RESULTS OF THE CYCLOPHOSPHAMIDE, DOXORUBICIN, VINCRISTINE, PREDNISOLONE (CHOP)+ -BLEOMYCIN TREATMENT AND EVALUATION OF PROGNOSTIC FACTORS IN AGGRESSIVE LYMPHOMAS IN TURKEY/

Prognostic factors and the results of the cyclophosphamide, doxorubici n, vincristine, prednisolone (CHOP) +/- bleomycin treatment in 93 cons ecutive evaluable patients with aggressive lymphomas are presented. Th e overall response rate, excluding 7 patients with primary extranodal lymphoma who were in complete remission after surgery, was 83% with a complete response (CR) rate of 69%. Overall survival (OS) rates of all patients and disease-free survival (DFS) rates of complete responders at 4 years were 52 and 66%, respectively. Almost two thirds of the pa tients could be given at least 75% of the planned chemotherapy doses. Treatment toxicities were in acceptable limits, only 10% of the patien ts had grade 3-4 hematological toxicity. Age, performance status (PS), stage, number of extranodal sites (ENS) ( less than or equal to 1 vs. > 1), B symptoms, serum LDH levels were evaluated as prognostic facto rs. Univariate survival analysis yielded stage, ENS and PS as signific ant prognostic factors for OS (p = 0.0009, p = 0.0028 and p = 0.0155, respectively). Only involvement of more than 1 ENS was strongly associ ated with low CR (p = 0.0479) and high relapse rates (p = 0.0118), and it was also determined as the only independent prognostic factor for OS in patients younger than 60 (p = 0.0015). A modified age-adjusted p rognostic index, including ENS in addition to stage, LDH and PS, was f ound to be more significant than the original age-adjusted Internation al Prognostic Index (IPI) for both DFS (p = 0.0030) and OS (p < 0.0000 1). In conclusion, modified age-adjusted index may be a convenient alt ernative to the original age-adjusted IPI to identify high-risk patien ts with aggressive lymphomas in Turkey and probably also in other deve loping countries for experimental intensive regimens.