Early versus late alternating chemotherapy in XXXX . Swiss Group for Clinical @entity5 Research (SAKK).

@entity1 @entity632 @entity137 @entity66 @entity5 @entity900 @entity786 @entity2879 @entity1891 @entity1499 @entity151
BACKGROUND: From 1984 to 1989, the Swiss Group for Clinical @entity5 Research (SAKK) performed a randomized phase III trial comparing early versus late alternating chemotherapy in @entity1 with @entity151 . @entity1 AND METHODS: 406 eligible @entity1 were entered into the trial. Regimen A consisted of PAV ( @entity900 , @entity632 , @entity2879 , and Regimen B of CyMOC ( @entity786 , @entity1499 , @entity1891 , CCNU). Cycles were repeated as rapidly as possible. @entity1 were randomized to receive either ABABAB (early alternating chemotherapy) or AAABBB (late alternating chemotherapy). After six cycles @entity1 with limited disease in complete or partial remission and those with @entity66 in complete remission received irradiation to the primary (45 Gy) and the CNS (36 Gy). RESULTS: The overall remission rate was 87% with 31% complete remissions. The median survival of all 406 eligible @entity1 was 346 days with 15% of the @entity1 alive at two years. The overall remission rate, the rate of complete remission, the median survival and the rate of long-term survival were not significantly different in the two treatment arms. In limited disease the estimated percentages of survival at 2 years were 33% in the early and 24% in the late alternating chemotherapy arms. @entity1 with @entity66 survived significantly longer with late alternating chemotherapy than on the early alternation regimen (median survival 336 days versus 301 days, p = 0.01). In the latter @entity1 the received dose intensities (RDI) of @entity900 , @entity632 and @entity2879 were significantly higher in the late-alternation arm. @entity1 treated with early alternating chemotherapy rated their @entity5 symptoms, functional states, fatigue/malaise and restriction of social activity significantly better, reflecting an improved subjective adjustment. CONCLUSIONS: Alternating chemotherapy with PAV-CyMOC plus consolidating radiotherapy is a feasible and effective treatment for @entity151 , with acceptable @entity137 . Whereas @entity1 with early alternating chemotherapy achieve a better subjective adjustment, late alternating chemotherapy allows for a higher RDI of @entity900 , @entity632 and @entity2879 , which results in a significantly longer median survival of @entity1 with @entity66 .
