AN INTENSIVE CHEMOTHERAPY OF ADULT T-CELL LEUKEMIA LYMPHOMA - CHOP FOLLOWED BY ETOPOSIDE, VINDESINE, RANIMUSTINE, AND MITOXANTRONE WITH GRANULOCYTE-COLONY-STIMULATING FACTOR SUPPORT/

An intensive combination chemotherapy regimen supported by granulocyte colony-stimulating factor (G-CSF) was evaluated in adult T-cell leuke mia/lymphoma (ATLL) patients in a multiinstitutional, cooperative stud y. Vincristine 1 mg/m(2) i.v. day 1, Adriamycin 40 mg/m(2) i.v. day 1, cyclophosphamide 400 mg/m(2) i.v. day 1, prednisolone 40 mg/m(2) i.v, days 1 to 3 and 8 to 10, etoposide 35 mg/m(2) i.v, days 1 to 8, vinde sine 2 mg/m(2) i.v, day 8, ranimustine 50 mg/m(2) i.v, day 8, mitoxant rone 7 mg/m(2) i.v. day 8, and G-CSF 50 mg/m(2) s.c. days 9 to 21 were given for 2 to 4 courses every 3 weeks to 83 patients with ATLL. Comp lete remission (CR) and partial remission (PR) were achieved in 35.8 a nd 38.3%, respectively, of 81 evaluable patients. The median survival of all patients was 8.5 months, with a predicted 3-year survival of 13 .5% by the Kaplan-Meier method. The median duration of response was 7. 6 months (range 0.2-42.7), and 13 patients were alive. Their median su rvival time was 29.1 months (range 19.2-44.7). In 67.6% of courses, wh ite blood cell (WBC) nadirs were < 1.0 x 10(9)/L. Days required for th e recovery of WBC from the nadir to >1.0 x 10(9)/L were <5 days in 71. 4% of the treatment courses. The G-CSF supported an intensified chemot herapy regimen for ATLL and yielded better response rate and longer su rvival compared to previous reports in Japan. Because duration of remi ssion is still short, further studies of postremission therapy or othe r strategies are warranted.