The Effect of Intensified Induction Using Vanderbilt Regimen in Patients with an Intermediate Grade Non-Hodgkin's Lymphoma Having 2 or 3 Adverse Factors on the Age-adjusted International Prognostic Index / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of our study was to evaluate the outcome of intensified induction therapy using the Vanderbilt regimen in patients with a poor prognosis non-Hodgkin's lymphoma (NHL). MATERIALS AND METHODS: We retrospectively analyzed the results of two pilot studies, which enrolled the patients aged 60 years or less, with a previously untreated NHL of intermediate grade on the Working formulation, having 2 or 3 adverse prognostic factors on the age- adjusted International Prognostic Index. Patients received an intensified induction, with the regimen described by the Vanderbilt group. RESULTS: Thirty-five patients were analyzed. After induction, 29 patients (83%) achieved more than partial response (PR): 22 (63%) complete response (CR) and 7 (20%) PR. Three of the PRs were subsequently converted to CR following consolidation therapy. The overall CR rate, following the completion of treatment, was 71%. The 3-year overall survival (OS) rate of all patients was 53%. In the univariate analysis, age (50 years) was the only factor affecting the OS. The 3-year disease-free survival (DFS) rate of patients with CR was 68%. In the univariate analysis, age and bone marrow involvement were the factors affecting the DFS. Two patients died from the treatment-related toxicity of the induction therapy: one due to sepsis and the other due to congestive heart failure. CONCLUSION: Although the CR rate was relatively high, the OS or DFS of patients with a poor prognosis NHL, who had received the intensified induction using the Vanderbilt regimen, were no different from those that had received the conventional chemotherapy, as reported by the International Prognostic Index Project. However, the OS or DFS in the young patient groups were encouraging. To test the hypothesized benefits of our approach in the young patient groups, a larger cohort of patients aged 50 years or less should be studied.

Effect of Treatment with Intensified Induction Regimen in Adult Acute Lymphocytic Leukemia / 대한혈액학회지

BACKGROUND: Adult acute lymphocytic leukemia (ALL) is a hematologic malignant disease characterized by an uncontrolled proliferation of immature lymphocytes and their progenitors. Progress in the treatment of adults with ALL has been more difficult to achieve, and until recently there was general agreement that adults have lower remission rates, briefer duration of remissions, and shorter survival times than that of children receiving identical treatment. METHODS: Twenty one patients with ALL were treated with remission induction chemotherapy consisting of vincristine, prednisolone, daunorubicin and L-asparaginase. After successful remission induction, consolidation-intensification and maintenance therapy, CNS prophylaxis were done. RESULTS: 1) The overall complete remission (CR) rate was 66.7% (14/21). The median remission duration for the 14 patients with CR was 16 months (3~31 months) and the median overall survival time was 11 months (1~35 months). The 3-year relapse free survival rate was 14.3% and the median time to complete remission was 41 days (18~71 days). The median overall survival time of complete remission group was 31.8 months and non-response group was 1.4 months. 2) Five (23.8%) patients died during the induction therapy period and two patients did not respond to treatment. 3) Six out of fourteen patients (42.9%) who had achieved remission relapsed and the sites of relapse were the bone marrow (66.7%) and CNS (16.7%). 4) Fourteen patients (66.7%, 14/21) died during follow-up period. The main causes of death were infection in eight cases (57.1%) and hemorrhage in two (14.3%). 5) Favorable factors influencing the remission rate were initial response to chemotherapy and sex (P=0.031), and factor influencing survival time was complete remission (P=0.005). CONCLUSION: This induction regimen was thought to be effective in remission rate, but it has considerable number of side effects and the shortness of the remission duration. In the future, more intensified induction and consolidation chemotherapy should be considered.