INTERMEDIATE-GRADE LYMPHOMAS TREATED WITH AMIDE-DOXORUBICIN-VINCRISTINE-PREDNISONE-BLEOMYCIN ALTERNATED WITH LOPHOSPHAMIDE-METHOTREXATE-ETOPOSIDE-DEXAMETHASONE - APPLICATION OF PROGNOSTIC MODELS TO DATA-ANALYSIS

Background. Numerous treatment strategies have been tried with the aim of improving results for patients with intermediate-grade lymphomas ( IGL) over those achieved with cyclophosphamide, doxorubicin, vincristi ne, prednisone, and bleomycin (CHOP-Bleo), and numerous prognostic mod els have been developed to identify and separate risk groups. This stu dy reports on a new protocol for Ann Arbor Stages II-IV IGL that consi sts of CHOP-Bleo alternated with a new regimen of cyclophosphamide, me thotrexate, etoposide, and dexamethasone (CMED) and radiation therapy and demonstrates the usefulness of prognostic models for identifying r isk groups and comparing treatment programs. Methods. One hundred seve nty patients with Ann Arbor Stages II-IV IGL were treated with alterna ting cycles of CHOP-Blee and CMED for a total of 12 cycles. Involved f ield radiation therapy was interspersed with courses of chemotherapy f or patients with Stage II and Stage III disease. Results were analyzed and compared with those of the authors' previous study of CHOP-Bleo a nd radiation therapy using the Ann Arbor staging system, their earlier prognostic model, and the recently published International Index. Res ults. A complete remission occurred in 78% of the patients. The overal l 5-year survival rate was 67%. Survival was better for patients with Ann Arbor Stage II disease (80%) than for those with Stage III or Stag e IV (67% and 58%, respectively). High tumor burden, above-normal leve ls of serum lactic dehydrogenase, serum PB-microglobulin, and Ann Arbo r Stage IV disease were adverse factors. The International Index and t he authors' earlier prognostic model separated four prognostic groups. CHOP-Bleo/CMED was generally well tolerated. Neutropenic fever was th e major complication that occurred in 25 patients during treatment. Si x of these patients died of sepsis. Conclusions. This study demonstrat ed that CHOP-Bleo/CMED is a well-tolerated regimen that produced bette r results than those reported for a former study that used CHOP-Bleo a lone. Further, results for CHOP-Bleo/CMED compared favorably with thos e of other second- and third-generation regimens. The study also valid ated the usefulness of prognostic models and, in particular, the new I nternational Index for identifying risk groups.