Sequential versus alternating chemotherapy for high grade non-hodgkin's lymphomas: A randomized multicentre trial

✍ Scribed by H. Köppler; K. H. Pflüger; I. Eschenbach; R. Pfab; J. Birkmann; W. Zeller; E. U. Steinhauer; C. Gropp; S. Oehl; E. Lötzke; H. Kuhn; P. Drings; H. H. Gossmann; K. Lennert; H. Stein; K. Havemann

• Publisher: John Wiley and Sons
• Year: 2006
• Tongue: English
• Weight: 406 KB
• Volume: 9
• Category: Article
• ISSN: 0278-0232
• DOI: 10.1002/hon.2900090407

✦ Synopsis

In a multicentre phase 111 trial 146 previously untreated patients with high grade non-Hodgkin's lymphomas stage I1 IV were randomized to receive either four cycles of CHOEP (cyclophosphamide 750 mg/m2 iv d 1, doxorubicin 50 mg/m2 iv d 1, vincristine 2 mg iv d 1, etoposide 100 mg/m2 iv d 3-5, prednisolone 100 mg PO d 1-5) (treatment arm A), or four cycles of chemotherapy with hCHOP (cyclophosphamide 1200 mg/m2 iv d 1, doxorubicin 40 mg/m2 iv d 1 + 2, vincristine 2 mg iv d 1, prednisolone 100 mg PO d 1-5) alternating with IVEP (ifosfamide 1500 mg/m2 iv d 1-5, vindesine 3 mg/m2 iv d 1, etoposide 120 mg/m2 iv d 3-5, prednisolone 100 mg PO d 1-5) (treatment arm B). After four cycles of chemotherapy an involved field irradiation with a total dose of 35 Gy was given to all patients in complete or partial remission without persisting extranodal disease. A complete response (CR) was seen in 124/146 patients (86 per cent) with 87 per cent CR in arm A versus 83 per cent CR in a r m B. During a median follow-up of 17 months (range 2-40) 30 patients relapsed (1 6 patients arm A, 14 patients arm B). The overall survival at 40months is projected to be 71 per cent versus 70 per cent for arm A and B, respectively. Disease-free survival is projected to be 68 per cent in arm A and 59 per cent in arm B at 40 months. So far, the differences in CR, survival and disease-free survival are not statistically significant. Toxicity of all regimens was acceptable, however, with a significant morbidity and one treatment-related death in patients > 70 years after hCHOP. Main side effects were mild nausea/vomiting, leukopenia and fever/infection associated with leukopenia.

In conclusion both treatment modalities produced high complete remission rates. A longer follow-up will be needed to exclude differences in over-all and disease-free survival.