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Blood, 15 December 2003, Vol. 102, No. 13, pp. 4284-4289.
Prepublished online as a Blood First Edition Paper on August 14, 2003; DOI 10.1182/blood-2003-02-0542.
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CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Intensive conventional chemotherapy (ACVBP regimen) compared with standard CHOP for poor-prognosis aggressive non-Hodgkin lymphoma
Hervé Tilly,
Eric Lepage,
Bertrand Coiffier,
Michel Blanc,
Raoul Herbrecht,
André Bosly,
Michel Attal,
Georges Fillet,
Catherine Guettier,
Thierry Jo Molina,
Christian Gisselbrecht, and
Félix Reyes, for the Groupe d'Etude des Lymphomes de l'Adulte
From the Centre Henri Becquerel, Rouen, France; Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France; Centre Hospitalier Lyon Sud, Pierre-Bénite, France; Centre Hospitalier de Chambéry, Chambéry, France; Hôpital de Hautepierre, Strasbourg, France; Cliniques Universitaires de Mont Godinne, Yvoir, Belgium; Hôpital de Purpan, Toulouse, France; Hôpital Universitaire de Liège, Liège, Belgium; Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France; Hôtel-Dieu, Assistance Publique Hôpitaux de Paris, Paris, France; and Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris, Paris, France.
We conducted a randomized trial to compare the intensive conventional chemotherapy regimen ACVBP (doxorubicin, cyclophosphamide, vindesine, bleomycin, prednisone) with standard CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) in previously untreated patients with poor-risk aggressive lymphoma. Patients aged 61 to 69 years who had aggressive non-Hodgkin lymphoma with at least one prognostic factor of the age-adjusted international prognostic index (IPI) were included. ACVBP consisted of an induction phase of intensified chemotherapy and central nervous system (CNS) prophylaxis followed by a sequential consolidation phase. Of the 708 patients registered for the study, 635 were eligible. The rate of complete response was 58% in the ACVBP group and 56% in the CHOP group (P = .5). Treatment-related death occurred in 13% of the ACVBP group and 7% of the CHOP group (P = .014). At 5 years, the event-free survival was 39% in the ACVBP group and 29% in the CHOP group (P = .005). The overall survival was significantly longer for patients treated with ACVBP, at 5 years it was 46% compared with 38% for patients treated with CHOP (P = .036). CNS progressions or relapses were more frequent in the CHOP group (P = .004). Despite higher toxicity, the ACVBP regimen, used as first-line treatment for patients with poor-risk aggressive lymphoma, is superior to standard CHOP with regard to both event-free survival and overall survival. (Blood. 2003;102:4284-4289)
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