Trials In Lymphoma Research Articles

Combined radiotherapy-chemotherapy for early stages non-Hodgkin'slymphoma: The 1975–1980 EORTC controlled lymphoma trial

Patients with stage I and II non-Hodgkin's lymphoma (NHL) are considered to have a relatively good prognosis. For this reason, they are seldom referred to specialized centers and the accrual of such patients in controlled studies is limited. Therefore, significant studies of homogeneously treated patients are difficult to collect and the management of these patients remains controversial. Some patients do very well after treatments with minimal toxicity while others require a much more aggressive approach. The Radiotherapy-Chemotherapy Group of the EORTC carried out its second controlled trial on patients with stage I and II NHL from 1975 to 1980. Its first aim was to assess the prognostic value of histologic classifications independently of treatment. The second aim was to compare two therapeutic options within each stage. In stage I, 124 patients were randomized to receive extended field radiotherapy (RT) either with or without adjuvant cyclophosphamide, vincristine prednisone (CVP) chemotherapy (CT). Relapse-free survival (RFS) was higher in patients who received adjuvant CVP but the total survival rates were not different. The RFS was lower in patients with diffuse than in those with follicular architectural histologies; in the former, RFS was not influenced by adjuvant CVP. Those patients who underwent a staging laparotomy had a higher 5-year total survival (TS) independent of the histologic type. Fifty-six stage II patients were included and extended field was randomized versus total nodal irradiation. Subsequently, adjuvant CVP was given to all patients. Results are good in follicular histologies but the advantage for total nodal irradiation is not significant. In diffuse histologies, results were unsatisfactory in both arms; a new therapeutic strategy was designed in which RT and CT are alternated and has been successfully tested in a pilot study.

Adjuvant low dose radiation in childhood T cell leukaemia/lymphoma (report from the United Kingdom Childrens' Cancer Study Group--UKCCSG)

From November 1977 to July 1983, 82 children with T leukaemia/lymphoma entered a randomised trial of combination chemotherapy and radiotherapy. Twenty-five were designated T lymphoma and 57 T leukaemia, 28 having greater than 100 x 10(9)1(-1) blasts in peripheral blood at diagnosis. Twenty-seven patients with mediastinal primaries who were treated on the companion non-Hodgkin lymphoma (NHL) trial were comparable in all respects to the T lymphoma patients and the results of treatment were therefore combined and analysed together. Overall 4-year survival (48-53%) and failure-free survival (FFS) (37-40%) were similar in all groups except the 28 with T leukaemia and WCC greater than 100 X 10(9)1(-1) (20% and 13%). There was a significant advantage in FFS for patients randomised to receive low dose mediastinal radiation, and this was most marked in patients with T lymphoma (66% vs 18%, P = 0.006).

Mitoxantrone hydrochloride (NSC-310739) in lymphoma. A Southwest Oncology Group study.

The members of the Southwest Oncology Group have treated thirteen patients with Hodgkin's disease and thirty-seven with non-Hodgkin's lymphoma with mitoxantrone on the every three week schedule. While the result (3/13 responses in Hodgkin's; 9/37 responses in non-Hodgkin's lymphoma) is not striking, there is a definite antitumor activity in a very heavily pretreated group of patients. Toxicity was acceptable. Additional trials in lymphoma are planned using mitoxantrone in combination with BCNU.

Report on the EORTC lymphoma trial 20751

The preliminary survival data are reported for the second non-Hodgkin lymphoma trial (LR-11, 20751) of the EORTC (European Organization for Research and Treatment on Cancer). A total of 576 patients were collected. Pathology was reviewed for 2 3 of the patients according to the Rappaport, the Lukes-Collins and the Kiel classification. Survival is correlated to pathology, stage and treatment.

Histologic progression in non-Hodgkin's lymphoma

The clinical course and biopsy specimens from 515 consecutive non-Hodgkin's lymphoma patients was evaluated retrospectively in an attempt to determine the clinical importance of documented changes in histology over time. Two-hundred and five of these patients has an initial diagnosis of nodular lymphoma and were reviewed for this anaysis. Sixty-three underwent a repeat biopsy greater than 6 mo after initial diagnosis. In 23 patients, these repeat biopsies revealed a change in histology to a diffuse pattern and/or a change to a larger ''histiocytic'' cell type, while repeat biopsies for the other 40 (63%) disclosd persistence of a nodular pattern and no clear change in basic cell type. Progression from nodular lymphoma to diffuse histiocytic, mixed, or undifferentiated types of lymphomas of Rappaport was found in repeate biopsies obtained from 19 patients (30%). Prognosis for survival following a biopsy that demonstrated histologic change was related to the histology demonstrated at the most recent biopsy and to the response to subsequent drug treatment. Survival following repeat biopsy for these 19 patients was significantly shorter than for the 40 patients whose histology remained nodular (p < 0.001). However, attainment of a complete remission with intensive combination chemotherapy was associated with prolonged survival inmore » eight patients and prolonged disease-free survival in one patient. Since prior treatment may compromise the ability to achieve a complete response to chemotherapy in patients with nodular lymphoma who develop an aggressive diffuse histology, the likelihood of histologic progression must be considered in the design of future clinical trials in nodular lymphoma. Histologic progression does not preclude attainment of a complete response to intensive chemotherapy.« less

Systematic restaging in patients with Hodgkin's disease: a Southwest Oncology Group Study.

Eighty-two patients with advanced Hodgkin's disease who were in apparent complete remission (CR) after receiving 10 courses of combination chemotherapy were systematically reevaluated for persisting disease. Occult Hodgkin's disease was found in 10 (12%) of these patients and was predominantly present in nodal sites (91%) which were known to have been involved at initial staging (100%). Repeat chest radiography, Gallium-67 tumor scanning and lymphography were the most helpful procedures for detecting residual disease. Nine of the 72 (13%) patients felt to be free of disease after negative restaging subsequently relapsed within 8 months. Sites of early relapse, like the sites of disease found at restaging, occurred almost always in previously involved nodal areas. We conclude that systematic restaging should be incorporated into subsequent lymphoma trials in order to define more clearly complete remission and that every patient treated for lymphoma should undergo a careful restaging evaluation before therapy is discontinued.