MACOP-B + - RADIATION-THERAPY FOR DIFFUSE LARGE-CELL LYMPHOMA - ANALYSIS OF THE STANFORD RESULTS ACCORDING TO PROGNOSTIC INDEXES/

Background. The efficacy and toxicity of the MA-COP-B regimen were ass essed after outstanding results were reported in diffuse large cell ly mphoma (DLCL) by the Vancouver group. The results are reported accordi ng to several proposed prognostic indices, including the recent Intern ational Prognostic Factors (IPF) Project. Methods. Forty-seven patient s with untreated DLCL received MACOP-B chemotherapy. Thirty patients, most of whom had bulky disease, also received consolidative radiation therapy (RT). Patient characteristics include median age of 42 years, Stage III/IV (57%), bulky or symptomatic Stage II disease (43%), eleva ted lactic dehydrogenase (81%) and at least one extranodal site (72%). Results. At a median follow-up of 3.3 years, overall survival was 57% and freedom from progression (FFP) was 52%. The 3-year FFP data were related to tumor extent: 74% for limited stage versus 38% for extensiv e disease. These data correlated well with four prognostic indices rep orted in the literature. The IPF index accurately identified low-, int ermediate-, and high-risk subgroups. Conclusions. Patients with limite d or low-risk DLCL have an excellent prognosis with MACOP-B +/- RT. Th ese results do not support the use of consolidative high-dose therapy and bone marrow transplantation in patients with limited disease, even if bulky or accompanied by an elevated lactic dehydrogenase. Compared to historical CHOP data, MACOP-B +/- RT does not appear to improve ou tcome for those patients with poor prognostic features, most of whom w ill fail. The IPF index is a simple, accurate method of distinguishing high-risk patients who require new therapeutic initiatives.