Bulky disease is an adverse prognostic factor in patients treated with chemotherapy comprised of cyclophosphamide, doxorubicin, vincristine, and prednisone with or without radiotherapy for aggressive lymphoma

BACKGROUND, In the current study, the authors analyzed prognostic factors i n patients with aggressive lymphoma treated with a chemotherapy regimen com prised of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) with or without radiotherapy. METHODS. Between September 1988 and December 1996, 294 patients with newly diagnosed, clinical Ann Arbor Stage I-IV, aggressive lymphoma were enrolled on 2 protocols at The University of Texas M. D. Anderson Cancer Center. Pa tients on these studies had a relatively favorable prognosis; 100% had M. D . Anderson tumor scores less than or equal to 2 and 95%% had International Prognostic Indices (IPIs) less than or equal to 2. Treatment was comprised of 5 +/- 1 (mean +/- the standard deviation) cycles of CHOP chemotherapy wi th or without involved-field radiotherapy to a total dose of 40.1 +/- 3.3 g rays (mean +/- the standard deviation). RESULTS, The median length of follow-up was 61 months. Three factors were f ound to retain independent prognostic significance on multivariate analysis in terms of progression-free survival: > 1 extranodal site of disease (P < 0.001), bulky disease (greater than or equal to 7 cm) (P = 0.005), and an at least 10% elevation in the serum lactate dehydrogenase (LDH) level (P = 0.007). Patient age > 60 years (P = 0.001), bulky disease (P = 0.016), and an at least 10% elevation in the serum LDH level (P = 0.040) also were foun d to be independent prognostic factors for overall survival. CONCLUSIONS. The independent prognostic factors in the current study sugges t that either the M. D. Anderson tumor score system or the IPI can be used to select which aggressive lymphoma patients are at high risk for disease r ecurrence based on their having more than two adverse factors and who conse quently are candidates for more intensive frontline therapy. Involved-field radiotherapy should be considered in those patients with bulky lymphomas. (C) 2001 American Cancer Society.