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A pilot study of cyclical chemotherapy with high-dose methotrexate and CHOP (MTX-CHOP) in poor-prognosis non-Hodgkin's lymphoma (NHL)

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Summary

In a pilot study of cyclical chemotherapy in patients with poor-prognosis non-Hodgkin's lymphoma (NHL), high-dose methotrexate (MTX) 1 g/m2 with folinic acid rescue was given as initial treatment and then between cycles of a single-arm CHOP combination administered every 4 weeks. Of 21 patients with previously untreated or minimally treated grade 2 (high-grade) histology stage II/III/IV NHL, 13 (62%) achieved complete remission (CR); the CR rate for stage III/IV patients was 56%. Of all 25 patients with grade 2 stage II/III/IV NHL, including previously treated patients, 16 (64%) achieved CR. The median folow-up of patients who completed treatment is currently 22 months and only 1 relapse has been recorded in the CR group. Only five of 24 grade 2 patients given the initial ‘test’ MTX failed to show any response, and eight patients achieved partial remission (PR) as a result of this single treatment. The response to MTX-CHOP in nine patients with grade 1 (low-grade) histology NHL was poor; only two achieved CR. These findings lend support to other data which indicate a useful role for MTX in the induction chemotherapy of advanced high-grade NHL, though the optimum dosage and drug sequence have yet to be determined.

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References

  1. 1.

    Blackledge G, Bush H, Chang J, et al. (1980) Intensive combination chemotherapy with vincristine, Adriamycin and prednisolone (VAP) in the treatment of diffuse histology non-Hodgkin's lymphoma. Eur J Chancer 16:1459

  2. 2.

    Canellos GP, Lister TA, Skarin AT (1978) Chemotherapy of the non-Hodgkin's lymphomas. Cancer 42:932

  3. 3.

    Canellos GP, Skarin AT, Rosenthal DS, Maloney WC, Frei E (1981) Methotrexate as a single agent and in combination chemotherapy for the treatment of non-Hodgkin's lymphoma of unfavourable histology. Cancer Treat Rep [Suppl 1] 65:125

  4. 4.

    Canellos GP, Skarin AT, Rosenthal DS, et al. (1982) High-dose methotrexate combination chemotherapy (M-BACOD) of advanced favourable and intermediate prognosis histology non-Hodgkin's lymphoma (NHL). Proc Am Soc Clin Oncol 1:159

  5. 5.

    Crowther C (1981) New approaches to the management of patients with non-Hodgkin's lymphoma of high-grade pathology. Br J Cancer 43:417

  6. 6.

    De Vita VT, Canellos GP, Chabner B, Schein PS, Hubbard SP, Young RC (1975) Advanced diffuse histiocytic lymphoma, a potentially curable disease: results with combination chemotherapy. Lancet I:248

  7. 7.

    Fisher RI, De Vita VT, Johnson BL, Sumon R, Young RC (1977) Prognostic factors for advanced diffuse histiocytic lymphoma following treatment with combination chemotherapy. Am J Med 63:177

  8. 8.

    Gomez GA, Stutzman L, Moayeri H, et al. (1982) Combination of methotrexate (COP or CHOP) in the treatment of previously untreated and treated lymphomas. Cancer Treat Rep 66:43

  9. 9.

    Henry K, Bennett MH, Farrer-Brown G (1978) Classification of the non-Hodgkin's lymphomas. In: Anthony PR, Woolf N (eds) Recent advances in histopathology, vol 10. Churchill Livingstone, Edinburgh London New York, p 275

  10. 10.

    Lister TA, Cullen MH, Brearley RG, et al. (1978) Combination chemotherapy for advanced Hodgkin's lymphoma of unfavourable histology. Cancer Chemother Pharmacol 1:107

  11. 11.

    McKelvey EM, Gottlieb JA, Wilson HE, et al. (1976) Hydroxydaunorubicin (Adriamycin) combination chemotherapy in malignant lymphoma. Cancer 38:1484

  12. 12.

    Pettingale KW (1981) The management of generalised grade 2 non-Hodgkin's lymphomas. (Report No. 18) Clin Radiol 32:553

  13. 13.

    Schein PS, De Vita VT, Hubbard S, et al. (1976) Bleomycin, Adriamycin, cyclophosphamide, vincristine and prednisolone (BACOP) combination chemotherapy in the treatment of advanced diffuse histiocytic lymphoma. Ann Intern Med 85:417

  14. 14.

    Skarin AT, Rosenthal DS, Maloney WC, Frei E III (1977a) Combination chemotherapy of advanced non-Hodgkin's lymphoma with bleomycin, Adriamycin, cyclophosphamide, vincristine and prednisolone (BACOP). Blood 49:759

  15. 15.

    Skarin AT, Zuckerman KS, Pitman SW, et al. (1977b) High-dose methotrexate with folinic acid in the treatment of advanced non-Hodgkin's lymphoma including CNS involvement. Blood 50:1039

  16. 16.

    Skarin AT, Canellos GP, Rosenthal D, Case D, Maloney W, Frei E III (1980) Therapy of diffuse histiocytic (DH) and undifferentiated (DU) lymphoma with high-dose methotrexate and citrovorum factor rescue (MTX-CF), bleomycin (B), Adriamycin (A), cyclophosphamide (C), Oncovin (O) and Decadron (D). (M-BACOD). Proc Am Soc Clin Oncol 21:463

  17. 17.

    Skarin AT, Canellos GP, Rosenthal DS, et al. (1983) Improved prognosis of diffuse histiocytic and undifferentiated lymphoma by use of high-dose methotrexate alternating with standard agents (M-BACOD). J Clin Oncol (in press)

  18. 18.

    Sweet DL, Colomb HM, Ultmann JE, et al. (1980) Cyclophosphamide, vincristine, methotrexate with Leucovorin rescue, and Cytarabine (COMLA) combination for advanced diffuse histiocytic lymphoma. Ann Intern Med 92:785

  19. 19.

    Sweet DL, Collins RD, Stein RS, Ultmann JE (1982) Prognostic significance of the Lukes and Collins classification in patients treated with COMLA. Cancer Treat Rep 66:1107

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Correspondence to J. A. Child.

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for the Yorkshire Lymphoma Group (YLG)

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Child, J.A., Barnard, D.L., Cartwright, S.C. et al. A pilot study of cyclical chemotherapy with high-dose methotrexate and CHOP (MTX-CHOP) in poor-prognosis non-Hodgkin's lymphoma (NHL). Cancer Chemother. Pharmacol. 11, 153–158 (1983). https://doi.org/10.1007/BF00254195

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Keywords

  • Lymphoma
  • Pilot Study
  • Methotrexate
  • Complete Remission
  • Initial Treatment