CODBLAM-IV CHEMOTHERAPY FOR LARGE-CELL LYMPHOMA - SEQUENTIAL USE OF INFUSIONAL VINCRISTINE AND BLEOMYCIN AND HIGH-DOSE CONSOLIDATION

Background: Based on prior results in large cell lymphoma (LCL) with C OPBLAM (Cyclophosphamide, Oncovin, Prednisone, Bleomycin, Adriamycin, Matulane) I and COPBLAM III, CODBLAM (Cyclophosphamide. Oncovin, Dexam ethasone, Bleomycin, Adriamycin, Matulane) IV was developed to intensi fy treatment further by utilizing four sequential cycles of infusional chemotherapy followed by high-dose chemotherapy and cycle active agen ts. Methods: Sixty-one patients with LCL, mostly B-cell lymphoma, with 54% >60 years of age, were treated with daily continuous infusion of vincristine 1.0 mg/m(2) days 1-2, bleomycin 4 mg/m(2) i.v. push x 1 on ly followed by daily infusion 4 mg/m(2) days 1-5, dexamethasone 10 mg/ m(2) days 1-5, procarbazine 100 mg/m(2) orally days 1-5, doxorubicin 3 5 mg/m2 i.v. push day 1 (escalated), and cyclophosphamide 350 mg/m2 i. v. push day 1 (escalated), all given every 3 weeks for four cycles. Af ter infusions, patients were restaged and treated with single courses of doxorubicin 90 mg/m(2) i.v. push followed at 3 weeks with cyclophos phamide 1500 mg/m(2) i.v. push (both with concomitant vincristine 1 mg /m2 i.v. push and dexamethasone 10 mg/m(2) p.o. daily for 5 days). Rem aining treatment consisted of methotrexate 120 mg/m(2) i.v. push with citrovorum rescue, cytarabine 250 mg/m2 i.v. push, and etoposide 100 m g/m(2) i.v. infusion over 1 h, all given every 10 days for six cycles. Results: The overall complete response (CR) rate was 88%. Of all pati ents, 36 (59%) are sustained disease free at a median follow-up time o f 55 months. In patients age less than or equal to 60 years, 89% achie ved CR and 85% of patients age >60 years attained CR. CR was achieved in 83% of patients with constitutional B-type symptoms, 69% of patient s with bulky adenopathy, and 86% of patients with immunoblastic histol ogy. Toxicity was primarily pulmonary, occuring in 15% of patients. On e toxic death was observed. Conclusions: Infusional CODBLAM IV may rep resent an effective and unique treatment for LCL.