CHEP与B-CHOP方案治疗非霍奇金淋巴瘤

（目的）评价CHEP方案和B-CHOP方案治疗非霍奇金淋巴瘤（NHL）的疗效和毒性。（方法）1990年6月至1998年4月应用CHEP方案（环磷酰胺、阿霉素、足叶乙甙、强的松）或B-CHOP方案（平阳毒素、环磷酰胺、阿霉素、长春新碱、强的松）治疗NHL30例，随机分组，每组15例。疗效和毒性用卡方检验。（结果）CHEP组有效率86．6％（13／15），其中初治6例中，完全缓解（CR）5例；B-CHOP组有效率73．3％（11／15），初治10例中，CR5例（5／10）。随访至1998年4月底，CHEP组存活10例，B-CHOP组存活9例，中位生存期为25个月和19个月。初治CR者，一年无病生存（DFS）率两组分别为83．3％和Zo％，差异有显著性（P＜0．05），2～5年DFS率差异无显著性（P＞0．05）。两组毒性均可耐受。（结论）CHEP治疗NHL，初治一年DFS率显著优于BCHOP组（P＜0．05），且CHEP组无发热反应，无末梢神经毒性。     

CHEP与B—CHOP方案治疗非霍奇金淋巴瘤

目的 评价ＣＨＥＰ方案和Ｂ－ＣＨＯＰ方案治疗非霍奇金淋巴瘤（ＮＨＬ）的疗铲和毒性。方法 １９９０的上６月至１９９８年４月应用ＣＨＥＰ方案（环磷酰胺、阿霉素、足叶乙甙、足叶乙甙、强的松）或Ｂ－ＣＨＯＰ方案（平阳毒素、环磷酰胺、阿霉素、长春新碱、强的松）治疗ＮＨＬ３０例，随机分组，每组１５例。疗效和毒性用卡方检验。结果 ＣＨＥＰ组有效率８６．６％（１３／１５），其中初治６例中，完全缓解（ＣＲ）５例；Ｂ     

不同方案治疗中高度恶性非霍奇金淋巴瘤的临床探讨

目的寻找治疗中、高度恶性非霍奇金淋巴瘤（ＮＨＬ）完全缓解（ＣＲ）率高的最佳方案。方法将７４例组织学证实的ＮＨＬ患者随机分为两组：治疗组应用改良的ＰｒｏＭＡＣＥ—ＣｙｔａＢＯＭ方案,对照组应用ＣＨＯＰ方案。结果治疗组ＣＲ率５６．８％,对照组为３５．１％,两组差异无显著性（Ｐ＞０．０５）。治疗高度恶性ＮＨＬ治疗组ＣＲ率达６０．０％,而对照组只有３２．０％,两组差异有显著性（Ｐ＜０．０５）。两组毒副反应均为骨髓抑制及消化道反应,一般均耐受。结论治疗高度恶性ＮＨＬ,Ｐｒｏ－ＭＡＣＥ—ＣｙｔａＢＯＭ方案是一个安全且ＣＲ率高的化疗方案,其远期效果有待进一步研究。     

PROMACE和CYTBOM方案治疗中高度非霍奇金淋巴瘤疗效及毒性观察

目的　评价PROMACE和CYTBOM方案治疗中高度非霍奇金淋巴瘤疗效及毒性。方法　 44例经组织学证实的NHL患者分为PROMACE和CYTBOM方案治疗组 ,CHOP方案对照组。结果　治疗组总缓解率为 90 9% ,对照组为 73 9% ,两组差异无显著性 (P >0 .0 5 ) ;治疗组CR率 45 5 % ,对照组为 3 4 8% ,两组差异无显著性。初治病例CR率 :治疗组 5 3 3 % ,对照组为 3 8 5 % ,两组差异无显著性 (P >0 .0 5 )。治疗组 2年生存率及中位生存期分别为 5 0 % ,2 2 5月 ;对照组为 40 5 %和 19 5月 ,两组差异无显著性。两组毒副反应均为骨髓抑制及轻度消化道反应 ,均能耐受。结论　对于中高度恶性非霍奇金淋巴瘤 ,PROMACE和CYTBOM方案是一个疗效及安全性较高的第三代化疗方案。     

