RESULTS OF A RANDOMIZED STUDY OF PREVIOUSLY-UNTREATED INTERMEDIATE AND HIGH-GRADE LYMPHOMA USING CHOP VERSUS CNOP

A randomized multicenter phase III study was conducted to compare the efficacy and toxicity of CHOP and CNOP in intermediate and high-grade non-Hodgkin's lymphoma. CHOP consisted of cyclophosphamide 750 mg/m2, vincristine 1.4 mg/m2, doxorubicin 50 mg/m2 on day 1 and prednisone 50 mg/m2 on days 1 to 5. The CNOP regimen was identical to CHOP except f or replacement of doxorubicin by 10 mg/m2 mitoxantrone. Patient charac teristics were evenly distributed in the two arms, except for age and stage, which slightly favoured the CHOP arm. The rate of complete remi ssion was 70% (31/44) in patients treated with CHOP and 51% (23/45) in those receiving CNOP (P = 0.09). At 48 months and with a median follo w-up of 41 months, 44% of the complete responders treated with CHOP an d 64% of those treated with CNOP were estimated to still be in their f irst complete remission (P = 0.14), while 31% and 34% remained alive a nd free of progression. The Kaplan-Meier estimate of overall survival at 48 months is 53% and 50%, respectively. The higher response rate ob tained with CHOP probably reflected a less aggressive lymphoma populat ion. The mean WBC nadir was 2.0 x 10(9)/l for CHOP and 1.8 x 10(9)/ fo r CNOP. One and three patients, respectively, died during induction. N ausea, vomiting and cardiac toxicity were similar. MOre alopecia and m ucositis were observed with CHOP. We conclude that CHOP and CNOP have similar toxicities and are equivalent in previously untreated non-Hodg kin's lymphoma in terms of complete response rate, event-free survival and overall survival.