CHEMOTHERAPY WITH MECOP-B FOR INTERMEDIATE-GRADE AND HIGH-GRADE NON-HODGKINS-LYMPHOMA IN SAUDI-ARABIA - CLINICAL-RESULTS AND ANALYSIS OF PROGNOSTIC FACTORS

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.