CHEMOTHERAPY WITH MECOP-B FOR INTERMEDIATE-GRADE AND HIGH-GRADE NON-HODGKINS-LYMPHOMA IN SAUDI-ARABIA - CLINICAL-RESULTS AND ANALYSIS OF PROGNOSTIC FACTORS
Em. Ibrahim et al., CHEMOTHERAPY WITH MECOP-B FOR INTERMEDIATE-GRADE AND HIGH-GRADE NON-HODGKINS-LYMPHOMA IN SAUDI-ARABIA - CLINICAL-RESULTS AND ANALYSIS OF PROGNOSTIC FACTORS, Acta haematologica, 96(3), 1996, pp. 126-134
Between August 1985 and January 1994, 73 evaluable adult patients with
bulky localized or advanced-stage, intermediate- and high-grade de no
vo non-Hodgkin's lymphoma (NHL) were treated with MECOP-B (methotrexat
e and leucovorin rescue, epirubicin, cyclophosphamide, vincristine, pr
ednisone, and bleomycin). Over a median follow-up of 32 months (range,
4-98 months), 55 patients (75%) achieved complete remission (CR) (95%
confidence interval, 81-69%) and 3 attained partial remission (PR) (4
%) for an overall response rate of 79%. Using a multiple regression an
alysis where the dependent variable was response to therapy (CR vs. PR
+ treatment failure), poor performance status, and the presence of a
bulky disease were negatively associated with the likelihood of achiev
ing CR. Survival analysis showed that 49 (67%) patients (95% confidenc
e interval, 74 and 60%) were alive, of whom 47 (64%) were disease-free
. While the median survival has not been reached, the actuarial surviv
al probability at 5 years +/- SE was 64 +/- 6%. Time to treatment fail
ure for those attaining CR was also estimated. While the median surviv
al has not been reached, probability of freedom from treatment failure
at 5 years +/- SE was estimated as 74 +/- 7%. However, the long-term
CR (CR rate times disease-free survival rate) was only 48%, and the 'm
easurement of efficacy' was 53%. These results were inferior to those
from our earlier reports. The proportional hazards model of Cox identi
fied poor performance status, older age, and high lactate dehydrogenas
e as factors with an adverse effect on survival. Using the results of
the model, patients were categorized into three pre defined risk group
s with significant differences in outcome. Toxicity of the regimen was
high, but comparable to that reported in the literature with a toxic
death rate of 8%. We conclude that MECOP-B is an effective therapy for
patients with aggressive NHL; however, based on the current results;a
s compared with our earlier analysis, besides the emergence of prognos
tic factors, therapy of NHL should be individualized. Less expensive,
less toxic regimens should be used for lower-risk patients, while the
use of more intense, more toxic, more expensive programs should only b
e offered to those with a predicted poor outcome.