Chlorambucil, vincristine and cytarabine (COA) treatment of low grade lymphomas

R. V. Iaffaioli, G. Frasci, G. Palmieri, P. Tagliaferri, V. Montesarchio, C. Pagliarulo, A. Tortoriello, G. Facchini, E. Matano, R. Laurlv, A. R. Bianco

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Forty-five patients with stage III-IV low grade non-Hodgkin's lymphoma (NHL) were treated with a non-intensive polychemotherapy regimen including chlorambucil-vincristine and cytarabine (Ara-C), termed COA, for a total of 366 courses, beginning in June 1986. Grade 4 myelotoxicity occurred in only 4/45 patients. No treatment related death was observed. All patients were evaluable for response. Overall, 38 (84% objective responses, including 31 (69% complete responses (CR), were observed. At a median follow-up of 57 (21-84+ months, only 8 deaths occurred. Twenty-seven (60% patients are still disease-free. All disease-free patients were in their first CR. The seven-year estimated survival is 71% and the estimated 7-year progression-free survival (PFS) was 48% The estimated probability of complete responders to be disease-free at 6 years is 78% Pretreatment laboratory parameters (serum levels of thymidine kinase, LDH and TNF-alpha showed a good prognostic relevance at using univariate analysis. At multivariate analysis, only the pretreatment serum levels of TNF-alpha were significantly associated with a higher CR achievement probability (p = 0.02) and a longer PFS (p = 0.02). We established a risk model for clinical outcome based on these 3 parameters. Patients having all parameters within the normal range at diagnosis, showed a very good prognosis (100% 7-year PFS and survival), while patients with all parameters increased had a very poor prognosis (0% 7-year PFS and 22% 7-year survival). In conclusion, COA treatment appears to be a non-toxic and very effective treatment for low-grade non-Hodgkin's lymphomas. More intensive treatment is probably needed for patients showing multiple negative prognostic laboratory parameters at diagnosis.

Original languageEnglish
Pages (from-to)147-153
Number of pages7
JournalLeukemia and Lymphoma
Issue number1-2
Publication statusPublished - 1995


  • COA chemotherapy
  • Low grade lymphomas
  • Multivariate analysis
  • Serum thymidine-kinase
  • TNF-alpha

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research


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