CHOP-Bleo plus interferon for stage IV low-grade lymphoma

• Published in: Annals of oncology 1993-03, Vol.4 (3), p.205-211
• Main Authors: McLaughlin, P., Cabanillas, F., Hagemeister, F. B., Swan, F., Romaguera, J. E., Taylor, S., Rodriguez, M. A., Velasquez, W. S., Redman, J. R., Gutterman, J. U.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Bleomycin - administration & dosage; chemotherapy; Combined Modality Therapy; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Cyclophosphamide - administration & dosage; Doxorubicin - administration & dosage; Female; Follow-Up Studies; Humans; Interferon Type I - administration & dosage; Interferon-alpha - administration & dosage; Interferon-alpha - adverse effects; low-grade lymphoma; Lymphoma, Non-Hodgkin - drug therapy; Lymphoma, Non-Hodgkin - mortality; Lymphoma, Non-Hodgkin - pathology; Lymphoma, Non-Hodgkin - radiotherapy; Male; malignant lymphoma; Medical sciences; Middle Aged; Neoplasm Staging; Pharmacology. Drug treatments; Prednisone - administration & dosage; Recombinant Proteins; Survival Rate; Vincristine - administration & dosage; α-interferon
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/oxfordjournals.annonc.a058457

Background Alpha interferon (IFN) is an effective single agent for patients with low-grade lymphoma, but until 1982 had not been integrated with standard chemotherapy for these patients. Since relapse from complete remission (CR) is the rule for patients with advanced stage low-grade lymphoma, a maintenance IFN schedule was explored for patients in CR. Patients and methods From 1982–1987, 127 patients with stage IV low-grade lymphoma were treated with cyclophosphamide, doxorubicin, vincristine, prednisone, and bleomycin (CHOP-Bleo) for 9–18 mo. (median 13 mo.), followed by interferon alfa-n-1 (Wellferon®) maintenance therapy for 24 mo. for CRs. Results The overall response rate for the entire treatment program was 73% CR and 23% partial remission. The median follow up was 59 months. At 5 years, survival was 74%, failure-free survival (FFS) 47%, and FFS of CRs 60%. Compared to a group of 96 patients with similar pretreatment clinical features treated with CHOP-Bleo from 1972–1982, this represents a significant improvement for both overall FFS (p – 0.01) and FFS of CRs (P < 0.01). Toxicity from the IFN maintenance was generally acceptable, but even at the modest dose employed in this trial (3 × 106 U/m2 three times weekly), dose modification was required in more than 30% of patients, usually because of fatigue. Conclusions The integration of IFN and conventional chemotherapy is feasible and effective. Maintenance IFN prolongs remission duration for patients with stage IV low-grade lymphoma.