COMBINATION CHEMOTHERAPY FOR INTERMEDIATE AND HIGH-GRADE NON-HODGKINS-LYMPHOMA

One hundred and eighteen consecutive adults with newly diagnosed inter mediate and high-grade non-Hodgkin's lymphoma were treated with chemot herapy comprising Doxorubicin, Cyclophosphamide, Vincristine and Predn isolone with mid-cycle Methotrexate (MTX) and leucovorin rescue ('CHOP -M'). Intrathecal MTX was given with each treatment cycle as central n ervous system (CNS) prophylaxis. 'Clinical remission' was achieved in 70/110 evaluable,patients (64%), complete remission: 45/110, (41%), go od partial remission: 25/110 (23%). Twenty two patients (19%) died pri or to completion of therapy, 18 patients had persistent disease. Hypon atremia (< 137 mmol l-1), advanced age and hypoalbuminaemia (< 32 g l- 1) correlated adversely with achievement of CR (P=0.0007, 0.0005 and 0 .04 respectively). With a minimum follow up of 4 1/2 years, 47 of the seventy patients (67%) in whom clinical remission was achieved-remain well, 19 have developed recurrent disease, resulting in an actuarial p rojected remission duration of 70% at 8 years. Four died in CR. There has been only one isolated CNS recurrence. On univariate analysis, hyp oalbuminaemia, hyponatremia and beta2 microglobulin (> 3) correlated w ith unfavourable outcome in terms of duration of remission (P = 0.0009 , 0.007 and 0.04 respectively). On multivariate analysis, only the ser um sodium (0.002) and advanced age (0.01) were predictive for remissio n duration. Fifty patients (45%) are alive, the overall actuarial proj ected survival is thus 42% at 8 years. On univariate analysis, age, hy poalbuminaemia, hyponatraemia, liver involvement and the presence of B symptoms correlated unfavourably with survival. On multivariate analy sis, hypoalbuminaemia, advanced age, hyponatraemia, male gender (aged > 50) and diffuse large cell or large cell, immunoblastic histology (W orking Formulation) had an adverse effect (P = 0.003, < 0.0001, < 0.00 01, 0.002, and 0.03). It was further possible, using cut-off points of 32 g l-1 and 136 mmol l-1 for albumin and sodium respectively to defi ne prognostic categories for patients who differed significantly in te rms of survival.