Studies on treatment of malignant lymphoma Part 1. Combination of adriamycin, vincristine, ifosfamide and prednisolone (AVIP) for malignant lymphomas refractory to conventional chemotherapy

Fifty-seven patients with advanced malignant lymphoma, who had failed to achieve complete remission or relapsed after conventional combination chemotherapy, were treated with a combination of adriamycin, vincristine, ifosfamide and prednisolone (AVIP). Twenty-five patients were given relatively low doses of adriamycin (0.5mg/kg), vincristine (0.025mg/kg), and ifosfamide (25mg/kg) at 7-day intervals (Regimen I), and the remaining 32 patients were given relatively high doses of these drugs (1.2mg/kg of adriamycin, 50mg/kg of ifosfamide and 0.03mg/kg of vincristine) at 21-day intervals (Regimen Ⅱ). Among 8 patients with Hodgkin's disease, 7 (88%) achieved objective remission including 4 (50%) complete remissions, and 3 complete respondors remain disease free in a follow-up from 44 months to 89 months. The overall median survival was more than 50 months, ranging from 12 months to more than 90 months. Among 49 patients with non-Hodgkin's lymphoma, 32 (65%) achieved objective remission including 15 (31%) complete remissions. The median duration of complete remission was 8 months, and 3 complete respondors remain disease free at 13, 36 and 90 months, respectively. The overall median survival was 8 months, ranging from 2 months to more than 91 months. The diffuse large cell type was the most frequent in non-Hodgkin's lymphoma. Among 27 patients with this histologic type, 17(63%) had objective remission including 7 (26%) complete remissions. The median duration of complete remission and the median survival were 11 months and 8 months, respectively. There were no significant differences in the therapeutic results of Regimen I and Regimen Ⅱ, although the latter showed a slightly higher response rate and longer duration of complete remission in non-Hodgkin's lymphoma. Reversible bone marrow toxicity was the major toxic reaction, but both regimens were well tolerated. These results indicate that a combination of AVIP is useful for treatment of malignant lymphomas refractory to conventional chemotherapy