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Annals of Oncology 7:157-163, 1996
© 1996 European Society for Medical Oncology

research-article

High rate of prolonged remissions following combined modality therapy for patients with localized low-grade lymphoma

J. F. Seymour1,2, P. McLaughlin1, L. M. Fuller1, F B. Hagemeister1, M. Hess1, F Swan1, J. Romaguera1, M. A. Rodriguez1, P. Besa1, J. Cox1 and F. Cabanillas1

1The University of Texas M.D. Anderson Cancer Center Houston, TX, U.S.A.
2Ludwig Institute for Cancer Research, Melbourne Tumour Biology Branch, Royal Melbourne Hospital, Victoria Parkville, Australia

Peter McLaughlin, MD. Lymphoma Section, Box 68 The University of Texas M.D. Anderson Cancer Center 1515 Holcombe Blvd. Houston, TX 77030 U.S.A.

Purpose: Involved field (IF) radiation can cure as many as 40% to 50% of patients with stage I-II low-grade lymphoma. We sought to improve these results by prospectively evaluating the combination of IF radiation and chemotherapy consisting of 10 courses of cyclophosphamide, vincristine, prednisone, and bleomycin, with doxorubicin added in a risk-adapted manner (COP/CHOP-Bleo).

Patients and methods: From 1984 until December 1992, 91 patients, median age 56 years (range 28 to 77 years), with clinical stage I-II low-grade lymphoma were treated. No patients were excluded on the basis of age or organ function.

Results: A complete response was attained in 99% of evaluable patients. Treatment-related toxicity was mild, and no deaths occurred during therapy. With a median follow-up of 60 months, there have been only 16 relapses. The actuarial freedom from relapse rate at five years is 82% (95% confidence interval 71% to 89%) and at 10 years is 73%. At five years the overall survival rate is 90% (95% confidence interval 81% to 95%) and at ten years it is 82%. Of the clinical features examined, only older age (>56 years; p = 0.07) was associated with shorter survival. No features examined were predictive of disease relapse.

Conclusion: The combination of IF radiation and risk-adapted COP/CHOP-Bleo chemotherapy is well-tolerated, produces a very high rate of complete remission, and with a median follow-up of five years, has produced lower rates of relapse and better overall survival than has been reported for IF radiation alone in patients with clinically-staged I-II low-grade lymphoma.

combined chemotherapy-radiotherapy, follicular small cleaved cell lymphoma, stage I-II low-grade lymphoma


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