PROMACE和CYTBOM方案治疗中高度非霍奇金淋巴瘤疗效及毒？…

目的评价ＰＲＯＭＡＣＥ和ＣＹＴＢＯＭ方案治疗中高度非霍奇金淋巴瘤疗效及毒性。方法４４经组织学证实 ＰＲＯＭＡＣＥ和ＣＹＴＢＯＭ方案治疗组。ＣＨＯＰ方案对照组。结果 治疗组总缓解率为９０．９％，对照组为７３．９％，两组差异无显著性；治疗组ＣＲ率４５．５％，对照组为３４．８％，两组差异无显著性。初治病便ＣＲ率；治疗组５３．３％，对照组为３８．５％，两组差异无显著性。治疗 ２年生存率及中位生存期分别为５     

增强剂量CHOP方案治疗非霍奇金淋巴瘤51例

〔目的〕探讨增强剂量CHOP方案治疗非霍奇金淋巴瘤的临床完全缓解率和3年生存率及骨髓抑制等情况。（方法）对51例非霍奇金淋巴瘤患者进行增强剂量CHOP方案治疗及良好的支持治疗并长期、定期治疗及随访。（结果）全组完全缓解率为784％；3年生存率为779％。（结论）增强剂量CHOP方案与传统CHOP方案相比在完全缓解率和3年生存率上有明显提高，而其骨髓抑制等毒副反应未见明显增加。     

CHOP—平阳霉素方案治疗非霍奇金淋巴瘤29例的疗效观察

目的观察环磷酰胺、阿霉素、长春新碱、泼尼松－平阳霉素（ＣＨＯＰ－ＢｌｅｏＡ５）方案治疗非霍奇金淋巴瘤的疗效。方法采用ＣＨＯＰ－ＢｌｅｏＡ５方案治疗非霍奇金淋巴瘤２９例，其中初治４例，复治２５例。结果２９例中，完全缓解１０例（３４．５％），部分缓解１１例（３７．９），有效率为７２．４％。有效病例的中位生存期为１３个月，明显长于无效者的２．５个月。本方案不良反应小，患者都能耐受。结论ＣＨＯＰ－ＢｌｅｏＡ５方案可作为治疗非霍奇金淋巴瘤患者的有效方案。     

MACOP方案治疗非霍奇金淋巴瘤

34例非霍奇金淋巴瘤患者随机分为两组（各17例），分别采用CHOP方案及CHOP方案基础上加用中剂量甲氨喋呤（MTX）及甲酰四氢叶酸钙（CF）解救进行治疗（MACOP方案）。结果MACOP组及CHOP组的CR率分别52．9％和23．5％，RR率分别为76．5％和58．8％。两组方案的Ⅲ-Ⅳ度骨髓抑制MACOP组比CHOP组明显，MACOP组口腔溃疡的发生率明显高于CHOP组（P＜0．05），余无明显差异。     

CHNP和CHOP方案治疗非霍奇金淋巴瘤的临床疗效和安全性比较

目的 观察和比较含长春瑞滨(盖诺)的CHNP方案与含长春新碱的CHOP方案治疗非霍奇金淋巴瘤的疗效及安全性.方法 收集并统计23例以标准CHNP及21例CHOP方案治疗的病例.结果 CHNP组总有效率(CR+PR)为87.0%,CHOP组的总有效率(CR+PR)为61.9%,两者差异有显著性.两组毒副作用差异无显著性.结论 含长春瑞滨(盖诺)的CHNP方案治疗晚期非霍奇金淋巴瘤有较好的疗效,与CHOP方案相比毒副作用相仿,疗效更显著.     

