Phase I study of the combination of irinotecan hydrochloride, carboplatin, and dexamethasone for the treatment of relapsed or refractory malignant lymphoma.

A phase I study of irinotecan hydrochloride (CPT-11), carboplatin, and dexamethasone treatment in 7 patients with relapsed lymphoma and 7 patients with refractory lymphoma was conducted to evaluate the maximal tolerated dose. The 6 female and 8 male patients had a median age of 63 years (range, 45-73 years), a median performance status of 0 (range, 0-2), and a median disease stage of IV. This study included patients with diffuse large B-cell lymphoma (n = 5), adult T-cell leukemia/lymphoma (n = 2), mantle cell lymphoma (n = 2), follicular lymphoma (n = 2), angioimmunoblastic T-cell lymphoma (n = 1), anaplastic large cell lymphoma (n = 1), and Hodgkin's lymphoma (n = 1). All patients had received anthracycline-containing combination chemotherapy prior to this therapy. The starting dosage of CPT-11 was 15 mg/m2 per day (days 1-3 and 8-10), and dosage-escalation increments of 5 mg/m2 per day were planned, with fixed dosages of carboplatin (250 mg/m2 per day, day 1) and dexamethasone (40 mg/body, days 1-3 and days 8-10). Five patients were enrolled at level 1, 3 at level 2, 4 at level 3, and 2 at level 4. Ten patients (71%) and 11 patients (79%) experienced grade 3 or 4 hematologic toxicities of leukocytopenia and neutropenia, respectively. Three patients (29%) and 9 patients (64%) experienced grade 3 or 4 thrombocytopenia and anemia, respectively. Two patients who received 30 mg/m2 (level 4) of CPT-11 developed sepsis. We concluded that the recommended dose of CPT-11 with carboplatin and dexamethasone is 25 mg/m2. No deaths were related to this chemotherapy, and no patient developed liver dysfunction. The overall response rate was 36%. We conclude that the combination therapy of CPT-11, carboplatin, and dexamthasone is effective as salvage therapy but that the duration of response is too short.

Primary central nervous system lymphoma: the clinical features and treatment of 22 cases.

OBJECTIVE: To clarify the efficacy of chemotherapy after radiation therapy in immunocompetent patients with primary central nervous system lymphoma (PCNSL). PATIENTS AND METHODS: A retrospective analysis of 22 PCNSL patients was performed. Twenty-two patients were divided into a combined treatment (chemotherapy after radiation) group and a radiation group. The survival curves, calculated according to the Kaplan and Meier method, were compared using the Log-rank and Wilcoxon statistical analyses. RESULTS: Eight patients were treated with radiation therapy alone, and their median survival time (MST) after diagnosis was 21.9 months. Fourteen patients were treated with chemotherapy after radiotherapy. Six patients received chemotherapy consisting of cyclophosphamide, adriamycin, vincristine and prednisolone (CHOP), while 6 patients received carboplatin-based chemotherapy and 2 patients received methotrexate-based chemotherapy. The MST of these 14 patients was 34.4 months, which was not significantly better than that of the radiation therapy group (p=0.159). Leukoencephalopathy occurred in 3 patients, who received whole brain radiation. CONCLUSION: The use of chemotherapy after radiation has up to now been thought to be a standard treatment modality but CHOP or carboplatin-based chemotherapy did not improve the survival time.