levoleucovorin and Lymphoma--Follicular

Topics: Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Cyclophosphamide; Doxorubicin; Etoposide; Humans; Interferon-alpha; Leucovorin; Lymphoma, Follicular; Mechlorethamine; Methotrexate; Prednisone; Procarbazine; Vincristine

Radiation therapy has a broad range of applications in the management of patients with non-Hodgkin's lymphoma. It has curative potential for patients with Stage I to II low-grade lymphoma (small lymphocytic, follicular small cleaved, and follicular mixed) and has substantial palliative efficacy in patients with more advanced stage low-grade lymphoma. Low-dose whole-body irradiation may be used as palliative therapy even in patients with bone marrow involvement by these lymphomas. In the management of the large cell lymphomas (diffuse large cell, diffuse mixed, and immunoblastic), radiation alone has curative potential in only the most favorable early-stage presentations. However, since radiation can achieve significant responses in these tumors, it should be considered for inclusion in combined-modality programs. Reports that have appeared in the literature as well as results of treatment at Stanford that bear upon these issues are reviewed.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Clinical Trials as Topic; Combined Modality Therapy; Cyclophosphamide; Dexamethasone; Doxorubicin; Follow-Up Studies; Humans; Leucovorin; Lymphoma, Follicular; Lymphoma, Non-Hodgkin; Meningeal Neoplasms; Methotrexate; Mycosis Fungoides; Palliative Care; Prednisone; Radiotherapy Dosage; Skin Neoplasms; Time Factors; Vincristine; Whole-Body Irradiation

Radiation therapy has a broad range of applications in the management of patients with non-Hodgkin's lymphoma. It has curative potential for patients with Stage I to II low-grade lymphoma (small lymphocytic, follicular small cleaved, and follicular mixed) and has substantial palliative efficacy in patients with more advanced stage low-grade lymphoma. Low-dose whole-body irradiation may be used as palliative therapy even in patients with bone marrow involvement by these lymphomas. In the management of the large cell lymphomas (diffuse large cell, diffuse mixed, and immunoblastic), radiation alone has curative potential in only the most favorable early-stage presentations. However, since radiation can achieve significant responses in these tumors, it should be considered for inclusion in combined-modality programs. Reports that have appeared in the literature as well as results of treatment at Stanford that bear upon these issues are reviewed.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Clinical Trials as Topic; Combined Modality Therapy; Cyclophosphamide; Dexamethasone; Doxorubicin; Follow-Up Studies; Humans; Leucovorin; Lymphoma, Follicular; Lymphoma, Non-Hodgkin; Meningeal Neoplasms; Methotrexate; Mycosis Fungoides; Palliative Care; Prednisone; Radiotherapy Dosage; Skin Neoplasms; Time Factors; Vincristine; Whole-Body Irradiation

The natural history of follicular lymphoma is believed not to have changed over the last 30 years. Median survivals have ranged from 7 to 10 years, and the disease is considered incurable. However, multiple new treatment options have been developed in the last decade, and their impact on survival of follicular lymphoma remains unknown.. In the current analysis, we identified all previously untreated, advanced-stage, follicular lymphoma patients treated with the following three sequential treatment approaches: cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy +/- nonspecific immunostimulants (Southwest Oncology Group [SWOG] 7426 and 7713: 1974 to 1983); prednisone, methotrexate, doxorubicin, cyclophosphamide, and etoposide (ProMACE) plus mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) +/- interferon (SWOG 8809: 1988 to 1994); and CHOP followed by monoclonal antibody (MoAb) therapy (SWOG 9800 and 9911: 1998 to 2000). We assessed the patients' progression-free survival (PFS) and overall survival (OS). The MoAb trials included CHOP followed by rituximab (SWOG 9800) and CHOP followed by (131)I-tositumomab (SWOG 9911).. The PFS curves for the CHOP and ProMACE-MOPP studies are overlapping, with 4-year PFS estimates of 46% and 48%, respectively. However, the PFS rate of the CHOP + MoAb studies is significantly improved at 61% (P = .005). The OS curves show improvement with each succeeding study. The 4-year estimate of OS is 69% for the CHOP regimens, 79% for the ProMACE-MOPP study, and 91% for the CHOP + MoAb regimens (P < .001). These conclusions were retained after adjusting for differences in prognostic factors between the study groups.. The results of this study suggest that OS for patients with follicular lymphoma has improved over time and that the choice of initial therapy may matter.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Disease-Free Survival; Doxorubicin; Etoposide; Female; Humans; Leucovorin; Lymphoma, Follicular; Male; Mechlorethamine; Methotrexate; Middle Aged; Multivariate Analysis; Prednisone; Procarbazine; Proportional Hazards Models; Prospective Studies; Survival Rate; United States; Vincristine

