• Treatment of non-Hodgkin's lymphoma with intensive chemotherapy regimen as ALL
  • Mohammad-Salar Hosseini,1,* Mohammad Naghavi-Behzad,2 Reza Piri,3
    1. Student Research Committee, Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
    2. Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
    3. Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.


  • Introduction: The non-Hodgkin lymphomas (NHLs) are a heterogeneous group of malignancies arising from lymphoid tissue, with varied clinical and biological features. The current recommended treatment for most patients with B-cell aggressive NHL is rituximab-containing CHOP or CHOP-like regimens and for T-cell NHL same regimens without rituximab. Improvement results with intensive chemotherapy regimens and decreased response rate and survival with decreased chemotherapy intensity were reported in some studies. Therefore very intensive chemotherapy regimens, as intensive as high-dose chemotherapy with autologous stem cell support were used for the treatment of patients with aggressive NHL. This study describes the effect of high-dose short-course chemotherapy regimen, as used in the treatment of acute lymphoblastic leukemia (ALL), on non-lymphoblastic NHLs. Which induced remission and sustained disease-free survival, and may be feasible in the treatment of patients with aggressive NHL.
  • Methods: From 2002 – 2016, 30 cases of non-lymphoblastic NHL patients, have been treated as ALL. They have received Vincristin1.2mg/m2 weekly for 4 doses, Daunrobicine 45/m2 for three doses, prednisolone 100mg daily for 28 days and Cyclophosphamide 800-1200 mg/m2 on day one. All of them, except for one case, have received about 5 gr intravenous methotrexate for CNS prophylaxis. Also, they received maintenance therapy with oral methotrexate and 6-mercaptopurine after attaining complete remissions. Ten cases have received an additional course as consolidation. Two cases have been received radiation to bulky tumor sites, also. CR was defined as the disappearance of all clinical evidence of disease that had been present before therapy and no evidence of relapse for at least, month. All patients were hospitalized during treatment.
  • Results: Twenty-seven patients have achieved CR. Twelve patients with diffuse large-B cell lymphoma (DLCL) in their last follow-ups were disease-free years after treatment. Lymphomatous form of adult T-cell lymphoma/leukemia (ATLL) was diagnosed in a patient treated as ALL. Six patients have been diagnosed as diffuse small non-cleaved cell lymphoma (DSNCL), one with skull mass and 3 with pleural involvement. Reevaluation of histologic martials of the patients with DSNCL in CR showed malignant cells are CD5 and CD20 positive, compatible with SLL. Nine patients with a final diagnosis of SLL/CLL have relapse of their diseases less than a year after treatment and one patient with splenomegaly, generalized lymphadenopathy and lymphocytosis has had as T-cell ALL.
  • Conclusion: Results of the current study suggest that remission and sustained disease-free survival may be achieved in patients with aggressive NHL disease-free using high-dose short-course chemotherapy regimens, as used in the treatment of ALL. Low-grade SLL/CLL treated as ALL although achieve CR, may relapse in a few months.
  • Keywords: non-Hodgkin lymphoma, Chemotherapy, Acute Lymphoblastic Leukemia, ALL