Non-hodgkin's lymphoma, poorly differentiated lymphocytic and mixed cell types. Results of sequential staging procedures, response to therapy, and survival of 100 patients
✍ Scribed by Jacob D. Bitran; Harvey M. Golomb; John E. Ultmann; Donald L. Sweet Jr.; Eric P. Lester; Richard S. Stein; J. Bruce Miller; Edgar M. Moran; Ann E. Kinnealey; James E. Vardiman; Jeannie Kinzie; Nina O. Roth
- Publisher
- John Wiley and Sons
- Year
- 1978
- Tongue
- English
- Weight
- 687 KB
- Volume
- 42
- Category
- Article
- ISSN
- 0008-543X
No coin nor oath required. For personal study only.
✦ Synopsis
The results of sequential staging procedures including laparotomy, radiotherapy, and combination chemotherapy are reported for 100 patients with poorly differentiated lymphocytic (PDL) and mixed cell (M€) non-Hodgkin's lymphoma (NHL). Twelve patients were found to have localized disease, pathologic stage (PS) I or 11; 88 patients had PS I11 or IV disease. Bone marrow biopsy showed a high incidence of involvement and advanced 34% of the patients from CS I, 11, and I11 to PS IV. Staging laparotomy has a very limited role in the evaluation of these patients. All of 12 patients with PS I and I1 NHL were treated with radiotherapy; at 5 years, they had 100% survival, 80% being disease-free. Fifteen patients with PS I11 disease were treated with total nodal radiotherapy (TNRT) alone and had a median diseasefree survival of 41 months. The remaining patients with PS I11 and IV disease were treated with chemotherapy consisting of vincristine afid prednisone (V 8c P); cyclophosphamide, vincristine (Oncovin@), procarbazine, and prednisone (COPP); cyclophosphamide, vincristine (Oncovin@), adriamycin, and prednisone (COPA); or "palliative therapy", consisting of chlorambucil and prednisone. Two-year and 4-year survivals for patients with diffuse lymphoma were 93% and SO%, respectively; for patients with +2 nodular lymphoma, 80% and 30%; for patients with nodular lymphomas, 76-93% and 5076, respectively. Treatment with COPP showed no advantage over V and P, "palliative therapy," or TNRT for patients with +2 nodular and nodular disease. The likelihood of cure appears most promising for patients in complete remission (CR) with diffuse lymphoma; patients in CR with nodular lymphoma show a high rate of relapse over 5 years of observation.
We conclude that staging laparotomy in PDL and MC NHL is of limited value, and that the role of aggressive chemotherapy for patients with +2 nodular and nodular lymphoma needs to be redefined.
Cancer 42:88-95, 1978.