长春地辛组成CHOP方案治疗非霍奇金淋巴瘤临床观察

为了观察长春地辛(vindesine，VDS)或长春新碱(vineristine，VCR)组成CHOP方案治疗非霍奇金淋巴瘤(non-hodgkins lymphoma，NHL)的疗效砭毒副反应，将46例NHL患者随机对照(randomized control trail)应用VDS或VCR组成的CHOP方案化疗。结果VDS组有效率为90．5%(19/21)，VCR组为81．3％(13/16)．差异无统计学意义，P=0．634。9例CHOP方案无效患者应用VDS组成的CHOP方案后1例CR，3例PR。VDS组神经系统毒副反应明显低于VCR组，P=0．028。初步研究结果提示，VDS或VCR组成CHOP方案疗效相当．VDS神经毒性较低，其他系统毒性与其相当。含有长春地辛的方案对传统方案不敏感的中、低度恶性NHL可能有效。     

Dose-escalation of CHOP in non-Hodgkin's lymphoma

Background: CHOP is considered to be the gold standard for patients with histologically aggressive non-Hodgkin's lymphoma both in limited and advanced stages. In order to determine the maximum tolerable dose of an intensified CHOP regimen, a dose-escalation study of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) in patients with non-Hodgkin's lymphoma (NHL) was started.Patients and methods: With an increased fixed dose of doxorubicin at 75 mg/m2 instead of 50 mg/m2 on day 1 and standard doses of vincristine (1.4 mg/m2 on day 1) and prednisone (100 mg day 1 through 5), cyclophosphamide dose was escalated by increments of 250 mg/m2 in consecutive cohorts of at least three patients starting from 1000 mg/m2. Granulocyte-colony stimulating factor (G-CSF) support was added to the regimen starting from the dose-level inducing grade 4 neutropenia lasting more than five days in two patients. Dose limiting toxicity was defined as either the dose inducing grade 4 neutropenia lasting more than seven days despite the use of G-CSF, or grade 3–4 thrombocytopenia lasting more than seven days, or any grade 4 non-hematological toxicity other than alopecia. The dose-level below the one inducing dose-limiting toxicity was defined as maximum tolerable dose. All patients were treated on an outpatient basis. Dose-intensity parameters for single agent doxorubicin and cyclophosphamide as well as for the whole regimen were evaluated.Results: Eighty-seven patients are evaluable over a four-year study period. At 1750 mg/m2 dose-level, G-CSF was added to the regimen according to described criteria. At the cyclophosphamide dose of 3000 mg/m2, dose-limiting hematological toxicity occurred in two patients, with one grade 4 thrombocytopenia and neutropenia and one grade 4 neutropenia lasting more than seven days. Thus, cyclophosphamide dose of 2750 mg/m2 was defined as maximum tolerable dose.Conclusions: CHOP intensification of approximately 1.8 times that of the standard regimen is feasible and safely administered on an outpatient basis with G-CSF support. Further investigation on the role of dose-intensity in the outcome of NHL should focus on the comparison of intensified CHOP regimen and standard CHOP or high-dose chemotherapy.     

Addition of etoposide to CHOP chemotherapy in untreated patients with high-grade non-Hodgkin's lymphoma

