Original Article
ACVBP versus CHOP plus Radiotherapy for Localized Aggressive Lymphoma
N Engl J Med 2005; 352:1197-1205March 24, 2005
- Abstract
Background
Chemoradiotherapy is standard treatment for localized aggressive lymphoma. To determine the optimal therapy for nonelderly persons with low-risk localized lymphoma, we conducted a randomized trial comparing chemoradiotherapy with chemotherapy alone.
Methods
Previously untreated patients less than 61 years old with localized stage I or II aggressive lymphoma and no adverse prognostic factors according to the International Prognostic Index were randomly assigned to three cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus involved-field radiotherapy (329 patients) or chemotherapy alone with dose-intensified doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (ACVBP) plus sequential consolidation (318 patients).
Results
With a median follow-up of 7.7 years, event-free and overall survival rates were significantly higher in the group given chemotherapy alone than in the group given CHOP plus radiotherapy (P<0.001 and P=0.001, respectively). The five-year estimates of event-free survival were 82 percent (95 percent confidence interval, 78 to 87 percent) for patients receiving chemotherapy alone and 74 percent (95 percent confidence interval, 69 to 78 percent) for those receiving chemoradiotherapy. The respective five-year estimates of overall survival were 90 percent (95 percent confidence interval, 87 to 93 percent) and 81 percent (95 percent confidence interval, 77 to 86 percent). In a multivariate analysis, event-free and overall survival rates were affected by treatment group, independently of tumor stage and the presence or absence of bulky disease.
Conclusions
In patients under 61 years of age, chemotherapy with three cycles of ACVBP followed by sequential consolidation is superior to three cycles of CHOP plus radiotherapy for the treatment of low-risk localized lymphoma.
Media in This Article
Figure 1
Event-free Survival among 647 Patients Assigned to Chemotherapy Alone with the ACVBP Regimen or to CHOP plus Involved-Field Radiotherapy.Figure 2
Event-free Survival among 574 Patients without Bulky Tumor Assigned to Chemotherapy Alone with the ACVBP Regimen or to CHOP plus Involved-Field Radiotherapy.Article Activity
- Article
Radiotherapy was the standard treatment for limited (stage I or II) aggressive lymphoma until 1980, although the five-year rate of disease-free survival was less than 50 percent.1 Subsequently, chemotherapy was added to involved-field radiotherapy (chemoradiotherapy) with the goals of controlling occult systemic disease and reducing the size of irradiation fields.2 Other investigators, however, advanced the idea that chemotherapy alone could cure limited aggressive lymphoma3; as a result, either chemoradiotherapy or chemotherapy alone was used for localized lymphoma4 until the superiority of three cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) followed by involved-field radiotherapy over eight cycles of CHOP alone was demonstrated.5
The Groupe d'Etude des Lymphomes de l'Adulte (GELA) has developed a chemotherapy regimen that consists of an induction phase of intensified doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (ACVBP) followed by sequential consolidation. In a previous study of two chemotherapy regimens for intermediate or high-grade lymphoma,6 the estimated five-year rate of overall survival among patients with localized disease who received the ACVBP regimen was 80 percent, which is similar to results in other trials that used chemoradiotherapy. We therefore launched the present randomized study to compare the ACVBP regimen with chemoradiotherapy in patients under 61 years of age who had localized aggressive lymphoma and no adverse prognostic factors, as defined by the age-adjusted International Prognostic Index.7
Methods
Patients
Study patients had to be older than 15 and younger than 61 years of age, to have newly diagnosed aggressive lymphoma (diffuse mixed, diffuse large-cell, or immunoblastic according to the Working Formulation,8 and anaplastic according to the updated Kiel classification9), and to have no adverse prognostic factors according to the age-adjusted International Prognostic Index.7 Exclusion criteria included positive serologic tests for human immunodeficiency virus or human T-cell lymphotropic virus type 1, transformation of a previously indolent lymphoma, primary cerebral lymphoma, previous organ transplantation, concomitant or previous cancer (except in situ cervical carcinoma), liver or kidney failure, and a cardiac contraindication to doxorubicin. Patients with intestinal lymphoma that could not be safely encompassed in a radiation field were also excluded from the study. The trial was approved by the ethics committee of Hôpital Saint-Louis, and all patients gave written informed consent.
Pathology
The Working Formulation8 and the Kiel classification9 were used to classify lymphoma at the time of enrollment. A central review was conducted by at least two pathologists from the GELA, and tumors were then reclassified according to the classification of the World Health Organization.10
Staging
The extent of the disease was evaluated by means of physical examination, computed tomography of the chest, abdomen, and pelvis, cerebrospinal fluid examination, bone marrow biopsy, and other investigational procedures depending on clinical symptoms. The stage of lymphoma was defined on the basis of the Ann Arbor classification: stage I was defined as the involvement of a single lymph-node region or extranodal site, and stage II as the involvement of two or more nodal regions or involvement of an extranodal site and one or more adjacent nodal regions on the same side of the diaphragm. Tumor measurements were obtained before biopsy, and bulky disease was defined as any mass 10 cm or more in maximal diameter. Performance status was assessed according to the Eastern Cooperative Oncology Group scale, and the serum lactate dehydrogenase level was expressed as the ratio of the maximal value to the normal value.7
Treatment
Patients were randomly assigned to treatment with chemotherapy alone or chemoradiotherapy, both delivered on an ambulatory basis. Chemotherapy alone consisted of three cycles of ACVBP6 (75 mg of doxorubicin per square meter of body-surface area and 1200 mg of cyclophosphamide per square meter on day 1, 2 mg of vindesine per square meter and 10 mg of bleomycin on days 1 and 5, and 60 mg of prednisone per square meter on days 1 through 5) given at two-week intervals and followed by sequential consolidation consisting of two cycles of methotrexate (3 g per square meter) plus leucovorin rescue, four cycles of etoposide (300 mg per square meter) and ifosfamide (1500 mg per square meter), and two cycles of cytarabine (100 mg per square meter) subcutaneously for four days given at two-week intervals.6
Chemoradiotherapy consisted of three cycles of CHOP (50 mg of doxorubicin per square meter, 750 mg of cyclophosphamide per square meter, 1.4 mg of vincristine per square meter [up to a maximal dose of 2 mg] on day 1 and 60 mg of prednisone per square meter on days 1 through 5) repeated at 21-day intervals. Involved-field radiotherapy began one month after the last cycle of CHOP. The prescribed dose of radiation was 40 Gy in 22 fractions of 1.8 Gy, five days per week. Irradiated volumes encompassed involved nodal or extranodal sites and adjacent uninvolved nodes.
