Addition of etoposide to CHOP chemotherapy in untreated patients with high-grade non-Hodgkin's lymphoma

Background. Second- and third-generation chemotherapy protocols for the tre atment of aggressive non-Hodgkin's lymphomas (NHL) have considerable, and a ge-related, toxic effects. In addition, they do not seem to prolong overall survival in comparison to standard CHOP chemotherapy. In this phase II stu dy we investigated the feasibility and efficacy of the addition of etoposid e to the conventional CHOP regimen. Patients and methods: Toxicity and clinical efficacy were determined in 132 patients with previously untreated high-grade NHL. There were 51 patients in clinical stage I and II and 81 patients in stage III and IV, with a medi an age of 54 years (range 17-85). Patients received standard-dose CHOP plus etoposide 100 mg/m(2) i.v. on day 1 and 200 mg/m(2) p.o. on days 2-3. Results. The overall response rate was 84%, with 70% complete and 14% parti al responses. The predicted three- and five-year survivals for the group as a whole were 60% and 53%, respectively, and the corresponding disease-free survivals for patients achieving complete remissions were 65% and 56%, res pectively. Outcome was not different from that of CHOP-treated patients in a recently completed Nordic study performed during the same time period. My elosuppression (WHO grade 3-4): observed in 87% of patients and infectious complications (WHO grade 3-4) in 33%, dominated the toxicity profile of thi s regimen. Fifty-seven of 92 complete responders (62%) received 6-8 CHOP-E cycles with no reductions in planned dose intensity. LDH level higher than normal, extranodal sites = 2, stage III-IV at diagnosis were all indicators of a poor survival. Conclusions. We conclude that CHOP-E treatment is effective in high-grade N HL. However, mainly due to severe myelosuppression frequent schedule modifi cations were required and the results are not obviously superior to those o f conventional CHOP.