CHICAGOA new regimen that includes an anthracycline plus
interferon-alfa-2b (Intron A) as induction chemotherapy of patients
with low- or intermediate-grade non-Hodgkins lymphoma (NHL)
appears to be as effective as CHOP, Sari Enschede, MD, of Rush
Presbyterian-St. Luke Medical Center, said at an ASH poster session.
For intermediate-grade NHL, this treatment is at least as
effective as standard CHOP and may be more effective, she
said.(CHOP: cyclophosphamide, doxorubicin, vincristine, prednisone.)
The 68 patients in the phase II trial conducted at the Rush Cancer
Institute were treated between January 1993 and September 1996. They
received cyclophosphamide (750 mg/m²), mitoxantrone (Novantrone)
(12 mg/m²), and teniposide (Vumon) (60 mg/m²) on day 1;
prednisone (100 mg/d) on days 1 to 5; vincristine (1.4 mg/m²)
and bleomycin (Blenoxane) (10 units/m²) on day 15; and
interferon (5 × 106 units/m2) on days 22 to 26 of a
28-day cycle (see Table).
The rationale for adding interferon is based on studies showing that
administration of agents that slow tumor proliferation between
courses of cytotoxic therapy can overcome regrowth resistance, Dr.
The median age of the patients was 52 years. Thirty-six had low-grade
and 32 had intermediate-grade NHL. Most had stage III-IV NHL (81%),
and the remaining 19% had stage I-II disease. The median IPI
(International Prognostic Index) was 2.
Of the low-grade NHL patients, 67% had a complete response and 33% a
partial response. Of those with intermediate-grade NHL, 59% had a
complete response and 22% a partial response.
Overall and event-free survival was the same in the low-grade
patients (about 65% at 4.2 years). For the intermediate-grade
patients, overall survival was 81% and event-free survival was 56% at
4.3 years. Patients with advanced stage (III-IV) intermediate-grade
disease were assessed independently and found to have an overall
survival and event-free survival of 89% and 63%, respectively, at 4.3 years.
Compared with the results of the Intergroup trial by SWOG and ECOG
that evaluated standard CHOP therapy (N Engl J Med, 1993), the
intermediate-grade NHL patients on the new regimen seemed to fare
better, she said.
The Intergroup trial patients with advanced intermediate-grade
disease had an overall survival of 54% at 3 years and 30% at 12
years. Disease-free survival was 41% at 3 years.
Leukopenia was the main severe toxicity, and this was related
to the chemotherapy regimen on days 1 to 15, but not to the
interferon, Dr. Enschede said in an interview. However, severe
infection was rare. There were no severe (grade 4) hematologic,
flu-like, GI, and infectious toxicities from interferon during days
22 to 28 of the cycles.
She commented that although longer follow-up is needed for the
low-grade NHL patients, the reseachers feel that the preliminary
results show better efficacy in intermediate-grade disease. We
are still enrolling patients with both low-grade and
intermediate-grade lymphomas, she said.