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Annals of Oncology 11:S87-S90, 2000
© 2000 European Society for Medical Oncology

Symposium Articles

A Randomised British National Lymphoma Investigation trial of CHOP vs. a weekly multi-agent regimen (PACEBOM) in patients with histologically aggressive non-Hodgkin's lymphoma

D. C. Linch1, P. Smith1, B. W. Hancock2, P. J. Hoskin3, D. C. Cunningham4, A. C. Newland5, D. Milligan6, P. A. Stevenson7, J. K. Wood8, K. A. Maclennan9, B. Vaughan Hudson1, G. Vaughan Hudson1 and W. M. Gregory1

1 The British National Lymphoma Investigation, The CRC and UCL Cancer Trials Centre, Department of Oncology, Macdonald Buchanan Building, The Middlesex Hospital London, UK
2 YCRC Department of Clinical Oncology, Weston Park Hospital Sheffield, UK
3 Cancer Treatment Centre, Mount Vernon Hospital Northwood, UK
4 CRC Section of Medicine and the Lymphoma Unit, Institute of Cancer Research and the Royal Marsden Hospital London and Surrey, UK
5 Department of Haematology, The London Hospital Medical College London, UK
6 Department of Haematology, Birmingham Heartlands Hospital Birmingham, UK
7 Department of Haematology, Aintree General Hospital Liverpool, UK
8 Department of Haematology, Leicester Royal Infirmary Leicester, UK
9 ICRF Cancer Medicine Research Unit, St James' Hospital Leeds, UK
Clinical Oncology Unit, Guy's Hospital London, UK

Correspondence to: Prof. D. C. Linch The British National Lymphoma Investigation, The CRC and UCL Cancer Trials Centre, Department of Oncology, Macdonald Buchanan Building, The Middlesex Hospital, Mortimer Street London WIN 8AA UK

Background: Between 1987 and 1991, the British National Lymphoma Investigation randomized 459 patients with non-Hodgkin's lymphoma with a large-cell component to either CHOP or the PACEBOM regimen.

Patients and methods: Four hundred fifty-nine eligible patients were included in this trial, four hundred one with diffuse large-cell lymphoma and fifty-eight with diffuse mixed-cell lymphoma according to the Working Formulation. Two hundred twenty-six patients were randomized to receive CHOP and two hundred thirty-three to receive PACEBOM. The two arms of the trial were well balanced for all potential prognostic factors.

Results: The complete remission rate with PACEBOM was 64% and with CHOP 57% (NS). At eight years, the actuarial cause specific survival (CSS) in the PACEBOM arm is 59% compared to 49% in the CHOP arm (P=0.09). Patients <50 years of age fared significantly better in the PACEBOM arm both for CSS and overall survival (P=0.002) and the CSS was also significantly improved in stage IV disease (P=0.02).

Conclusions: The mature data from this trial suggest that an etoposide-containing multi-agent weekly regimen can be superior to CHOP.

CHOP vs. PACEBOM, non-Hodgkin's lymphoma, long-term results, randomized trial


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