Background: Second- and third-generation chemotherapy protocols for the treatment of aggressive non-Hodgkin's lymphomas (NHL) have considerable, and age-related, toxic effects. In addition, they do not seem to prolong overall survival in comparison to standard CHOP chemotherapy. In this phase II study we investigated the feasibility and efficacy of the addition of etoposide to the conventional CHOP regimen.Patients and methods: Toxicity and clinical efficacy were determined in 132 patients with previously untreated high-grade NHL. There were 51 patients in clinical stage I and II and 81 patients in stage III and IV, with a median age of 54 years (range 17–85). Patients received standard-dose CHOP plus etoposide 100 mg/m2 i.v. on day 1 and 200 mg/m2 p.o. on days 2–3.Results: The overall response rate was 84%, with 70% complete and 14% partial responses. The predicted three- and five-year survivals for the group as a whole were 60% and 53%, respectively, and the corresponding disease-free survivals for patients achieving complete remissions were 65% and 56%, respectively. Outcome was not different from that of CHOP-treated patients in a recently completed Nordic study performed during the same time period. Myelosuppression (WHO grade 3–4), observed in 87% of patients and infectious complications (WHO grade 3–4) in 33%, dominated the toxicity profile of this regimen. Fifty-seven of 92 complete responders (62%) received 6–8 CHOP-E cycles with no reductions in planned dose intensity. LDH level higher than normal, extranodal sites = 2, stage III–IV at diagnosis were all indicators of a poor survival.Conclusions: We conclude that CHOP-E treatment is effective in high-grade NHL. However, mainly due to severe myelosuppression frequent schedule modifications were required and the results are not obviously superior to those of conventional CHOP.     

Risk of febrile neutropenia among patients with intermediate-grade non-Hodgkin's lymphoma receiving CHOP chemotherapy

We sought to identify risk factors associated with the time to febrile neutropenia in patients with intermediate-grade, non-Hodgkin's lymphoma (NHL) who were receiving treatment with CHOP chemotherapy. Data were collected from 12 community and academic oncology practices participating in the Oncology Practice Pattern Study between 1991 and 1999. We reviewed the medical records of 577 intermediate-grade NHL patients who received initial CHOP chemotherapy and evaluated risk factors associated with time to first febrile neutropenic event. A febrile neutropenic event was defined as a body temperature of > 100.6 degrees F and an ANC nadir < 1000/mm3. A total of 160 patients experienced 224 febrile neutropenic events. The risk of febrile neutropenia was significantly associated with age > or = 65 years (p = 0.001), cardiovascular disease (p = 0.020), renal disease (p = 0.006), baseline hemoglobin < 12 g/dl (p = 0.018), > 80% planned average relative dose intensity (ARDI; p = 0.018), and no prophylactic colony-stimulating factor (CSF) use (p = 0.046). First febrile neutropenic events occurred by day 14 of cycle 1 in one-half of patients experiencing febrile neutropenia. In multivariate analysis, the risk of febrile neutropenia remained significantly associated with age > or = 65 years (HR = 1.65, 95% CI: 1.18-2.32), renal disease (HR = 1.91. 95% CI: 1.10-3.30), cardiovascular disease (HR = 1.54, 95% CI: 1.02-2.33), baseline hemoglobin < 12 g/dl (HR = 1.44, 95% CI: 1.04-2.00), > 80% planned CHOP ARDI (HR = 2.41, 95% CI: 1.30-4.47), and no CSF prophylaxis (HR = 2.13, 95% CI: 1.20-3.76). Such a model may permit the identification of patients at greatest risk of febrile neutropenia and, therefore, candidates for the selective prophylactic use of the hematopoietic growth factors.     

Rituximab-CHOP-ESHAP vs CHOP-ESHAP-high-dose therapy vs conventional CHOP chemotherapy in high-intermediate and high-risk aggressive non-Hodgkin's lymphoma

