Autologous Bone Marrow Transplantation - Blog Science Connections

300 Treatment Strategies for NHL
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Figure 2. Overall survival (n = 35).
demonstrates a trend toward poor prognosis for patients older than 65 years.
Only one survives (at 29 months), and all others died of progressive disease.
Five of the six patients who died had significant dose reductions in order to limit
treatment-related toxicity.
DISCUSSION
Based on the CHOP regimen (5-11), several other "first-generation"
regimens (4,23-34) are capable of producing long-term survival in advanced
aggressive non-Hodgkin's lymphoma. With those regimens, CR is reached in
40-60% of patients, and relapse occurs in 25-50%. The cure rate is estimated to
be 30-40%. During the past decade, further progress has been achieved.
Several more intensive chemotherapy regimens (Table 2) have produced
better response rates and improved long-term survivorship. Adding methotrexate
reduced CNS relapse significantly (12). Initial intensification (13,15,16)
produced higher CR rates; sequential chemotherapy and late intensification
(13-15) resulted in prolonged duration of remission. More aggressive treatment
is limited by toxicity (Table 2) and raises treatment-related morbidity and
mortality. Patients may have a prognosis so poor it justifies using a potentially
toxic treatment. Several of these prognostic factors recognizable at diagnosis
have been identified but not completely confirmed (35-38). Even among
subgroups with poor prognoses heterogeneity prevents data from being
comparable. In contrast, everybody agrees that response to initial treatment has
a constant and predominant prognostic significance.
Patients who respond completely carry a good prognosis. Complete
remission rates have improved with the newer, more intensive regimens (Table