In neither group was adjustment of the dose of chemotherapy planned in response to specific adverse events, but courses were postponed until leukocyte and platelet counts increased to greater than 2000 and 100,000 per cubic millimeter, respectively. Patients could receive granulocyte colony-stimulating factor at the discretion of each investigator.
Assessment of Response
Response was evaluated one month after the completion of treatment, according to the International Workshop criteria.11 A complete response was defined as the disappearance of all clinical evidence of disease and of radiologic abnormalities observed at diagnosis. An unconfirmed complete response was defined as a complete response with some persisting radiologic abnormalities, which in the aggregate had to be at least 75 percent smaller than the original abnormality. A partial response was defined as the regression of tumor volumes by more than 50 percent, and stable disease was defined as a lesser response. Progressive disease (growth of the initial lesion by more than 25 percent or the appearance of a new lesion) during treatment was considered to indicate primary treatment failure.
Statistical Analysis
Randomization was stratified according to center and the presence or absence of bulky disease. The main objective of the trial was to detect an absolute improvement of 10 percent with chemotherapy alone given a two-year rate of event-free survival of 75 percent in the group assigned to CHOP plus radiotherapy (with a type I error of 0.05 and a type II error of 0.10). This design required the enrollment of 400 patients over a period of four years. After a planned interim analysis performed after 200 patients had been enrolled and monitored for at least six months, the data and safety monitoring committee recommended that the sample size be calculated on the assumption of an absolute improvement of 7 percent in the two-year rate of event-free survival and thus that the total enrollment be increased to 600 patients. Secondary end points were the rate of response and overall survival.
Analyses included all the enrolled patients and followed the intention-to-treat principle. They were also performed on patients who met the eligibility criteria, after histologic review, and after the exclusion of those with an erroneous International Prognostic Index score (Table 1Table 1
Characteristics of the 647 Patients.). Patients' characteristics and response rates were compared by means of the chi-square and Fisher's exact tests. Event-free survival was measured from the date of randomization to primary treatment failure, relapse, or death from any cause or the stopping date, which for this analysis was February 1, 2004. Overall survival was measured from the date of randomization to the date of death from any cause or the stopping date. Data were censored on the date of the last follow-up evaluation when the stopping date was not reached. Survival rates were estimated according to the Kaplan–Meier method12 and compared with the use of the log-rank test.13 Taking into account the stratification according to bulky-disease status, we used a stratified log-rank test to analyze event-free and overall survival. Multivariate analyses were performed with the use of the Cox model for survival data.14 Differences were considered significant when the two-sided P value was less than 0.05. All statistical analyses were performed with SAS software, version 8.0.The study was designed by the GELA scientific committee. Data collected at participating centers were checked by GELA research assistants and sent to the centralized database in Creteil. One investigator analyzed the data and was the principal writer of this article.
Results
Patients' Characteristics
Between March 1993 and June 2000, 647 patients were enrolled at 86 participating centers; 318 were assigned to chemotherapy alone with ACVBP and 329 to chemoradiotherapy consisting of CHOP plus involved-field radiotherapy. The main characteristics of the patients were similar in the two groups (Table 1). Diffuse large B-cell lymphoma was the most common subtype of lymphoma. Extranodal involvement was found in 49 percent of the patients. Bulky disease was present at randomization in 73 patients; mediastinal and abdominal involvement accounted for 34 percent and 16 percent of these cases, respectively.
Response to Treatment
A complete or unconfirmed complete response occurred in 93 percent of the patients treated with chemotherapy alone and 92 percent of those treated with chemoradiotherapy (Table 2Table 2
Outcome of Treatment at One Month in the 630 Patients Who Could Be Evaluated.). Eighty percent of the patients in the ACVBP group received at least 80 percent of the planned dose of doxorubicin and cyclophosphamide, and 98 percent did so in the group given CHOP plus radiotherapy. In the latter group, 26 patients did not receive the planned radiotherapy, as a result of a lack of response to CHOP in 15, medical decision in 6, and refusal in 5. Among the remaining patients, 93 percent received a dose of 36 to 40 Gy.There were no treatment-related deaths. Thirty-four episodes of grade 3 infection (11 percent of patients) and two episodes of grade 4 infection (1 percent) occurred in the chemotherapy group, as compared with four episodes of grade 3 infection in the chemoradiotherapy group (1 percent). No life-threatening acute adverse effects of radiotherapy were reported.
Outcome
During a median follow-up of 7.7 years, there were 168 events (primary treatment failure, relapse, or death): 61 in the chemotherapy group and 107 in the chemoradiotherapy group. Event-free survival differed significantly between the groups (P<0.001), with five-year estimates of 82 percent in the chemotherapy group (95 percent confidence interval, 78 to 87 percent) and 74 percent in the chemoradiotherapy group (95 percent confidence interval, 69 to 78 percent) (Figure 1Figure 1
Event-free Survival among 647 Patients Assigned to Chemotherapy Alone with the ACVBP Regimen or to CHOP plus Involved-Field Radiotherapy.). The difference remained significant in separate analyses of the 574 patients without bulky disease (Figure 2Figure 2Event-free Survival among 574 Patients without Bulky Tumor Assigned to Chemotherapy Alone with the ACVBP Regimen or to CHOP plus Involved-Field Radiotherapy.) and the 73 patients with bulky disease (P=0.002 and P=0.04, respectively). In a multivariate analysis of the 647 patients, event-free survival was independently affected by the presence of bulky disease (P<0.001; risk ratio, 2.5; 95 percent confidence interval, 1.7 to 3.7), treatment with chemoradiotherapy (P<0.001; risk ratio, 1.8; 95 percent confidence interval, 1.3 to 2.5), and the presence of stage II disease (P=0.03; risk ratio, 1.4; 95 percent confidence interval, 1 to 1.9).There were 120 relapses, 42 in the chemotherapy group and 78 in the chemoradiotherapy group. In the former group, the median time to relapse was 21 months and relapses involved the initial site of disease in 41 percent of patients, a distant site in 38 percent, and both initial and distant sites in 21 percent. In the chemoradiotherapy group, the median time to relapse was 15 months and relapses occurred in the irradiation field in 23 percent of the patients, outside the field in 72 percent, and both within and outside the field in 5 percent.
