DIFFUSE SMALL NONCLEAVED-CELL, NON-BURKITTS LYMPHOMA IN ADULTS - A HIGH-GRADE LYMPHOMA RESPONSIVE TO PROMACE-BASED COMBINATION CHEMOTHERAPY

Purpose: To review the efficacy of cyclophosphamide, doxorubicin, etop oside, methotrexate with leucovorin, and prednisone (ProMACE)-based co mbination chemotherapy programs in the treatment of patients with diff use small noncleaved-cell non-Burkitt's lymphoma. Patients and Methods : Thirty-three patients with diffuse smell noncleaved;cell non-Burkitt 's lymphoma were accrued: eight with localized disease were treated wi th modified ProMACE-mechlorethamine, vincristine, procarbazine, and pr ednisone (MOPP) plus involved-field radiation therapy, and 25 with adv anced-stage disease were treated with ProMACE/MOPP flexitherapy (n = 8 ), ProMACE-MOPP (n = 9), or ProMACE-cytarabine, bleomycin, vincristine , and methotrexate with leucovorin (CytaBOM) (n = 8). The median follo w-up duration is 10 years. Results: All eight patients with localized disease achieved a complete response, none have relapsed, and one died of intercurrent illness. Among patients with advanced-stage disease, five of eight (63%) flexitherapy-treated patients, six of nine (67%) P roMACE-MOPP-treated patients, and eight of eight (100%) ProMACE-CytaBO M-treated patients achieved a complete response. If the two ProMACE-MO PP-based groups are considered together, disease-free and overall surv ival rates at 15 years are projected at 61% and 35%, respectively. In contrast, only one patient has relapsed from a ProMACE-CytaBOM-induced complete remission, and overall survival of ProMACE-CytaBOM-treated p atients (88%) is significantly higher than that for flexitherapy and p roMACE-MOPP (P-2 = .04). Conclusion: Adult patients with diffuse small noncleaved-cell non-burkitts lymphoma may be effectively treated with regimens that are effective in other aggressive lymphomas (eg, diffus e large-cell lymphoma).