PROGNOSTIC FACTORS FOR THERAPEUTIC OUTCOME OF DIFFUSE SMALL NON-CLEAVED CELL LYMPHOMA IN ADULTS

Most reports of prognosis and therapy in diffuse small non-cleaved cel l lymphoma (DSNCL), an aggressive high-grade non-Hodgkin's lymphoma (N HL) which appears to be of two histopathologic subtypes, have included predominantly a pediatric population and very few adults. We studied 20 newly diagnosed, previously untreated adults with DSNCL. Three pati ents had Ann Arbor Stage I disease, five Stage II, and 12 Stage IV. Bo ne marrow involvement was present in seven of 20 (35%) patients; no pa tient had central nervous system involvement at diagnosis. Clonal chro mosomal abnormalities were found on cytogenetic analysis of all 12 cas es studied. Ten patients had specific recurring translocations, includ ing t(8;14) (q23;q32) (five patients), t(14;18) (q32;q21) (four patien ts), and t(2;8) (q12;924) (one patient). Induction chemotherapy with t he COMP regimen (cyclophosphamide, vincristine, methotrexate, and pred nisone) or a variant schedule of the same drugs resulted in complete r emission for 13 patients (65%), and partial remission for 5 patients ( 25%). Clinical characteristics predictive of a favorable response to i nduction therapy included Stage I or II disease, a normal lactic dehyd rogenase (LDH), and performance status (PS) of 0 or 1. Remission durat ion ranged from two to 125+ (median 37+) months. Survival ranged from one to 126+ (median 23) months; ten patients (50%) remain alive, nine with no active disease. Factors predictive of longer survival included achievement of a complete remission with induction therapy, a normal LDH, and PS 0 or 1. As in children with DSNCL, long-term disease-free survival may be achieved in adults with combination chemotherapy. (C) 1994 Wiley-Liss, Inc.