There were 115 deaths, 40 in the chemotherapy group and 75 in the chemoradiotherapy group. Overall survival differed significantly (P=0.001), with five-year estimates of 90 percent in the chemotherapy group (95 percent confidence interval, 87 to 93 percent) and 81 percent in the chemora-diotherapy group (95 percent confidence interval, 77 to 86 percent) (Figure 3Figure 3
Overall Survival among 647 Patients Assigned to Chemotherapy Alone with the ACVBP Regimen or to CHOP plus Involved-Field Radiotherapy.). The difference remained significant when the patients without bulky disease (P=0.01) (Figure 4Figure 4
Overall Survival among 574 Patients without Bulky Tumor Assigned to Chemotherapy Alone with the ACVBP Regimen or to CHOP plus Involved-Field Radiotherapy.) and those with bulky disease (P=0.03) were analyzed separately. In a multivariate analysis of the 647 patients, survival was adversely affected by the presence of bulky disease (P<0.001; risk ratio, 3.0; 95 percent confidence interval, 2.0 to 4.8) and treatment with chemoradiotherapy (P=0.002; risk ratio, 1.8; 95 percent confidence interval, 1.3 to 2.7), but not by the presence of stage II disease (P=0.2; risk ratio, 1.3; 95 percent confidence interval, 0.9 to 1.9).The influence of chemotherapy alone remained significant with respect to both event-free and overall survival when multivariate analysis was restricted to the patients who met eligibility criteria (Table 1) (P=0.001 and P=0.004, respectively), as well as to those with diffuse large-B-cell lymphoma (P=0.004 and P=0.03, respectively).
Of the 115 deaths, 89 were related to progressive lymphoma, 29 in the chemotherapy group and 60 in the chemoradiotherapy group. Sixteen deaths occurred as a result of a second cancer that developed after enrollment: seven of these were in the chemotherapy group, including one acute myelogenous leukemia; nine occurred in the chemoradiotherapy group, including two cases of myelodysplasia and one pancreatic cancer within the irradiation field. At the time of death, 15 of these 16 patients with a second cancer were in a primary remission from their lymphoma and 1 was in a secondary remission. Death was related to salvage treatment for relapsed lymphoma in four patients. Other causes of death in patients in a primary remission included suicide in two, a car accident in one, myocardial infarction in one (outside the irradiation field), and stroke in one; one patient in secondary remission died from peritonitis.
Nonfatal late effects of radiotherapy included persistent xerostomia in 6 percent of patients with Waldeyer's-ring lymphoma, hypothyroidism (five cases), carotid stenosis (two cases), gastritis (three cases), and vertebral fracture (two cases). No episodes of congestive heart failure were reported in either treatment group.
Discussion
This randomized trial, which enrolled 647 patients with low-risk aggressive lymphoma in stage I or II who were younger than 61 years of age, compared chemotherapy alone (three cycles of ACVBP followed by sequential consolidation) with three cycles of CHOP followed by involved-field radiotherapy. The latter has been considered standard therapy for localized lymphoma since Miller et al. reported the results of a randomized study of 400 patients, with a median follow-up of 4.4 years.5 After a median follow-up of 7.7 years, we found superior event-free and overall survival rates among patients treated with chemotherapy alone.
The ACVBP regimen consists of an induction phase with higher doses of doxorubicin and cyclophosphamide than those used in CHOP and a consolidation phase consisting of treatment with drugs not used during induction. The ACVBP regimen improves survival among elderly patients with poor-risk aggressive lymphoma, as compared with eight cycles of standard CHOP.15 Two other studies have suggested that the efficacy of CHOP can be improved by increasing the doses of doxorubicin and cyclophosphamide.16,17 In the present trial, the increased doses and reduced intervals between the three courses of ACVBP increased the theoretical dose intensity of doxorubicin and cyclophosphamide by a factor of 2.25 and 2.4, respectively, as compared with three cycles of CHOP. As a consequence, in 95 percent of the patients in the chemotherapy group, the theoretical dose intensity was at least 150 percent of that delivered by three cycles of CHOP.
We defined our study population of patients younger than 61 years with localized lymphoma on the basis of the age-adjusted International Prognostic Index, the most widely used system to stratify tumors before therapy,7 thus providing a relatively homogeneous cohort of patients with regard to principal prognostic factors: age, lactate dehydrogenase level, and performance status. By contrast, in the study by Miller et al.,5 half the patients were over 60 years of age and 20 percent had an elevated lactate dehydrogenase level. An update of that study with a longer follow-up showed convergence of survival curves as a result of an excess of relapses and deaths from lymphoma in the group given CHOP plus radiotherapy.18
In our patients with limited disease, the influence of treatment group was independent of classic prognostic factors such as stage II disease5 and a large tumor burden.19 Thus, the advantage of chemotherapy alone over chemoradiotherapy applied to the entire population of patients — not only to the patients with bulky disease, a condition in which adjuvant radiotherapy is believed to result in optimal control of local disease,20,21 but also to patients without a bulky tumor. In our population of patients younger than 61 years, the ACVBP regimen could be given on an ambulatory basis. As a consequence of the high dose intensity of ACVBP, neutropenia was more frequent than with CHOP, but in our patients, we observed only two grade 4 life-threatening infections among 309 patients and no treatment-related deaths. In our previous study of 2210 patients who received ACVBP, an age of more than 60 years, elevated lactate dehydrogenase levels, and an Eastern Cooperative Oncology Group score of more than 1 predicted early treatment-related deaths.22
After a median follow-up of 7.7 years, there were a similar number of fatal second cancers in each group. There were nine cases in the chemoradiotherapy group, which is in keeping with other reports of a moderate risk of second cancer after brief CHOP chemotherapy plus involved-field radiotherapy.23,24 A longer follow-up may, however, reveal additional late solid tumors related to radiotherapy.25 There were seven cases of fatal second cancers in the ACVBP group, a number consistent with our retrospective analysis of 2837 patients treated with the ACVBP regimen in consecutive GELA trials.26 Thus, moving from CHOP plus radiotherapy to intensified chemotherapy alone did not increase the number of deaths from second cancers.
In conclusion, chemotherapy with ACVBP alone significantly improved event-free and overall survival among persons younger than 61 years with newly diagnosed, low-risk, localized aggressive lymphoma, as compared with the standard treatment with CHOP plus radiotherapy. Efforts are now needed to further improve event-free survival among such patients. Given the benefit of the combination of rituximab and chemotherapy,27 the GELA has undertaken a trial of rituximab plus the ACVBP regimen in young adults with localized low-risk aggressive lymphoma.
