Treatment of low‐grade and intermediate‐grade lymphoma with intensive combination chemotherapy results in long‐term, disease‐free survival

To define the role of intensive combination chemotherapy in the treatment of low‐grade or intermediate‐grade lymphomas, the authors report results in 49 patients treated with intermediate‐dose or high‐dose methotrexate, bleomycin, Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), cytoxan (cyclophosphamide), vincristine, and dexamethasone (m/M‐BACOD) with long‐term follow‐up. The complete response rate was 59% (29 of 49), including 67% (eight of 12) with low‐grade and 57% (21 of 37) with intermediate‐grade disease. The median survival for the entire group was 81 months. The 29 complete responders had a long median survival of 131 months. Forty‐five percent (13 of 29) of the complete responders, 27% of the entire group, continue in remission with a median disease‐free survival of 76 months. This includes five of 19 patients with diffuse poorly differentiated lymphoma, a disease generally characterized by early relapse. Twelve patients achieved a partial response and had a shorter median survival of 53 months, whereas nonresponders survived a median of less than 5 months. Late relapse was noted in patients with low‐grade and intermediate‐grade disease. Age (younger than or older than 60 years) was the only predictor of long‐term survival. These data indicate very long disease‐free survival can be achieved in low‐grade and intermediate‐grade lymphomas after attaining a complete remission. Intensive doxorubicin containing chemotherapy can be considered as an option for patients with advanced low‐grade lymphoma but can only be proven to be superior to single‐agent chemotherapy or no initial therapy by controlled randomized trials.