With currently available combination chemotherapy regimens, the outcome of the patients newly diagnosed with aggressive non-Hodgkin's lymphoma (NHL) identified as 'high' and 'high-intermediate' risk groups according to the international prognostic index (IPI) is still unsatisfactory and a more innovative therapy is urgently required to improve the survival of the patients. The purpose of this study was to compare the efficacy of rituximab given in combination with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) and ESHAP (etoposide, methylprednisolone, high-dose Ara-C, cisplatin) vs CHOP-ESHAP and upfront high-dose therapy (HDT) and autologous stem cell transplantation (ASCT) vs standard CHOP in patients aged < or = 65 years old newly diagnosed with 'high' and 'high-intermediate' risk aggressive lymphoma enrolled onto two consecutive treatment trials at the institute. Between May 1995 - July 2002, 84 patients, aged 15 - 65 years old, with newly diagnosed aggressive NHL and an age-adjusted IPI of 2 or 3 were enrolled. The median age of the patients was 38 years (range 15 - 65). The baseline demographic features, in particular the major prognostic variables, were similar between the treatment groups. Patients treated with rituximab-CHOP-ESHAP received eight cycles of rituximab (375 mg m(-2) on day 1 of cycles 1 - 6 and days 21 and 28 of cycle 7) plus CHOP (day 3 of cycles 1, 3 and 5) and ESHAP (day 3 of cycles 2, 4 and 6 and day 1 of cycle 7) at 21-day intervals. Patients enrolled onto the CHOP-ESHAP-HDT arm (n = 23) were treated with three courses of CHOP and then switched to two or four cycles of ESHAP followed by HDT. Patients treated with CHOP alone (n = 25) were treated with the standard eight cycles of CHOP. The rate of complete remission was significantly improved with rituximab-CHOP-ESHAP compared with either CHOP-ESHAP-HDT or CHOP alone (67% compared with 44% and 36%, respectively; p = 0.043). With a median follow-up time of 53 months, the 5-year overall survival (OS) was improved by the addition of rituximab-61% with rituximab-CHOP-ESHAP, compared with 43% for CHOP-ESHAP-HDT and 24% for CHOP alone (p = 0.088). Significant increases in failure-free survival (FFS) and disease-free survival (DFS) (61% and 96%), compared with CHOP-ESHAP-HDT (34% and 90%) and CHOP (16% and 44%; p = 0.002 and p < 0.001, respectively) were observed. Compared to CHOP, rituximab-CHOP-ESHAP yielded significantly superior OS (p = 0.014), FFS (p < 0.001) and DFS (p < 0.001). The survivals, however, were not significantly different from patients treated with CHOP-ESHAP-HDT. It is concluded that rituximab-ESHAP-CHOP is superior over standard CHOP and fares comparably to upfront HDT/ASCT in previously untreated patients with aggressive lymphoma. A prospective randomized controlled trial is warranted to confirm these results.     

Modified CHOP therapy in patients with non-Hodgkin's lymphoma

From July 1983 to December 1989, 31 previously untreated patients with non-Hodgkin's lymphoma were treated with modified CHOP regimen (cyclophosphamide 300 mg/m2 on day 1, aclacinomycin 40 mg/m2 on day 1, vincristine 0.7 mg/m2 on day 1 and prednisolone 40 mg/m2 on days 1-5). The therapy was repeated at 2-week intervals. The complete response rate was 66.7% for clinical stage (CS) II according to the Ann Arbor criteria, 60.0% for CS III and 33.3% for CS IV, respectively. The 5-year survival rate was 100% for CS II, 36.6% for CS III and 34.6% for CS IV, respectively. Clinical effects of modified CHOP regimen were almost the same as those of other therapies including adriamycin from the standpoint of 5-year survival rate. On the other hand, the myelosuppression accompanying modified CHOP therapy was not severe. Only one patient had a white blood count below 1,000/microliters during 6 courses of the therapy. It is thought that this regimen is useful to enhance the quality of life of patients because of no severe complications such as myelosuppression.     

Early cardiotoxicity of the CHOP regimen in aggressive non-Hodgkin's lymphoma.