Supported by a grant (AOM95061) from the Programme Hospitalier de Recherche Clinique du Ministère de la Santé and grants from Amgen, Roche, Schering-Plough, and Astra-Medica.
We are indebted to Isabelle Gaillard, Denis Collet, and Chafika Coppeaux for data management; to Nicolas Nio for statistical analyses; and to Corinne Haioun for invaluable discussion.
Source Information
From the Hôpital Henri Mondor, Assistance Publique–Hôpitaux de Paris, Créteil (F.R., E.L.); Clinique Victor Hugo, Le Mans (G.G.); Hôpital Hôtel-Dieu, Assistance Publique–Hôpitaux de Paris, Paris (T.J.M.); Hôpital Saint-Louis, Assistance Publique–Hôpitaux de Paris, Paris (P.B.); Centre Hospitalier Lyon Sud, Pierre-Bénite (B.C.); Centre Hospitalier de Lens, Lens (P.M.); Institut Gustave Roussy, Villejuif (C.F.); Centre Hospitalier Brabois, Vandoeuvre lès Nancy, Nancy (P.L.); Hôpital Purpan, Toulouse (G.L.); and Centre Henri Becquerel, Rouen (H.T.) — all in France; and the Cliniques Universitaires de Mont Godinne, Yvoir, Belgium (A.B.).
Address reprint requests to Dr. Reyes at the Service d'Hématologie Clinique, Hôpital Henri Mondor, 94010 Créteil, France, or at felix.reyes@hmn.ap-hop-paris.fr.
Participants in the GELA study are listed in the Appendix.
Appendix
The following persons and study centers participated in the GELA study (all in France, unless otherwise specified): Hôpital Saint-Antoine, Paris — M. Aoudjane; Clinique du Mail, Grenoble — D. Assouline; Hôpital Pasteur, Colmar — B. Audhuy; Centre Hospitalier de Saint Germain, Saint Germain en Laye — M. Azagury; Hôpital de Bayonne, Bayonne — F. Bauduer; Centre Medico-Chirurgical de Foch, Suresnes — E. Baumelou; Centre Hospitalier de Montluçon, Montluçon — M.A. Bichoffe; Centre Léon Berard, Lyon — P. Biron; Centre Hospitalier de Chambery, Chambery — M. Blanc; Hôpital Dupuytren, Limoges — D. Bordessoulle; Cliniques Universitaires de Mont Godinne, Yvoir, Belgium — A. Bosly; Institut Paoli Calmette, Marseille — R. Bouabdallah; Centre Hospitalier de Saint Brieuc, Saint Brieuc — P. Bourquard; Hôpital Saint-Louis, Paris — P. Brice, N. Mounier, D. Simon, C. Gisselbrecht, H. Dombret; Hôpital Beaujon, Clichy — J. Brière; Centre Hospitalo-Universitaire de Dijon, Dijon — D. Caillot, O. Casasnovas, M. Flesch, B. Chauffert; Centre Hospitalo-Universitaire de Nice, Nice — G.P. Cassuto; Hôpital André Mignot, Le Chesnay — S. Castaigne; Hôpital Bon Secours, Metz — B. Christian; Hôpital Lyon-Sud, Pierre-Bénite — B. Coiffier, G. Salles; Polyclinique de Courlancy, Reims — P. Colin and G. Pinon-Netter; Centre A. Vautrin, Vandoeuvre lès Nancy — T. Conroy; Centre Jean Perrin, Clermont-Ferrand — H. Curé; Hôpital Hôtel-Dieu, Paris — A. Delmer; Hôpital Jean Bernard, Poitiers — V. Delwail; Centre Hospitalier de Corbeil, Corbeil Essonnes — A. Devidas; Hôpital Cochin, Paris — F. Dreyfus; Clinique de Chaumont, Chaumont — G. Dupont; Centre Hospitalier E. Muller, Mulhouse — J.C. Eisenmann; Centre Val d'Aurelle, Montpellier — M. Fabbro; Centre de Bligny, Briis sous Forges — C. Fermé; Centre Hospitalo-Universitaire de Liège, Liège, Belgium — G. Fillet; Hôpital J. Monod, Le Havre — C. Fruchart; Hôpital de la Pitié-Salpêtrière, Paris — J. Gabarre; Hôpital du Creusot, Le Creusot — M. Gabez; Centre Hospitalier de Juvisy, Juvisy sur Orge — M. Gautier; Hôpital Henri Mondor, Créteil — C. Haioun, M. Diviné, K. Belhadj, F. Reyes; Hôpital de Hautepierre, Strasbourg — R. Herbrecht; Hôpital Necker, Paris — O. Hermine, B. Varet; Centre René Huguenin, Saint-Cloud — M. Janvier; Centre Hospitalo-Universitaire de Nîmes, Nîmes — E. Jourdan; Hôpital de l'Ouest Parisien, Trappes — D. Kamioner; Centre Hospitalier René Dubos, Pontoise — Y. Kerneis, F. Morvan; Centre Hospitalo-Universitaire Brabois, Vandoeuvre lès Nancy — P. Lederlin; Centre Hospitalier de Brives, Brives La Gaillarde — S. Lefort; Centre Hospitalier de la Durance, Avignon — G. Lepeu; Hôpital Tenon, Paris — J.P. Lotz, C. Bouleuc; Hôpital Paul Brousse, Villejuif — D. Machover; Hôpital de Chaneaux, Macon — F. Marechal; Centre F. Magendie, Bordeaux — G. Marit; Centre Hospitalier d'Annecy, Annecy — C. Martin; Centre Hospitalier d'Esch sur Azette, Esch sur Azette, Luxembourg — S. Meyer; Centre Hospitalier de Lens, Lens — P. Morel, B. Dupriez; Institut Gustave Roussy, Villejuif — J.N. Munck, C. Fermé, P. Carde; Hôpital Universitaire de Gent, Ghent, Belgium — F. Offner; Centre Hospitalier de Troyes, Troyes — J.M. Pavlovitch; Hôpital V. Provo, Roubaix — I. Plantier; Hôpital de Fleyriat, Bourg en Bresse — H. Orfeuvre; Hôpital de Valence, Valence — P.Y. Péaud, D. Dramais; Centre François Baclesse, Caen — A.M. Peny; Hôpital de Thionville, Thionville — C. Platini; Hôpital Victor Dupuy, Argenteuil — M. Pullik; Centre Hospitalo-Universitaire de Lille, Lille — B. Quesnel, F. Morschausher; Centre Hospitalo-Universitaire de Caen, Caen — O. Reman, M. Leporrier; Centre Hospitalier Saint-Vincent, Lille — C. Rose; Centre Hospitalier de Blois, Blois — P. Rodon; Centre Hospitalo-Universitaire de Montpellier, Montpellier — J.F. Rossi; Hôpital de Chalon, Chalon sur Saône — B. Salles; Hôpital de Purpan, Toulouse — D. Schlaifer, F. Huguet, A. Huyn; Hôpital Edouard Herriot, Lyon — C. Sebban; Centre Hospitalier de Valenciennes, Valenciennes — M. Simon; Clinique Victor Hugo, Le Mans — P. Solal-Céligny; Centre Hospitalo-Universitaire de Grenoble, Grenoble — J.J. Sotto; Centre Hospitalier de Meaux, Meaux — C. Soussain, C. Allard; Hôpital Bicêtre, Paris — G. Tertian; Centre H. Becquerel, Rouen — H. Tilly; Centre A. Lacassagne, Nice — A. Thyss; Centre Hospitalo-Universitaire d'Amiens, Amiens — C. Traulle; Hôpital Hotel-Dieu, Clermont-Ferrand — P. Travade; Academisch Ziekenhuis Sint-Jan, Bruges, Belgium — A. Van Hoof; Hôpital Lariboisière, Paris — J.M. Zini; Pathologists — J. Brière, J. Diebold, B. Fabiani, P. Gaulard, C. Guettier, T. Molina, T. Petrella.
