https://scholars.lib.ntu.edu.tw/handle/123456789/543561
標題: | Systemic chemotherapy alone for patients with non-acquired immunodeficiency syndrome-related central nervous system lymphoma: A pilot study of the BOMES protocol | 作者: | ANN-LII CHENG KUN-HUEI YEH Uen W.-C. Hung R.-L. Liu M.-Y. Wang C.-H. |
公開日期: | 1998 | 卷: | 82 | 期: | 10 | 起(迄)頁: | 1946-1951 | 來源出版物: | Cancer | 摘要: | BACKGROUND. Anecdotal reports have suggested that systemic chemotherapy with agents that better cross the blood-brain barrier may result in long term disease remission in some patients with central nervous system (CNS) lymphoma. This treatment strategy has the advantage of sparing patients the late neurologic complications from brain irradiation. METHODS. Eligible patients were required to 1) have tissue-proven and measurable non-acquired immunodeficiency syndrome (AIDS)- related primary or metastatic CNS lymphoma; 2) have normal hemogram, renal function, and hepatic function; 3) be age ? 75 years; and 4) have provided informed consent. Patients with lymphoblastic lymphoma or patients who previously had been exposed to nitrosoureas, etoposide, or high dose methotrexate were not eligible. The systemic chemotherapy (BOMES regimen) included carmustine, 65 mg/m2/day, intravenously (i.v.) on Days 1-2; vincristine, 2 mg/day, i.v. on Days 1 and 8; methotrexate, 1.5 g/m2, i.v. on day 15 followed by leucovorin rescue; etoposide, 50 mg/m2/day, i.v. on Days 1-5; and methylprednisolone, 200 mg/day, i.v. on Days 1-7; repeated every 4 weeks (BOMES regimen). Four doses of intrathecal methotrexate were given to patients who had involvement in the cerebrospinal fluid. RESULTS. Between March 1991 and March 1997 a total of 19 patients were enrolled on the study. There were 13 men and 6 women, with a median age of 57 years. Fourteen patients had primary CNS lymphoma and 5 patients had concurrent extra-CNS lymphoma. Nine patients previously had been treated by radiotherapy (four patients), chemotherapy (three patients), or both (two patients). There were 11 complete remissions (CR) (57.9%) and 5 partial remissions (26.3%), with a total remission rate of 84.2%. One patient had progressive brain lymphoma during systemic chemotherapy with the conventional cyclophosphamide, doxorubicin, vincristine, and prednisolone regimen, but achieved CR soon after the regimen was changed to BOMES. The median time to progression of the responders was 6 months. At last follow- up, 4 patients were alive without lymphoma at 10, 47, 64, and 66 months, respectively. There were two treatment-related deaths due to sepsis. Another two patients died of fulminant hepatitis that most likely was chemotherapy- related reactivation of chronic B viral hepatitis. CONCLUSIONS. The authors believe systemic chemotherapy alone may result in long term disease remission in some select patients with non-AIDS-related CNS lymphoma. Further investigation for better protocols is mandatory. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-0032525224&doi=10.1002%2f%28SICI%291097-0142%2819980515%2982%3a10%3c1946%3a%3aAID-CNCR19%3e3.0.CO%3b2-T&partnerID=40&md5=94796e2699c88995724d947fb506402a https://scholars.lib.ntu.edu.tw/handle/123456789/543561 |
ISSN: | 0008-543X | DOI: | 10.1002/(SICI)1097-0142(19980515)82:10<1946 | SDG/關鍵字: | carmustine; cyclophosphamide; doxorubicin; etoposide; folinic acid; methotrexate; methylprednisolone; prednisolone; vincristine; adult; aged; article; brain lymphoma; brain radiation; cancer combination chemotherapy; cancer radiotherapy; cancer regression; central nervous system tumor; clinical article; clinical protocol; clinical trial; female; hepatitis; human; intrathecal drug administration; intravenous drug administration; male; priority journal; sepsis; treatment outcome; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Carmustine; Central Nervous System Neoplasms; Disease Progression; Etoposide; Female; Humans; Lymphoma, AIDS-Related; Male; Methotrexate; Methylprednisolone Hemisuccinate; Middle Aged; Pilot Projects; Prospective Studies; Survival Rate; Treatment Outcome; Vincristine |
顯示於: | 腫瘤醫學研究所 |
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