Journal of Clinical Oncology, Vol 6, 128-141, Copyright © 1988 by American Society of Clinical Oncology
Chemotherapeutic results and prognostic factors of patients with advanced non-Hodgkin's lymphoma treated with VEPA or VEPA-M
M Shimoyama, K Ota, M Kikuchi, K Yunoki, S Konda, K Takatsuki, M Ichimaru, M Ogawa, I Kimura and S Tominaga
Hematology-Oncology Division, National Cancer Center Hospital, Tokyo, Japan.
One hundred sixty-three patients with advanced non-Hodgkin's lymphoma
including adult T cell leukemia/lymphoma (ATL) were treated from 1981 to
1983 with VEPA (vincristine, cyclophosphamide, prednisolone, and
doxorubicin) or VEPA-M (VEPA plus methotrexate) in randomized fashion after
stratification by surface marker. The complete response (CR) rate and the
4-year survival rate of patients treated with VEPA-M was 62.2% and 36.9%,
respectively, while for those treated with VEPA the rates were 51.9% and
26.6, respectively. The difference was not statistically significant, but
pretreatment characteristics predictive for response and survival were
interesting. Three factors, leukemic change, poor performance status (PS),
and T cell marker, were negatively associated with both CR and survival
rates, and high-grade pathology was adversely associated with survival rate
in a multivariate analysis. These prognostic factors are somewhat different
from those in Western lymphomas. This may be reflection of major
differences in patients' characteristics between Japanese and Western
lymphomas: in this study, there was a high incidence of T cell
lymphoma/leukemia (50%) including ATL (33%), leukemic manifestation (34%),
poor PS (34%), and a low incidence of follicular lymphoma (9%). The
statistically significant three factors for both CR and survival rates were
used to construct a model containing eight categories of patients at
increasing risk for poor response and shortened survival. These categories
were divided into four groups, with respective CR and 4-year survival rates
of 91% and 73%, 67% and 35%, 27% and 7%, and 10% and 5%. Ninety-three
patients in whom CR was induced by VEPA or VEPA-M therapy were evaluated
for prognostic factors predictive for disease-free survival. A shorter
period (less than 28 days) required to achieve CR, a clinical diagnosis of
ATL, and a lower hemoglobin level were found to affect disease-free
survival adversely. These results have important implications for both the
design of prospective randomized therapeutic trials and the determination
of optimal therapy for individual patients.
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