Abstract
Granulocyte-macrophage colony stimulating factor (GM-CSF) has been shown to enhance CD20 antigen expression, augment antibody-dependent cell-mediated cytotoxicity, and stimulate immune cell proliferation. This may lead to an improved anti-tumor effect of rituximab while reducing the severity of chemotherapy-induced myelosuppression. We evaluated the safety and efficacy of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) in sequential combination with GM-CSF priming and rituximab in previously untreated patients (n = 39) with diffuse-large B-cell lymphoma (DLBCL) and mantle cell lymphoma (MCL). CHOP was administered every 21 days on day 1, GM-CSF 250 μg/m(2)/day on days 9 through 15, and rituximab 375 mg/m(2) on day 15 of each cycle. The overall response rate was 87%, with complete response in 64%. At a median follow-up of 84.3 months, the overall and progression-free survival rates were 54% and 49%, respectively. The most common toxicity was myelosuppression. Sequential combination of CHOP with GM-CSF priming and rituximab was feasible and effective, warranting further evaluation.
MeSH terms
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Adult
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Aged
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Aged, 80 and over
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Agranulocytosis / chemically induced
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Antibodies, Monoclonal, Murine-Derived / administration & dosage
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Antibodies, Monoclonal, Murine-Derived / adverse effects
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Antineoplastic Combined Chemotherapy Protocols / adverse effects
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
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Cyclophosphamide / administration & dosage
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Cyclophosphamide / adverse effects
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Doxorubicin / administration & dosage
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Doxorubicin / adverse effects
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Drug Administration Schedule
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Feasibility Studies
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Follow-Up Studies
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Granulocyte-Macrophage Colony-Stimulating Factor / administration & dosage
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Granulocyte-Macrophage Colony-Stimulating Factor / adverse effects
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Humans
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Kaplan-Meier Estimate
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Leukopenia / chemically induced
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Lymphoma, Large B-Cell, Diffuse / drug therapy*
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Lymphoma, Mantle-Cell / drug therapy*
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Male
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Middle Aged
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Neutropenia / chemically induced
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Pilot Projects
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Prednisone / administration & dosage
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Prednisone / adverse effects
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Rituximab
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Treatment Outcome
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Vincristine / administration & dosage
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Vincristine / adverse effects
Substances
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Antibodies, Monoclonal, Murine-Derived
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Rituximab
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Vincristine
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Doxorubicin
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Granulocyte-Macrophage Colony-Stimulating Factor
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Cyclophosphamide
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Prednisone