Blood, Vol. 92 No. 3 (August 1), 1998:
pp. 790-794
Anaplastic Large Cell Lymphoma Hodgkin's-Like: A Randomized
Trial of ABVD Versus MACOP-B With and Without Radiation Therapy
Pier Luigi Zinzani,
Maurizio Martelli,
Massimo Magagnoli,
Alfonso Zaccaria,
Fioravante Ronconi,
Maria Cantonetti,
Monica Bocchia,
Roberto Marra,
Marco Gobbi,
Brunangelo Falini,
Filippo Gherlinzoni,
Luciano Moretti,
Amalia De Renzo,
Patrizio Mazza,
Enzo Pavone,
Elena Sabattini,
Angela Amendola,
Maurizio Bendandi,
Stefano A. Pileri,
Franco Mandelli, and
Sante Tura
From the Institute of Hematology and Medical Oncology
"Seràgnoli," University of Bologna, Bologna; the Department
of Hematology, "La Sapienza" University, Rome; the Department of
Hematology, Ravenna Hospital, Ravenna; the Department of Hematology,
Avellino Hospital, Avellino; the Department of Hematology, "Tor
Vergata" University, Rome; the Department of Hematology, Siena
Hospital, Siena; the Department of Hematology, "Cattolica"
University, Rome; the Department of Hematology, D.I.M.I. University of
Genova, Genova; the Department of Hematology, University of Perugia,
Perugia; Hematology Division, Pesaro Hospital, Pesaro; the Department
of Hematology, University of Napoli, Napoli; the Division of
Hematology, Taranto Hospital, Taranto; and the Department of
Hematology, University of Bari, Bari, Italy.
During the last few years, morphological, immunohistochemical, and
genetic findings have placed anaplastic large cell lymphoma (ALCL) as a
distinct clinicopathologic entity, and several reports have focused on
the existence of different subtypes of the tumor. Particular attention
has been paid to the ALCL-Hodgkin's-like (HL) subtype, which seems to
be on the border between Hodgkin's disease (HD) and high-grade
non-Hodgkin's lymphoma (HG-NHL). From September 1994 to July 1997, during the course of an Italian multicentric trial, 40 ALCL-HLs were
randomized to receive as front-line chemotherapy MACOP-B (methotrexate
with leucovorin, doxorubicin, cyclophosphamide, vincristine,
prednisone, and bleomycin
a third-generation HG-NHL regimen) or ABVD
(doxorubicin, bleomycin, vinblastine, and dacarbazinea scheme
specific for HD). All patients with bulky disease in the mediastinum at
diagnosis underwent local radiotherapy after the chemotherapeutic
program. Complete response (CR) was achieved in 17 of the 19 (90%)
patients who were treated with MACOP-B, and in 19 of the 21 (91%)
patients who were administered ABVD. The probability of relapse-free
survival, projected at 32 months, was 94% for the MACOP-B subset and
91% for the ABVD subset. The majority of patients with mediastinal
bulky disease obtained CR (evaluated with 67Ga single
photon emission computed tomography [SPECT]) after their radiotherapy. The present study suggests that ALCL-HL, in line with its
borderline status, responds in an equivalent way to third-generation chemotherapy for HG-NHL and to conventional HD treatment in terms of
both CR and relapse-free survival rates. However, as to the latter, a
longer follow-up period may be needed before stating the absolute
equivalence of the two regimens used.
© 1998 by The American Society of Hematology.
