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Anthracycline-based chemotherapy as primary treatment for intravascular lymphoma

Ferreri, AJM; Campo, E; Arnbrosetti, A; Ilariucci, F; Seymour, JF; Willemze, R; Arrigoni, G; Rossi, G; Lopez-Guillermo, A and Berti, E, et al. (2004) In Annals of Oncology 15(8). p.1215-1221
Abstract
Background: Optimal therapeutic management of intravascular lymphoma (IVL) lacks precise guidelines. Patients and methods: The clinico-pathological features of 38 HIV-negative patients with IVL were reviewed to define efficacy of chemotherapy in these malignancies. Clinical characteristics of 22 patients treated with chemotherapy and of 16 untreated patients were compared in order to understand better the impact and causes of potential patient selection. Results: Median age was 70 years (range 34-90), with a male/female ratio of 0.9; 23 (61%) patients had Eastern Cooperative Oncology Group performance status (ECOG-PS) >1;21 (55%) had systemic symptoms. Cutaneous lesions and anemia were significantly more common among patients treated... (More)
Background: Optimal therapeutic management of intravascular lymphoma (IVL) lacks precise guidelines. Patients and methods: The clinico-pathological features of 38 HIV-negative patients with IVL were reviewed to define efficacy of chemotherapy in these malignancies. Clinical characteristics of 22 patients treated with chemotherapy and of 16 untreated patients were compared in order to understand better the impact and causes of potential patient selection. Results: Median age was 70 years (range 34-90), with a male/female ratio of 0.9; 23 (61%) patients had Eastern Cooperative Oncology Group performance status (ECOG-PS) >1;21 (55%) had systemic symptoms. Cutaneous lesions and anemia were significantly more common among patients treated with chemotherapy; central nervous system (CNS) and renal involvement were significantly more common among untreated patients. Chemotherapy was associated with a response rate of 59% and a 3-year overall survival of 33 +/- 11%. Five of six patients with CNS involvement received chemotherapy: four of them died early; only one patient, treated with adriamycin, cyclophosphamide, vincristine, methotrexate, bleomycin and prednisolone (MACOP-B) followed by high-dose chemotherapy and autologous stem cell transplantation (ASCT), was alive at 19 months. High-dose chemotherapy supported by ASCT was indicated at diagnosis in another patient (43 years of age, stage 1), who was alive at 71 months, and at relapse after cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) in two patients who died early after transplantation. PS less than or equal to 1, disease limited to the skin, stage 1, and use of chemotherapy were independently associated with better outcome. Conclusions: Anthracycline-based chemotherapy is the standard treatment for IVL. However, survival is disappointing, with a relevant impact of diagnostic delay and lethal complications. More intensive combinations, containing drugs with higher CNS bioavailability, are needed in cases with brain involvement, and the role of high-dose chemotherapy supported by ASCT should be further investigated in younger patients with unfavorable features. (Less)
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Contribution to journal
publication status
published
subject
keywords
angiotropic lymphoma, CHOP regimen, cutaneous lymphoma, CNS lymphoma, chemotherapy, intravascular lymphomatosis
in
Annals of Oncology
volume
15
issue
8
pages
1215 - 1221
publisher
Oxford University Press
external identifiers
  • pmid:15277261
  • wos:000223355400010
  • scopus:4444313474
ISSN
1569-8041
DOI
10.1093/annonc/mdh274
language
English
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yes
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886752f9-1dc8-4464-9267-008dde2c0b1c (old id 270628)
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http://annonc.oxfordjournals.org/content/15/8/1215.abstract
date added to LUP
2007-08-02 13:13:10
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2017-11-19 04:14:21
@article{886752f9-1dc8-4464-9267-008dde2c0b1c,
  abstract     = {Background: Optimal therapeutic management of intravascular lymphoma (IVL) lacks precise guidelines. Patients and methods: The clinico-pathological features of 38 HIV-negative patients with IVL were reviewed to define efficacy of chemotherapy in these malignancies. Clinical characteristics of 22 patients treated with chemotherapy and of 16 untreated patients were compared in order to understand better the impact and causes of potential patient selection. Results: Median age was 70 years (range 34-90), with a male/female ratio of 0.9; 23 (61%) patients had Eastern Cooperative Oncology Group performance status (ECOG-PS) >1;21 (55%) had systemic symptoms. Cutaneous lesions and anemia were significantly more common among patients treated with chemotherapy; central nervous system (CNS) and renal involvement were significantly more common among untreated patients. Chemotherapy was associated with a response rate of 59% and a 3-year overall survival of 33 +/- 11%. Five of six patients with CNS involvement received chemotherapy: four of them died early; only one patient, treated with adriamycin, cyclophosphamide, vincristine, methotrexate, bleomycin and prednisolone (MACOP-B) followed by high-dose chemotherapy and autologous stem cell transplantation (ASCT), was alive at 19 months. High-dose chemotherapy supported by ASCT was indicated at diagnosis in another patient (43 years of age, stage 1), who was alive at 71 months, and at relapse after cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) in two patients who died early after transplantation. PS less than or equal to 1, disease limited to the skin, stage 1, and use of chemotherapy were independently associated with better outcome. Conclusions: Anthracycline-based chemotherapy is the standard treatment for IVL. However, survival is disappointing, with a relevant impact of diagnostic delay and lethal complications. More intensive combinations, containing drugs with higher CNS bioavailability, are needed in cases with brain involvement, and the role of high-dose chemotherapy supported by ASCT should be further investigated in younger patients with unfavorable features.},
  author       = {Ferreri, AJM and Campo, E and Arnbrosetti, A and Ilariucci, F and Seymour, JF and Willemze, R and Arrigoni, G and Rossi, G and Lopez-Guillermo, A and Berti, E and Eriksson, Mikael and Federico, M and Cortelazzo, S and Govi, S and Frungillo, N and Dell'Oro, S and Lestani, M and Asioli, S and Pedrinis, E and Ungari, M and Motta, T and Rossi, R and Artusi, T and Iuzzolino, P and Zucca, E and Cavalli, F and Ponzoni, M},
  issn         = {1569-8041},
  keyword      = {angiotropic lymphoma,CHOP regimen,cutaneous lymphoma,CNS lymphoma,chemotherapy,intravascular lymphomatosis},
  language     = {eng},
  number       = {8},
  pages        = {1215--1221},
  publisher    = {Oxford University Press},
  series       = {Annals of Oncology},
  title        = {Anthracycline-based chemotherapy as primary treatment for intravascular lymphoma},
  url          = {http://dx.doi.org/10.1093/annonc/mdh274},
  volume       = {15},
  year         = {2004},
}