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- Citing Articles (77)
Citing Articles
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James O. Armitage. (2012) My Treatment Approach to Patients With Diffuse Large B-Cell Lymphoma. Mayo Clinic Proceedings 87:2, 161-171
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Belinda A. Campbell, Joseph M. Connors, Randy D. Gascoyne, W. James Morris, Tom Pickles, Laurie H. Sehn. (2012) Limited-stage diffuse large B-cell lymphoma treated with abbreviated systemic therapy and consolidation radiotherapy. Cancern/a-n/a
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Ling Cai, Michael C. Stauder, Yu-Jing Zhang, Philip Poortmans, Ye-Xiong Li, Nicolaos Constantinou, Juliette Thariat, Sidney P. Kadish, Tan Dat Nguyen, Youlia M. Kirova, Pirus Ghadjar, Damien C. Weber, Victoria Tuset Bertran, Mahmut Ozsahin, René-Olivier Mirimanoff. (2011) Early-Stage Primary Bone Lymphoma: A Retrospective, Multicenter Rare Cancer Network (RCN) Study. International Journal of Radiation Oncology*Biology*Physics
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Christian Récher, Bertrand Coiffier, Corinne Haioun, Thierry Jo Molina, Christophe Fermé, Olivier Casasnovas, Catherine Thiéblemont, André Bosly, Guy Laurent, Franck Morschhauser, Hervé Ghesquières, Fabrice Jardin, Serge Bologna, Christophe Fruchart, Bernadette Corront, Jean Gabarre, Christophe Bonnet, Maud Janvier, Danielle Canioni, Jean-Philippe Jais, Gilles Salles, Hervé Tilly. (2011) Intensified chemotherapy with ACVBP plus rituximab versus standard CHOP plus rituximab for the treatment of diffuse large B-cell lymphoma (LNH03-2B): an open-label randomised phase 3 trial. The Lancet 378:9806, 1858-1867
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Deok-Hwan Yang, Won Seog Kim, Seok Jin Kim, Jin Seok Kim, Jae-Yong Kwak, Joo Seop Chung, Sung Yong Oh, Cheol Won Suh, Je-Jung Lee. (2011) Pilot trial of yttrium-90 ( 90 Y)-ibritumomab tiuxetan consolidation following R-CHOP chemotherapy in patients with limited-stage, bulky diffuse large B-cell lymphoma. Leukemia & Lymphoma1-15
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Andrea K. Ng, David C. Hodgson. (2011) Is there a role for consolidative radiation therapy for aggressive B-cell lymphoma in the rituximab era?. Leukemia & Lymphoma 52:10, 1821-1822
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John L. Reagan, Alan Rosmarin, James N. Butera, Ahmed Nadeem, Fred J. Schiffman, William M. Sikov, Eric Winer, Anthony E. Mega. (2011) Phase I trial examining addition of gemcitabine to CHOP in intermediate grade NHL. Cancer Chemotherapy and Pharmacology 68:4, 1075-1080
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Luigi Marcheselli, Raffaella Marcheselli, Alessia Bari, ElianaValentina Liardo, Fortunato Morabito, Luca Baldini, Maura Brugiatelli, Francesco Merli, Nicola Di Renzo, Stefano Sacchi. (2011) Radiation therapy improves treatment outcome in patients with diffuse large B-cell lymphoma. Leukemia & Lymphoma 52:10, 1867-1872
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Ranjit S Bindra, Joachim Yahalom. (2011) The important role of radiation therapy in early-stage diffuse large B-cell lymphoma: time to review the evidence once again. Expert Review of Anticancer Therapy 11:9, 1367-1378
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N. Boujelbene, N. Ketterer, N. Boujelbene, K. Khanfir, S. Bhagwati, E. Herrmann, R. O. Mirimanoff, M. Ozsahin, A. Zouhair. (2011) Mise au point sur le lymphome testiculaire primaire. Oncologie 13:9, 598-604
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S. Tebra, K. Mahjoubi, K. Chaouach, A. Laatiri, N. Bouaouina. (2011) À propos de quatre cas de lymphome malin non hodgkinien primitif du cavum. Cancer/Radiothérapie 15:4, 338-341
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T. Illidge. (2011) X. When should radiotherapy be used in lymphoma?. Annals of Oncology 22:Supplement 4, iv57-iv60
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Michael Mian, Gianluca Gaidano, Annarita Conconi, Richard Tsang, Mary K. Gospodarowicz, Alessandro Rambaldi, Andrea Rossi, Elena Oldani, Massimo Federico, Stefano Luminari, Monica Bellei, Enrico M. Pogliani, Fausto Rossini, Maria Elena Cabrera, Maurizio Martelli, Armando Lopez-Guillermo, Mario Busetto, Franco Cavalli, Emanuele Zucca, Sergio Cortelazzo. (2011) High response rate and improvement of long-term survival with combined treatment modalities in patients with poor-risk primary thyroid diffuse large B-cell lymphoma: an International Extranodal Lymphoma Study Group and Intergruppo Italiano Linfomi study. Leukemia & Lymphoma 52:5, 823-832
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Xiao Du, Yupei Zhao, Taiping Zhang, Quan Liao, Menghua Dai, Ziwen Liu, Junchao Guo, Ya Hu. (2011) Primary Pancreatic Lymphoma. Pancreas 40:1, 30-36
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Jeong Il Yu, Heerim Nam, Yong Chan Ahn, Won Seog Kim, Keunchil Park, Seok Jin Kim. (2010) Involved-Lesion Radiation Therapy After Chemotherapy in Limited-Stage Head-and-Neck Diffuse Large B Cell Lymphoma. International Journal of Radiation Oncology*Biology*Physics 78:2, 507-512
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Nozomi Niitsu. (2010) Current treatment strategy of diffuse large B-cell lymphomas. International Journal of Hematology 92:2, 231-237
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Pierre Morel, Jean-Nicolas Munck, Bertrand Coiffier, Christian Gisselbrecht, Dana Ranta, Andre Bosly, Hervé Tilly, Bruno Quesnel, Antoine Thyss, Nicolas Mounier, Josette Brière, Thierry Molina, Felix Reyes. (2010) Comparison of two high-dose cyclophosphamide, doxorubicin, vincristine, and prednisone derived regimens in patients aged under 60 years with low–intermediate risk aggressive lymphoma: a final analysis of the multicenter LNH93-2 protocol. Leukemia & Lymphoma 51:9, 1668-1677
