Treatment of low grade and
intermediate grade non-hodgkin's lymphomas with intensive
combination chemotherapy
Zahit Bolaman, Taskin Sentürk, Gürhan
Kadköylü
Adnan Menderes University, Medical School, Internal Medicine,
Aydin, Turkey
Correspondence: Zahit Bolaman, Adnan Menderes University, Medical
School, Internal Medicine, 9100 Aydin, Turkey
An important and unresolved problem is the treatment of
patients with indolent non-Hodgkin's lymphomas. In te August, 1999
issue Bocchia reported that results in patients low grade
non-Hodgkin's lymphomas were treated with low dose fludarabine
plus epirubicin and cyclophosphamide (FLEC) regimen.1
In all patients who had completed five cycle of FLEC regimen .
Complete remission (CR) was 36% (11 of 30 patients), partial
remission (PR) was 36% (11 of 30 patients) and remaining 6
patients resistant or poor responders to the treatment. Overall
survival rate at 24 months as 70% (median duration 13 months) and
progression free survival rate at 24 months was 79% (median
duration 10 months). Grade IV neutropenia had observed in 10% (3
of 30 patients).1 To define role of intensive
combination chemotherapy in the treatment of indolent
non-Hodgkin's lymphomas 24 patients were treated with COP-BLAM V
(Cyclo-phosphamide, Vincristine, Prednisone Bleomycine,
Adriamycine and Prokarbazine).2,3 In all the patients
were treated with COP-BLAM V regimen, CR was 50% (12 of 24
patients) including the rate of patients low grade was 60 % (9 of
24 patients) and patients with intermediate grade was 33% (3 of 24
patients) and 2 patients were non-responder (mean follow-up time
54 months) (Table
1). The median survival
was 41 months and disease free survival was 34 months. In the 12
patiens with CR median survival was 48 months and median disease
free survival was 44 months. In the patients with PR median
survival 36 months and survival of the patients who did not
response chemotherapy was 3 and 7 months. Neutropenia was observed
in 8 patients (33%) and cyclophoshamide induced hemorrhaggic
cystitis in one patiens (4%). Treatment of indolent non-Hodgkin's
lymphomas has not been resolved. Currently, fludarabine has been
evaluated as an alternative therapy in these patients and
especially when has been used together wh other chemotherapy
agents answer to therapy has increased. But because of fludarabine
is an expensive drug, patients who need this drug could be treated
other drugs. In our study COP-BLAM V therapy has found as
effective as combination therapies in patients with indolent
non-Hodgkin's lymphoma. As a result COP-BLAM V regimen may be
evaluate as an alternatve therapy in these patients.
