CHLORAMBUCIL PREDNISONE VS CHOP IN SYMPTOMATIC LOW-GRADE NON-HODGKINS-LYMPHOMAS - A RANDOMIZED TRIAL FROM THE LYMPHOMA-GROUP-OF-CENTRAL-SWEDEN

Two hundred fifty-nine previously untreated patients with low-grade no n-Hodgkin's lymphomas (NHLs), Ann Arbor stages III and IV, entered a r andomized multicenter trial comparing the therapeutic effect of chlora mbucil/prednisone (ChP) vs. CHOR All patients had symptomatic disease. The therapeutic aim was to achieve an asymptomatic state in the ChP g roup (n = 132), while in CHOP-treated patients (n = 127) the intention was to reach a complete remission (CR). The response rate (CR + PR at 8 months) was 36% in the ChP and 60% in the CHOP group (p < 0.01). Th ree and 5-year survival rates were 59% and 41% in the ChP group and 64 % and 44% in the CHOP group. The corresponding median survival times w ere 46 and 52 months. After correction for intercurrent deaths, the ov erall 5-year survival was 49% for ChP and 54% for CHOP-treated patient s. The differences were statistically not significant. The time from d iagnosis to randomization (time with asymptomatic disease) was longer than one year in half of the patients. The median survival time from d iagnosis was 68 months, with no differences between the treatment grou ps. In all histological subgroups (CLL, IC, CC, and CB-CC), a higher r emission rate was seen with the CHOP regimen but with no statistically significant influence on survival. Comparing patients below and above 65 years of age, no significant difference in survival was noted betw een the two treatment groups. The results do not support the use of in tensive chemotherapy as first-line therapy in symptomatic low-grade NH L.