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H. Tilly, M. Dreyling, . (2010) Diffuse large B-cell non-Hodgkin's lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology 21:Supplement 5, v172-v174
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Michael A. Fridrik, Hubert Hausmaninger, Alois Lang, Johannes Drach, Otto Krieger, Dietmar Geissler, Gerhard Michlmayr, Ernst Ulsperger, Andreas Chott, Wilhelm Oberaigner, Richard Greil. (2010) Dose-dense therapy improves survival in aggressive non-Hodgkin’s lymphoma. Annals of Hematology 89:3, 273-282
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Thomas J. Pugh, Ari Ballonoff, Kyle E. Rusthoven, Robert McCammon, Brian Kavanagh, Francis Newman, Rachel Rabinovitch. (2010) Cardiac Mortality in Patients With Stage I and II Diffuse Large B-Cell Lymphoma Treated With and Without Radiation: A Surveillance, Epidemiology, and End-Results Analysis. International Journal of Radiation Oncology*Biology*Physics 76:3, 845-849
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Donato Mannina, Stefano Luminari, Alessandra Dondi, Giuseppe Polimeno, Luca Baldini, Caterina Stelitano, Francesco Merli, Matteo Dell'olio, Paolo G. Gobbi, Gianfranco Giglio, Elisa Barbolini, Maura Brugiatelli, Massimo Federico. (2010) Long term outcome of patients with localized aggressive non-Hodgkin lymphoma treated with PROMECE-CYTABOM plus involved-field radiation therapy: a study by the Gruppo Italiano Studio Linfomi. Leukemia & Lymphoma 51:3, 422-429
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Paolo F. Caimi, Paul M. Barr, Nathan A. Berger, Hillard M. Lazarus. (2010) Non-Hodgkinʼs Lymphoma in the Elderly. Drugs & Aging 27:3, 211-238
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Ritsuko Seki, Koichi Ohshima, Koji Nagafuji, Tomoaki Fujisaki, Naokuni Uike, Fumio Kawano, Hisashi Gondo, Shigeyoshi Makino, Tetsuya Eto, Yukiyoshi Moriuchi, Fumihiro Taguchi, Tomohiko Kamimura, Hiroyuki Tsuda, Ryosuke Ogawa, Kazuya Shimoda, Kiyoshi Yamashita, Keiko Suzuki, Hitoshi Suzushima, Kunihiro Tsukazaki, Masakazu Higuchi, Atae Utsunomiya, Masahiro Iwahashi, Yutaka Imamura, Kazuo Tamura, Junji Suzumiya, Minoru Yoshida, Yasunobu Abe, Tadashi Matsumoto, Takashi Okamura. (2010) Rituximab in combination with CHOP chemotherapy for the treatment of diffuse large B cell lymphoma in Japan: a retrospective analysis of 1,057 cases from Kyushu Lymphoma Study Group. International Journal of Hematology 91:2, 258-266
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Niels Murawski, Carsten Zwick, Michael Pfreundschuh. (2010) Unresolved issues in diffuse large B-cell lymphomas. Expert Review of Anticancer Therapy 10:3, 387-402
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Luis Vida Pérez, Ángel González Galilea, Enrique Fraga Rivas. (2010) Hemorragia por varices gástricas como manifestación inicial de linfoma pancreático primario. Gastroenterología y Hepatología 33:3, 165-170
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Junshik Hong, Ae Jin Kim, Jin Sun Park, Seok Ho Lee, Kyu Chan Lee, Jinny Park, Sun Jin Sym, Eun Kyung Cho, Dong Bok Shin, Jae Hoon Lee. (2010) Additional rituximab-CHOP (R-CHOP) versus involved-field radiotherapy after a brief course of R-CHOP in limited, non-bulky diffuse large B-cell lymphoma: a retrospective analysis. The Korean Journal of Hematology 45:4, 253
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Alvaro Alencar, David Pitcher, Gerald Byrne, Izidore S. Lossos. (2010) Primary bone lymphoma – the University of Miami experience. Leukemia & Lymphoma 51:1, 39-49
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Xuejun Ma, Ye Guo, Ziqiang Pang, Biyun Wang, Hongfen Lu, Ya-Jia Gu, Xiaomao Guo. (2009) A randomized phase II study of CEOP with or without semustine as induction chemotherapy in patients with stage IE/IIE extranodal NK/T-cell lymphoma, nasal type in the upper aerodigestive tract. Radiotherapy and Oncology 93:3, 492-497
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Enrico Derenzini, Vittorio Stefoni, Cinzia Pellegrini, Maria Paola Fina, Alessandro Broccoli, Filippo Venturini, Letizia Gandolfi, Stefano A. Pileri, Maurizio Martelli, Maria Concetta Petti, Alessio Perrotti, Amalia De Renzo, Francesco Zaja, Michele Baccarani, Pier Luigi Zinzani. (2009) Cyclophosphamide, doxorubicin, vincristine, methotrexate, bleomicin and prednisone plus rituximab in untreated young patients with low-risk (age-adjusted international prognostic index 0–1) diffuse large B-cell lymphoma. Leukemia & Lymphoma 50:11, 1824-1829
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Jason R. Westin, Luis E. Fayad. (2009) Beyond R-CHOP and the IPI in large-cell lymphoma: Molecular markers as an opportunity for stratification. Current Hematologic Malignancy Reports 4:4, 218-224
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Daniel O Persky, Thomas P Miller. (2009) Localized large cell lymphoma: is there any need for radiation therapy?. Current Opinion in Oncology 21:5, 401-406
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H. Tilly, M. Dreyling, . (2009) Diffuse large B-cell non-Hodgkin's lymphoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Annals of Oncology 20:Supplement 4, iv110-iv112
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C. Bouchikhi, H. Bouguern, A. Mimouni, H. Chaara, A. Melhouf, A. Amarti, A. Banani. (2009) Lymphome malin non hodgkinien primitif de l’ovaire: à propos d’un cas. Oncologie 11:4, 248-251
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Maria Giuseppina Cabras, Angela Maria Mamusa, Umberto Vitolo, Roberto Freilone R., Paolo Dessalvi, Lorella Orsucci, Anna Tonso, Alessandro Levis, Marina Liberati, Giancarlo Lay, Emanuele Angelucci. (2009) Long term outcome of localized aggressive non-Hodgkin lymphoma treated with a short weekly chemotherapy regimen (doxorubicin, cyclophosphamide, bleomycin, vincristine, and prednisone) and involved field radiotherapy: result of a Gruppo Italiano Multiregionale per lo Studio dei Linfomi e Leucenie (GIMURELL) study. Leukemia & Lymphoma 50:9, 1475-1481
