Prospectively randomized clinical trial of three intensive chemotherapy regimens for the treatment of advanced unfavorable histology non-Hodgkin's lymphoma

M. J. O'Connell, D. P. Harrington, J. D. Earle, G. J. Johnson, J. H. Glick, P. P. Carbone, R. H. Creech, R. S. Neiman, R. B. Mann, M. N. Silverstein

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17 Scopus citations

Abstract

Three hundred thirty-two eligible patients with advanced (Ann Harbor stage III or IV) non-Hodgkin's lymphoma of aggressive histologic subtype (Rappaport classification diffuse histiocytic [DH], diffuse poorly differentiated lymphocytic [DPDL], diffuse mixed [DM], or diffuse undifferentiated [DU] were randomly assigned to receive induction chemotherapy with one of three intensive regimens in a clinical trial conducted by Eastern Cooperative Oncology Group (ECOG) between 1978 and 1983. Chemotherapy regimens consisted of cyclophosphamide, vincristine, prednisone, and doxorubicin (Adriamycin; Adria Laboratories, Columbus, OH) (COPA) administered in 3-week cycles; cyclophosphamide plus doxorubicin plus prednisone beginning day 1, with vincristine plus bleomycin day 15 of each 3-week cycle (COPA + Bleo); or cyclophosphamide plus doxorubicin plus procarbazine beginning day 1, and bleomycin plus vincristine plus prednisone beginning day 15 of each 4-week cycle (CAP-BOP). The median patient follow-up from study entry for patients still alive is 5 years. The three regimens were not significantly different with respect to complete response (CR) rates (43% to 46%), time to progression of malignant disease (median, 1.0 to 1.7 years), or survival (5-year survival, 34% to 46%) although duration of complete remission appeared to be shorter in patients receiving COPA (P=.03). COPA + Bleo and CAP-BOP were significantly more toxic than the COPA regimen. This study did not demonstrate any substantial therapeutic advantage associated with the addition of a fifth or sixth chemotherapy drug, or with treatment administered on a more frequent administration schedule, compared with the COPA regimen in this population of patients with advanced diffuse non-Hodgkin's lymphoma. The relatively small proportion of long-term disease-free survivors treated with COPA underscored the need for prospective clinical trials of new and more effective treatments for patients with these potentially curable tumors.

Original languageEnglish (US)
Pages (from-to)1329-1339
Number of pages11
JournalJournal of Clinical Oncology
Volume5
Issue number9
DOIs
StatePublished - 1987

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