Effectiveness of interferon-alfa and mid-cycle chemotherapy added to an anthracycline-based regimen in the treatment of aggressive non-Hodgkin's lymphoma

Interferon-alfa in combination with cytotoxic chemotherapy has been shown t o be effective in treating certain types of non-Hodgkin's lymphoma (NHL) (1 ). However. there is no published data on upfront induction treatment of ag gressive NHL. with IFN-alfa containing regimens. Studies have also shown th at one can overcome regrowth resistance by administering mid-cycle agents w hich slow tumor proliferation between courses of cytotoxic therapy (2). Bas ed on this, we treated 32 consecutive patients between 1/93 and 9/96 with a regimen containing cyclophosphamide 750 mg/m(2), mitoxantrone 12 mg/m(2), and teniposide 60 mg/m(2) IV on day 1 with prednisone 100 mg PO given on da ys 1-5. On day 15, patients received vincristine 1.4 mg/m(2) (2 mg max.) an d bleomycin 10 units/m(2) IV. Interferon-alfa-2b 5x10(6) units/m(2) SQ was administered on days 22-26. The median age was 55 (range 26-83), M:F ratio was 2.5:1. and the median International Prognostic Index was 2.38% of patie nts had stages I -II and 62% had stages III-IV disease. Fifty-nine percent of the patients achieved a complete response. 22% a partial response, and 1 9% had progressive disease. The overrall survival (OS) was 81% and the prog ression free survival (PFS) was 56% at 4.3 years. There were no severe (gra de IV) hematologic. flu-like. GI and infectious toxicities from IFN-alpha. Leukopenia was the main severe toxicity related to the chemotherapy regimen (days 1-15), but nor IFN-alpha. Severe infection secondary to the chemothe rapy regimen occurred in one patient. Interferon-alfa-2b and mid-cycle chem otherapy added to an anthracycline based regimen is effective induction tre atment for patients with aggressive NHL. The OS and PFS using this regimen, based on regrowth resistance, appears to be at least as or more effective than CHOP therapy for this group of patients. Severe toxicities were rare.