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Ari Ballonoff, Kyle E. Rusthoven, Amanda Schwer, Robert McCammon, Brian Kavanagh, Michael Bassetti, Francis Newman, Rachel Rabinovitch. (2008) Outcomes and Effect of Radiotherapy in Patients With Stage I or II Diffuse Large B-Cell Lymphoma: A Surveillance, Epidemiology, and End Results Analysis. International Journal of Radiation Oncology*Biology*Physics 72:5, 1465-1471
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Aaron Liddell, Sidney L. Bourgeois. (2008) Systemic Lymphoproliferative Diseases. Oral and Maxillofacial Surgery Clinics of North America 20:4, 585-596
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J. Dupuis, E. Itti, A. Rahmouni, F. Hemery, C. Gisselbrecht, C. Lin, C. Copie-Bergman, K. Belhadj, T. El Gnaoui, I. Gaillard, F. Kuhnowski, M. Meignan, C. Haioun. (2008) Response assessment after an inductive CHOP or CHOP-like regimen with or without rituximab in 103 patients with diffuse large B-cell lymphoma: integrating 18fluorodeoxyglucose positron emission tomography to the International Workshop Criteria. Annals of Oncology 20:3, 503-507
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Jonathan W. Friedberg, Richard I. Fisher. (2008) Diffuse Large B-Cell Lymphoma. Hematology/Oncology Clinics of North America 22:5, 941-952
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Christoph Oehler-Jänne, Christian Taverna, Nadine Stanek, Laura Negretti, Urs M. Lütolf, Ilja F. Ciernik. (2008) Consolidative involved field radiotherapy after high dose chemotherapy and autologous stem cell transplantation for non-Hodgkin's lymphoma: a case-control study. Hematological Oncology 26:2, 82-90
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N. Mourad, N. Mounier, J. Briere, E. Raffoux, A. Delmer, A. Feller, C. J. L. M. Meijer, J.-F. Emile, R. Bouabdallah, A. Bosly, J. Diebold, C. Haioun, B. Coiffier, C. Gisselbrecht, P. Gaulard. (2008) Clinical, biologic, and pathologic features in 157 patients with angioimmunoblastic T-cell lymphoma treated within the Groupe d'Etude des Lymphomes de l'Adulte (GELA) trials. Blood 111:9, 4463-4470
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Michael Pfreundschuh, Anthony D Ho, Eva Cavallin-Stahl, Max Wolf, Ruth Pettengell, Ingrid Vasova, Andrew Belch, Jan Walewski, Pier-Luigi Zinzani, Walter Mingrone, Stein Kvaloy, Ofer Shpilberg, Ulrich Jaeger, Mads Hansen, Claudia Corrado, Adriana Scheliga, Markus Loeffler, Evelyn Kuhnt. (2008) Prognostic significance of maximum tumour (bulk) diameter in young patients with good-prognosis diffuse large-B-cell lymphoma treated with CHOP-like chemotherapy with or without rituximab: an exploratory analysis of the MabThera International Trial Group (MInT) study. The Lancet Oncology 9:5, 435-444
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L J Costa, I N Micallef, D J Inwards, P B Johnston, L F Porrata, S M Ansell. (2008) Time of relapse after initial therapy significantly adds to the prognostic value of the IPI-R in patients with relapsed DLBCL undergoing autologous stem cell transplantation. Bone Marrow Transplantation 41:8, 715-720
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K. D. Goodwin, M. A. Lewis, E. C. Long, M. M. Georgiadis. (2008) Crystal structure of DNA-bound Co(III){middle dot}bleomycin B2: Insights on intercalation and minor groove binding. Proceedings of the National Academy of Sciences 105:13, 5052-5056
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Matthew J. Matasar, Andrew D. Zelenetz. (2008) Overview of Lymphoma Diagnosis and Management. Radiologic Clinics of North America 46:2, 175-198
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Marcel Massoud, Serge Koscielny, Simona Lapusan, Jacques Bosq, Vincent Ribrag. (2008) Primary mediastinal large B-cell lymphomas treated with dose-intensified CHOP alone or CHOP combined with radiotherapy. Leukemia & Lymphoma 49:8, 1510-1515
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Tim Illidge, Shaun Tolan. (2008) Current treatment approaches for diffuse large B-cell lymphoma. Leukemia & Lymphoma 49:4, 663-676
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J. O. Armitage. (2007) How I treat patients with diffuse large B-cell lymphoma. Blood 110:1, 29-36
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Lloyd A. Mack, Janice L. Pasieka. (2007) An Evidence-Based Approach to the Treatment of Thyroid Lymphoma. World Journal of Surgery 31:5, 978-986
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Javier P. Berrios-Rivera, Shenying Fang, Maria E. Cabanillas, Fernando Cabanillas, Huifang Lu, Xianglin L. Du. (2007) Variations in Chemotherapy and Radiation Therapy in a Large Nationwide and Community-Based Cohort of Elderly Patients With Non-Hodgkin Lymphoma. American Journal of Clinical Oncology 30:2, 163-171
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B. Gleissner, C. Zwick, M. Pfreundschuh. (2007) Therapie großzelliger Lymphome. Der Internist 48:4, 389-395
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Nicolas Mounier, Michele Spina, Christian Gisselbrecht. (2007) Modern management of non-Hodgkin lymphoma in HIV-infected patients. British Journal of Haematology 136:5, 685-698
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Severin Daum, Eckhard Thiel, Martin Zeitz. (2007) Is intestinal diffuse large b cell lymphoma a relatively benign disease?. Leukemia Research 31:3, 287-289
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Andrew Wirth. (2007) The rationale and role of radiation therapy in the treatment of patients with diffuse large B-cell lymphoma in the Rituximab era. Leukemia & Lymphoma 48:11, 2121-2136