BACKGROUND: To determine the incidence of early cardiotoxicity induced by the CHOP regimen in patients with aggressive non-Hodgkin's lymphoma (NHL) and to identify associated risk factors. PATIENTS AND METHODS: A retrospective analysis included 135 consecutive patients who had been treated with the CHOP (cyclophosphamide, doxorubicin, vincristin, prednisone) regimen as first-line therapy between 1994 and 2000. The cardiac evaluation was based on a determination of the resting left ventricular ejection function (LVEF) by gated blood-pool imaging. Cardiotoxicity was defined as a significant decrease in LVEF or clinical evidence of congestive heart failure (CHF). RESULTS: Twenty-seven (20%) patients developed a cardiac event within 1 year of treatment. Among these, 14 patients had clinical signs of CHF. Three patients died suddenly from presumed cardiac causes. In multivariate analysis, a cumulative dose of doxorubicin >200 mg/m(2) [odds ratio (OR) = 4.2, P = 0.005)] and age over 50 years (OR = 2.9, P = 0.03) appeared to be significant risk factors. CONCLUSION: Early clinical and subclinical cardiotoxicity was frequent in patients receiving the CHOP regimen. The threshold of the cumulative dose of doxorubicin appeared to be low: at doses >200 mg/m(2), 27% of patients had cardiac events. Elderly patients appeared to be at higher risk. The development of cardioprotective strategies or alternative treatments are mandatory for aggressive NHL patients.     

Remission maintenance therapy of non-Hodgkin's lymphoma with CHOP protocol

We have retrospectively studied the problems concerning duration of maintenance therapy and chemotherapy regimens for non-Hodgkin's lymphoma treated at Shikoku Cancer Center Hospital. Four out of 15 complete remission cases had been in complete remission more than 3 years. Maintenance chemotherapy consists of CHOP protocol administering every 4 weeks and the median maintenance duration was 14 months with a median cycle of 14. Thereafter, patients have been followed up without receiving any therapy. The prospective study on maintenance therapy should be designed considering conditions such as 1) sufficient drug doses for cytocidal effects, 2) shorter maintenance period as possible, and 3) minimal side effects and complications to be expected.     

CHOP-PVP与CHOP方案治疗非霍奇金淋巴瘤的疗效比较

目的　比较CHOP PVP与CHOP方案治疗非霍奇金淋巴瘤 (NHL)的疗效。方法　 79例NHL患者采用CHOP PVP方案治疗 4 0例 ,采用CHOP方案治疗 39例。采用Kaplan Meier方法分析患者治疗后的生存期 ,采用Cox比例风险模型分析影响预后的因素。结果　CHOP PVP方案组完全缓解率 5 7.5 % (2 3/ 4 0 ) ,总有效率 87.5 % (35 / 4 0 ) ;CHOP方案组完全缓解率 33.3% (13/ 39) ,总有效率 6 9.2 %(2 7/ 39)。两组完全缓解率差异有显著性 (P <0 .0 5 ) ,总有效率差异有显著性 (P <0 .0 5 )。两组患者的主要毒副反应为骨髓抑制。白细胞下降CHOP PVP组为 82 .5 % ,CHOP组为 71.8% (P >0 .0 5 ) ,但均无Ⅳ度下降发生 ,亦无与毒性有关的死亡发生。结论　CHOP PVP方案具有有效率高、副反应无明显加重的优点 ,可替代经典的CHOP方案治疗NHL。     

Weekly CHOP for the treatment of advanced intermediate and high-grade non-Hodgkin's lymphoma

Between January 1981 and September 1986, 48 patients with advanced (stages III and IV) intermediate and high-grade non-Hodgkin's lymphoma (NHL) were treated with weekly CHOP (doxorubicin, vincristine, cyclophosphamide, and prednisolone), using reduced dosages of cyclophosphamide and doxorubicin. Low-dose oral maintenance chemotherapy was given for 2 years to those patients in remission. Twenty-seven patients (56%) of the evaluable 48 patients achieved a complete response and 12 patients (25%) had a partial response, for an overall response rate of 81%. The relapse-free survival for complete responders has been at a plateau of 67% at 16 months, and actuarial survival for complete responders has been 62%, with no deaths occurring beyond 43 months (survival plateau). One treatment-related death occurred, but toxicity was generally modest. The median time required from the start of weekly CHOP to complete response was only 5 weeks. Weekly CHOP can achieve results similar to those obtained by currently popular regimens utilizing a greater number of drugs at higher dosages.