The effect of intensive intermittent maintenance therapy in advanced low‐grade non‐Hodgkin's lymphoma

One hundred and eleven patients with low‐grade histology non‐Hodgkin's lymphoma achieving a restaged complete response to one of three induction therapies on Eastern Cooperative Oncology Group (ECOG) protocol EST 2474 were randomized to receive either maintenance treatment with BCNU, cyclophosphamide, vincristine, and prednisone (BCVP) given every 6 weeks for an additional 18 months or no further therapy. Overall toxicity was moderate. The median progression‐free survival (PFS) on maintenance therapy was 3.2 years versus 2.0 years for those observed without treatment (P = 0.02). Progression‐free survival was significantly shorter for patients with nodular and diffuse pattern (ND), histiocytic or mixed histology compared with pure nodular lymphocytic, or poorly differentiated counterpart (P = 0.0007), thus confirming the prognostic significance of histologic subtypes. However, the overall survival of patients was not improved by maintenance treatment, suggesting that therapy upon relapse was an equally effective alternative clinical strategy.

[1]  R. Hartsock,et al.  Moderate versus intensive chemotherapy of prognostically favorable non‐Hodgkin's lymphoma a progress report , 1980, Cancer.

[2]  C. Spurr,et al.  Management of patients with malignant lymphoma: a comparative study with cyclophosphamide and vinca alkaloids. , 1968, Cancer research.

[3]  T. Colby,et al.  Histologic conversion in the non-Hodgkin's lymphomas. , 1983, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[4]  E. Gehan,et al.  Combined cyclophosphamide, vincristine, and prednisone therapy of malignant lymphoma , 1971, Cancer.

[5]  M. Pike,et al.  Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. , 1977, British Journal of Cancer.

[6]  Mayo,et al.  Combination versus successive single agent chemotherapy in lymphocytic lymphoma , 1978, Cancer.

[7]  E. Kaplan,et al.  Nonparametric Estimation from Incomplete Observations , 1958 .

[8]  T. Landberg,et al.  CVP—Remission—maintenance in stage I or II non‐Hodgkin's lymphomas Preliminary results of a randomized study , 1979, Cancer.

[9]  S. Rosenberg,et al.  No initial therapy for stage III and IV non-Hodgkin's lymphomas of favorable histologic types. , 1979, Annals of internal medicine.

[10]  S. Horning,et al.  The natural history of initially untreated low-grade non-Hodgkin's lymphomas. , 1984, The New England journal of medicine.

[11]  C. Spurr,et al.  Combination chemotherapy in lymphosarcoma and reticulum cell sarcoma. , 1969, Blood.

[12]  F. Drislane,et al.  High‐dose pulse chlorambucil. Effective therapy for rapid remission induction in nodular lymphocytic poorly differentiated lymphoma , 1982, Cancer.

[13]  M. Greene,et al.  Evidence of a treatment dose response in acute nonlymphocytic leukemias which occur after therapy of non-Hodgkin's lymphoma. , 1983, Cancer research.

[14]  J. Glick,et al.  Moderate versus aggressive chemotherapy of nodular lymphocytic poorly differentiated lymphoma. , 1985, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[15]  S. Rosenberg.  Karnofsky memorial lecture. The low-grade non-Hodgkin's lymphomas: challenges and opportunities. , 1985, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.