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J. T. Sandlund. (2007) Should Adolescents with NHL Be Treated as Old Children or Young Adults?. Hematology 2007:1, 297-303
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Armando Santoro, Luca Castagna, Massimo Magagnoli. (2006) Lymphomas. Update on Cancer Therapeutics 1:4, 467-473
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Bertrand Coiffier. (2006) Rituximab and CHOP-like chemotherapy in good-prognosis diffuse large-B-cell lymphoma. Nature Clinical Practice Oncology 3:11, 594-595
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Thomas P. Miller, Catherine M. Spier, Lisa Rimsza. (2006) Diffuse Aggressive Histologies of Non-Hodgkin Lymphoma: Treatment and Biology of Limited Disease. Seminars in Hematology 43:4, 207-212
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Bertrand Coiffier. (2006) Standard Treatment of Advanced-Stage Diffuse Large B-Cell Lymphoma. Seminars in Hematology 43:4, 213-220
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Hideomi Yamashita, Koji Izutsu, Naoki Nakamura, Kenshiro Shiraishi, Shigeru Chiba, Mineo Kurokawa, Masao Tago, Hiroshi Igaki, Kuni Ohtomo, Keiichi Nakagawa. (2006) Treatment results of chemoradiation therapy for localized aggressive lymphomas: a retrospective 20-year study. Annals of Hematology 85:8, 523-529
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G. Held, J. Schubert, C. Rübe, M. Pfreundschuh. (2006) Fortschritte in der Behandlung der diffus-großzelligen Lymphome. Der Onkologe 12:7, 619-627
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Kathryn Beal, Laura Allen, Joachim Yahalom. (2006) Primary bone lymphoma: Treatment results and prognostic factors with long-term follow-up of 82 patients. Cancer 106:12, 2652-2656
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Parham Khosravi Shahi, Gumersindo Pérez Manga. (2006) Linfoma B difuso de células grandes. Medicina Clínica 127:1, 17-21
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Michael Pfreundschuh, Lorenz Trümper, Anders Österborg, Ruth Pettengell, Marek Trneny, Kevin Imrie, David Ma, Devinder Gill, Jan Walewski, Pier-Luigi Zinzani, Rolf Stahel, Stein Kvaloy, Ofer Shpilberg, Ulrich Jaeger, Mads Hansen, Tuula Lehtinen, Armando López-Guillermo, Claudia Corrado, Adriana Scheliga, Noel Milpied, Myriam Mendila, Michelle Rashford, Evelyn Kuhnt, Markus Loeffler. (2006) CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. The Lancet Oncology 7:5, 379-391
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Jonathan W Friedberg. (2006) Rituximab for early-stage diffuse large-B-cell lymphoma. The Lancet Oncology 7:5, 357-359
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Massimo Federico, Stefano Luminari, Paolo G. Gobbi, Stefano Sacchi, Nicola Renzo, Marco Lombardo, Francesco Merli, Luca Baldini, Caterina Stelitano, Giovanni Partesotti, Giuseppe Polimeno, Antonella Montanini, Caterina Mammi, Maura Brugiatelli. (2006) The length of treatment of aggressive non-Hodgkin's lymphomas established according to the international prognostic index score: long-term results of the GISL LA03 study. European Journal of Haematology 76:3, 217-229
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Luciano Wannesson. (2006) Primary lymphoma of the uterine cervix: An approach to management. Gynecologic Oncology 100:3, 626-627
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Noelle V. Frey, Jakub Svoboda, Charalambos Andreadis, Donald E. Tsai, Stephen J. Schuster, Rebecca Elstrom, Stephen C. Rubin, Sunita D. Nasta. (2006) Primary lymphomas of the cervix and uterus: The University of Pennsylvania's experience and a review of the literature. Leukemia & Lymphoma 47:9, 1894-1901
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Francisco Plancarte, Armando Lopez-Guillermo, Leonor Arenillas, Silvia Montoto, Eva Gine, Ana Muntanola, Ana Ferrer, Neus Villamor, Francesc Bosch, Lluis Colomo, Olga Balaguer, Elias Campo, Emili Montserrat. (2006) Follicular lymphoma in early stages: high risk of relapse and usefulness of the Follicular Lymphoma International Prognostic Index to predict the outcome of patients. European Journal of Haematology 76:1, 58-63
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Julie Vose, M. Neumann, Mildred Harris. (2005) Update on lymphoma management: Diffuse large B-Cell NHL. Hematology 10:4, 10-14
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T. Kober, N. Skoetz, S. Trelle, J. Bohlius, A. Engert. (2005) Third Biannual Report of the Cochrane Haematological Malignancies Group. JNCI Journal of the National Cancer Institute 97:16, E2-0
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S. M. Ansell, J. Armitage. (2005) Non-Hodgkin Lymphoma: Diagnosis and Treatment. Mayo Clinic Proceedings 80:8, 1087-1097
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Bertrand Coiffier. (2005) Current strategies for the treatment of diffuse large B cell lymphoma. Current Opinion in Hematology 12:4, 259-265
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(2005) Treatment of Localized Lymphoma. New England Journal of Medicine 352:23, 2449-2451
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(2005) Current Awareness in Hematological Oncology. Hematological Oncology 23:2, 82-89
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(2005) Localized aggressive lymphoma: ACVBP compared with CHOP plus radiotherapy. Nature Clinical Practice Oncology 2:5, 227-228
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Armitage, James O., . (2005) Defining the Stages of Aggressive Non-Hodgkin's Lymphoma — A Work in Progress. New England Journal of Medicine 352:12, 1250-1252
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Michael Pfreundschuh. (2005) Management of Diffuse Large B-Cell Lymphoma in Young Patients. American Journal of Cancer 4:6, 349-357
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