Journal of Clinical Oncology, Vol 21, Issue 1
(January), 2003: 5-15
© 2003 American Society for Clinical Oncology
Prolonged Single-Agent Versus Combination Chemotherapy in Indolent Follicular Lymphomas: A Study of the Cancer and Leukemia Group B
Bruce A. Peterson,
Gina R. Petroni,
Glauco Frizzera,
Maurice Barcos,
Clara D. Bloomfield,
Nis I. Nissen,
David D. Hurd,
Edward S. Henderson,
George P. Sartiano,
Jeffrey L. Johnson,
James F. Holland,
Arlan J. Gottlieb
From the University of Minnesota Medical School, Division of Hematology, Oncology and Transplantation, Minneapolis, MN; University of Virginia Cancer Center, Charlottesville, VA; New York Presbyterian-Cornell University Medical Center, New York; Mount Sinai Medical Center, New York; Roswell Park Cancer Center, and Veterans Affairs Western New York Healthcare System, Buffalo; and State University of New York Health Science Center at Syracuse, Division of Hematology/Oncology, Syracuse, NY; The Ohio State University Comprehensive Cancer Center, Columbus, OH; Department of Hematology, Finsen Center, Rigshospital, Copenhagen, Denmark; Wake Forest University School of Medicine, Winston-Salem; Salisbury Veterans Affairs Hospital, Salisbury; and CALGB Statistical Center, Duke University, Durham, NC.
Address reprint requests to Bruce A. Peterson, MD, Division of Hematology, Oncology and Transplantation, MMC 286, University of Minnesota, Minneapolis, MN 55455; email: peter001{at}umn.edu.
Purpose: The array of options for the initial management of follicular small cleaved lymphoma (FSCL) and follicular mixed lymphoma (FML) ranges from little or no therapy to the use of intensive combinations of drugs. The Cancer and Leukemia Group B (CALGB) compared two contrasting approaches: a single agent, and combination chemotherapy capable of curing diffuse aggressive lymphomas.
Patients and Methods: A total of 228 patients with stage III or IV FSCL or FML were randomized to cyclophosphamide or the combination of cyclophosphamide, doxorubicin, vincristine, prednisone, and bleomycin (CHOP-B). Treatment was continued in responders for 2 years beyond maximal response. The primary end point was survival in the most common subtype, FSCL.
Results: Ninety-one percent of all patients responded; complete responses were seen in 66% of those treated with cyclophosphamide and in 60% treated with CHOP-B (P = .36). At 10 years with either cyclophosphamide or CHOP-B, respectively, overall time to failure (25% failure free v 33%; P = .107) and survival (44% alive v 46%; P = .79) were similar by treatment. Outcomes in FSCL also were similar. In 46 patients with FML, at 10 years the combination was associated with better failure-free (9% v 48%; P = .005) and overall (25% v 61%; P = .024) survival. Acute toxic effects were more common with combination chemotherapy. Second malignancies, which might be attributed to treatment, were seen with both approaches.
Conclusion: There is no advantage to the initial use of the relatively intensive combination, CHOP-B, for patients with FSCL compared with the less toxic single agent, cyclophosphamide. However, in an unplanned subgroup analysis, patients with FML who received the combination experienced improved disease control and survival.
Deceased.
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