adriamycin, vincristine and prednisone (CHOP) or CHOP plus bleomycin. At the moment when the patient were diagnosed all clinical characteristics were evaluated according to a multiple regression analysis model, which has the following three factors associated to bad prognosis: a quick clinical evolution (less than three months) bone marrow infiltration and high levels of lactate dehydrogenase (LDH). The Cox model of analysis also agreed that a quick clinical evolution and the high levels of LDH were bad prognosis factors. These two factors were associated with poor complete remission and short survival rates. A mathematical model was built based on the last two factors. Five groups of patients were observed with increasing risk of a poor response and a short survival rates, which allowed us to identified three prognostic groups with clear differences in both the duration of remission and survival. These groups were low, moderate and high-risk. Results analysis in this paper have important clinical implications for the design of the prospective clinical trials in patients with malignant lymphoma.
Assuntos
Linfoma não Hodgkin/classificação , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/sangue , Bleomicina/administração & dosagem , Medula Óssea/patologia , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Humanos , L-Lactato Desidrogenase/sangue , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/mortalidade , Linfoma não Hodgkin/patologia , México/epidemiologia , Proteínas de Neoplasias/sangue , Prednisona/administração & dosagem , Prognóstico , Análise de Regressão , Fatores de Risco , Taxa de Sobrevida , Vincristina/administração & dosagemRESUMO
Serial assessment of ventricular function by means of radionuclide angiography was performed in previously untreated patients with lymphoproliferative diseases who received either 4'epidoxorubicin or mitoxantrone for longer than 6 months. No changes were observed in left ventricular function in patients received mitoxantrone at doses ranged 90 to 165 mg (mean 113 mg). Three patients (7%) in 4'epidoxorubicin group showed less than or equal to 10% drop in left ventricular ejection, but without clinical manifestations. The doses in this group were 420 to 810 mg (mean 610 mg). We felt that patients without high-risk factors (radiotherapy to mediastinum or previously anthracycline therapy) could be treated with high doses of both drugs and that radionuclide angiography is a useful method for monitoring cardiotoxicity of antineoplastic drugs.
Assuntos
Epirubicina/efeitos adversos , Mitoxantrona/efeitos adversos , Volume Sistólico/efeitos dos fármacos , Cardiomiopatias/induzido quimicamente , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/fisiopatologia , Epirubicina/farmacologia , Humanos , Linfoma/tratamento farmacológico , Mitoxantrona/farmacologia , CintilografiaRESUMO
The long-term results achieved with CHOP chemotherapy in 131 patients with non-Hodgkin's lymphoma of diffuse histological pattern and in advanced stages were analysed. The mean age of the patients was 49 years. Complete remission was achieved in 68 cases (60 %). There was good tolerance in general terms, without any lethal complications. The median survival was 27 months; 28 patients (25 % of the whole series) are alive and disease-free after 10 years, so they can be considered as cured. High lactate-dehydrogenase levels, bulky tumoural mass and high degree of histological malignancy were identified as poor-prognosis factors. CHOP chemotherapy appears as a useful means of treating non-Hodgkin's lymphoma, as shown by the number of patients achieving long lasting remission and by the tolerance. Nevertheless, this treatment is of less value in patients with poorer prognosis, in whom other regimens must be borne in mind.