Annals of Oncology 9:511-518, 1998
© 1998 European Society for Medical Oncology
research-article |
Alternating triple therapy for the treatment of intermediate grade and immunoblastic lymphoma
Division of Medicine, Department of Lymphoma-Myeloma and the Department of Biomathematics, The University of Texas M. D. Anderson Cancer Center Houston, TX, USA
Correspondence to: F. Cabanillas, MD Department of Hematology Box 068, The University of Texas M.D. Anderson Cancer Center 1515, Holcombe Blvd. Houston, TX 77030 USA E-mail: fcabanil@ notes.mdacc.tmc.edu
BACKGROUND: CHOP is currently considered the gold standard of treatment for intermediate grade lymphomas. We designed a new regimen known as ‘ATT’ (alternating triple therapy) which uses three non-cross resistant combinations in alternating sequence for nine cycles.
MATERIALS AND METHODS: This is a phase II clinical trial with comparison to CHOP/CMED historical controls using prognostic factors. The tumor score system was used to evaluate the results of this trial. Two hundred sixty-eight eligible patients who had one or more of the following adverse features: bulky disease, elevated LDH or > 1 extranodal site were analyzed. Outcome measures consist of survival and failure free survival.
RESULTS: At a median follow-up of 32 months, there was no statistically significant difference in survival for those with favorable prognostic factors (tumor score 
2). However, there was a statistically significant difference in favor of ATT for those with unfavorable tumor scores. When we examined the failure-free survival of those with unfavorable tumor scores, we again observed a superiority for the ATT regimen over CHOP/CMED but the opposite was true for those with favorable tumor scores. We also found a statistically significant difference in favor of the ATT regimen when compared with CHOP/CMED for patients 60 years old with a tumor score 
3, while no advantage was found for those > 60 years.
CONCLUSIONS: ATT appears more effective but only for patients < 60 years old with unfavorable tumor scores. In those older than 60 years with favorable tumor score, CHOP/CMED appears superior. ATT might be an adequate regimen for young patients with poor prognostic features while CHOP/CMED might be a better choice for those with good prognosis irrespective of age. For those >60 years with unfavorable tumor scores neither ATT or CHOP/CMED were adequate treatment. Because of the phase II nature of this study, these conclusions should be considered as hypotheses which require prospective testing.
aggressive lymphomas, intermediate grade lymphomas, CHOP, ATT, prognostic factors
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