Comparison of two high-dose cyclophosphamide, doxorubicin, vincristine, and prednisone derived regimens in patients aged under 60 years with low–intermediate risk aggressive lymphoma: a final analysis of the multicenter LNH93-2 protocol

Abstract

One-third of patients aged ≤60 years with aggressive lymphoma are at low–intermediate risk (LIR). Before the rituximab era, we prospectively compared ACVBP with ECVBP, a similar regimen including epirubicin instead of doxorubicin and increased dose intensity of cyclophosphamide, followed by conventional consolidation with an increased amount and dose intensity of cytosine-arabinoside, methotrexate, etoposide, and ifosfamide, in 652 patients with LIR aggressive lymphoma. The overall response rate, 5-year event-free survival (EFS), and survival were estimated to be 86%, 60%, and 74%, respectively, with no differences between the two arms. In patients with diffuse large B-cell lymphoma (DLBCL) who received ACVBP, the 5-year EFS and survival were estimated at 69% and 82%. These findings do not support the use of a chemotherapy regimen more intensive than ACVBP in patients aged ≤60 years with LIR aggressive lymphoma. The results in the control arm, without rituximab, have led to a randomized comparison of R-ACVBP and R-CHOP in this patient population.

Keywords:

• Aggressive non-Hodgkin lymphoma
• Chemotherapy model
• Clinical trial
• Dose escalation

Declaration of interest: This trial was supported by a grant (AOM95061) from the Programme Hospitalier de Recherche Clinique du Ministère de la Santé and La Societe de Medecine du Nord and grants from Amgen, Roche, Schering-Plough, and Astra-Medica.