While the use of radioimmunotherapy for lymphoma increases, the feasibility and efficacy of autologous stem cell transplant for subsequent relapse remains unknown. We report a 48-year-old male with transformed follicular mixed non-Hodgkin's lymphoma. After treatment with three different combination chemotherapy regimens, at relapse he received radioimmunotherapy with iodine (131)I tositumomab (anti-CD20), with very good response. At later relapse, a second course of (131)I tositumomab was given unsuccessfully. He underwent peripheral blood stem cell harvest, chemoradiotherapy conditioning and autologous transplantation with prompt engraftment and without significant complications. He remains in complete remission with normal blood counts 25 months post autograft.

Topics: Antibodies, Monoclonal; Antigens, CD20; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Cyclophosphamide; Dexamethasone; Doxorubicin; Hematopoietic Stem Cell Transplantation; Humans; Iodine Radioisotopes; Leucovorin; Lymphoma, Follicular; Lymphoma, Non-Hodgkin; Male; Methotrexate; Middle Aged; Neoplasm Recurrence, Local; Radioimmunotherapy; Remission Induction; Transplantation, Autologous; Treatment Outcome; Vincristine

Twenty-six patients with follicular small-cleaved lymphoma (FSCL) and 16 patients with follicular mixed lymphoma (FML) were treated at the Nichidai Itabashi Hospital between 1981 and 1995. The 5-year overall survival rate was 74.3% and 70.0% for the FSCL and FML patients, respectively. Of the patients with stage III-IV FSCL, 9 were assigned to a "watchful waiting" follow-up course and 13 were treated with a single alkylating agent or CHOP therapy. The 5-year failure-free survival rate was 66.7% and 33.0%, respectively. Of the patients with stage II-IV FML, 6 were treated with CHOP or MACOP-B protocol. The complete response rate for this group was only 33.3%, and none of the patients were in remission for more than 2 years. Histological transformation into diffuse aggressive lymphoma was observed in 7 patients, with the median time from diagnosis to transformation at 50 months. Three of those patients were successfully treated with intensive chemotherapy after transformation.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Combined Modality Therapy; Cyclophosphamide; Doxorubicin; Female; Humans; Leucovorin; Lymphoma, Follicular; Lymphoma, Non-Hodgkin; Male; Methotrexate; Middle Aged; Prednisone; Radiotherapy Dosage; Survival Rate; Treatment Outcome; Vincristine

We describe the excretion of Ascaris lumbicoides, an intestinal roundworm, in the emesis of an asymptomatic patient undergoing total body irradiation. This suggests that Ascaris is sensitive to irradiation.

Topics: Adult; Animals; Antineoplastic Combined Chemotherapy Protocols; Ascariasis; Ascaris lumbricoides; Bone Marrow Transplantation; Combined Modality Therapy; Cyclophosphamide; Doxorubicin; Etoposide; Female; Gastrointestinal Contents; Humans; Intestinal Diseases, Parasitic; Leucovorin; Lymphoma, Follicular; Lymphoma, Non-Hodgkin; Mechlorethamine; Methotrexate; Prednisone; Procarbazine; Vincristine; Vomiting; Whole-Body Irradiation

Seventy-nine patients with nodular mixed lymphoma were treated at the National Cancer Institute between 1966 and 1978. Fifteen patients had stage I or II disease, and 64, stage III or IV disease. The overall complete response rate for the patients that received various primary treatment regimens was 76%, with 52% of complete responders remaining in their first remission at a median follow-up of 7 years. Median survival of complete responders is projected to be more than 13 years. Median survival of patients who do not achieve complete remission is less than 2 years. Patients with B symptoms, bone marrow involvement, or a lactate dehydrogenase level greater than 250 U/mL had significantly shorter survivals than did patients without these features. Patients with advanced-stage (III and IV) nodular mixed lymphoma had a 72% complete response rate, with the average remission lasting more than 6 years. Although relapses have been seen up to 8 years after diagnosis in patients with nodular mixed lymphoma given C-MOPP chemotherapy (cyclophosphamide, vincristine, procarbazine, prednisone), prolonged initial remissions can be achieved with this therapy.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Cyclophosphamide; Doxorubicin; Etoposide; Female; Humans; Leucovorin; Lymphoma, Follicular; Male; Mechlorethamine; Methotrexate; Middle Aged; Neoplasm Staging; Prednisone; Procarbazine; Prognosis; Retrospective Studies; Time Factors; Vincristine