Journal of Clinical Oncology, Vol 11, 248-254, Copyright © 1993 by American Society of Clinical Oncology
AMOPLACE treatment of intermediate-grade and high-grade malignant lymphoma: a Cancer and Leukemia Group B study
BA Parker, M Santarelli, MR Green, JR Anderson, MR Cooper, D Case Jr, M Barcos, BA Peterson and AJ Gottlieb
University of California, San Diego Cancer Center 92103-8421.
PURPOSE: In an attempt to improve the efficacy of cyclophosphamide,
doxorubicin, vincristine, and prednisone (CHOP) chemotherapy for
intermediate-grade and high-grade non-Hodgkin's lymphomas, a phase II
evaluation of a regimen consisting of Adriamycin (doxorubicin; Adria
Laboratories, Columbus, OH), methotrexate, Oncovin (vincristine; Eli Lilly
Co, Indianapolis, IN), prednisone, leucovorin, cytarabine (ara- c),
cyclophosphamide, and etoposide (AMOPLACE) was conducted. This regimen
includes three additional agents not found in CHOP, uses weekly doses of
alternating myelosuppressive and nonmyelosuppressive drugs, and
incorporates most single agents active against diffuse lymphomas. PATIENTS
AND METHODS: Ninety-one previously untreated patients were enrolled and 60
patients were confirmed eligible after central pathology review.
Fifty-eight percent of patients had diffuse large- cell lymphoma (DLCL),
83% had stage III or IV disease, and 45% had B symptoms. RESULTS: Patients
were treated with six to eight cycles of AMOPLACE and analyzed for response
and survival. With a median follow- up of 48 months, complete responses
(CRs) were seen in 68% of all patients with failure-free survival (FFS) and
overall survival (OS) estimates at 4 years of 45% and 54%. In the DLCL
subset, the CR rate was 69% and FFS and OS estimates at 4 years were 49%
and 60%, respectively. The major toxicity was myelosuppression, with 73% of
patients having WBC nadirs less than 1,000/microL; two treatment- related
deaths occurred. CONCLUSION: We conclude that AMOPLACE is associated with
CR and OS rates comparable with those of other third- generation regimens.
