TAILORED THERAPY FOR AGGRESSIVE NON-HODGKINS-LYMPHOMA - RESULTS OF A PHASE-II STUDY WITH A LONG-TERM FOLLOW-UP

Aim of the study was to improve cure rate and survival of aggressive n on-Hodgkin's lymphoma (NHL) with a tailored program of therapy based o n histologic type, prognostic characteristics of patients and response to therapy, and with the use of differentiating or cytostatic agents such as Ara-C at low doses and alpha IFN. Fifty-four consecutive patie nts with aggressive NHL were treated in the induction phase with 4 seq uential courses of a third generation regimen (modified CODBLAM IV), f ollowed in responsive patients by 1 cycle of doxorubicin and cyclophos phamide and 1 cycle of high dose methotrexate with folinic acid rescue (AC-MTX). Patients who achieved partial. response (PR) were treated w ith the combination of CCNU + vinblastine if affected by high grade NH L, or with low dose Ara-C plus alpha IFN if affected by intermediate g rade NHL. Patients who obtained complete response (CR) with basal adve rse prognostic factors were treated with alpha IFN as maintenance ther apy for two years. Radiotherapy and surgery were effected in selected cases. Thirty-four patients (62.9%) achieved CR and 12 patients (22.2% ) showed PR after induction therapy. Among the 12 patients who achieve d PR, 6 prolonged CRs were obtained in 7 patients treated with Ara-C a t low doses plus alpha IFN and 4 CRs were obtained in 5 patients treat ed with CCNU + vinblastine. After completion of treatment, 44 patients (81.5%) obtained CR, 2 patients (3.7%) showed PR and 8 patients (14.8 %) presented progression of disease (PD). Fifteen patients received al pha IFN as maintenance therapy. The overall survival and failure-free survival rates are 53.7% and 50% respectively, with a median follow-up of 82 months: 27 patients remain alive, disease-free without relapses , and can be considered cured. This tailored program of therapy result ed effective and moderately toxic and may improve the outcome in aggre ssive NHL.