INTENSIVE CHEMOTHERAPY FOR HIGH-RISK PATIENTS WITH HIGH-GRADE MALIGNANT NON-HODGKIN LYMPHOMAS - A PILOT-STUDY USING ADRIAMYCIN, CYCLOPHOSPHAMIDE, VINCRISTINE, METHOTREXATE, ETOPOSIDE, AND DEXAMETHASONE (ACOMEDPROTOCOL)

Background: In high-grade malignant non-Hodgkin lymphomas (NHL), progn ostic risk is assessable by a series of initial parameters but adequat e treatment approaches to high-risk patients remain to be established. The aim of the present study was therefore to evaluate the feasibilit y and efficiency of the intensified induction chemotherapy regimen ACO MED for poor prognosis patients. Patients and Methods: Unpretreated pa tients With high-grade malignant NHL (Kiel classification) presenting with Ann Arbor stage II-IV disease and at least one prognostic risk fa ctor (stage III/IV, serum LDH > normal, performance status ECOG greate r than or equal to 2, bulky disease greater than or equal to 10 cm) we re treated with the ACOMED regimen consisting of four courses of adria mycin 25 mg/m2 i.v. days 4-5, cyclophosphamide 250 mg/m2 i.v. days 1-5 , vincristine 2 mg i.v. absolute day 1, methotrexate 500 mg/m2 i.v. da y 1 with leucovorin-rescue, etoposide 100 mg/m2 i.v. days 1-5, dexamet hasone 10 mg/m2 p.o. days 1-5, supported by G-CSF and repeated on day 21.