Journal of Clinical Oncology, Vol 8, 94-102, Copyright © 1990 by American Society of Clinical Oncology
Treatment results with an aggressive chemotherapeutic regimen (MACOP-B) for intermediate- and some high-grade non-Hodgkin's lymphomas
AM Schneider, DJ Straus, AE Schluger, DA Lowenthal, B Koziner, BJ Lee, G Wong and BD Clarkson
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Seventy previously untreated patients with stage II, III, and IV
intermediate- or high-grade lymphoma were treated with methotrexate,
doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin
(MACOP-B) between September 1985 and November 1987. Forty-nine of these
patients had diffuse large-cell lymphoma (DLCL), and eight of these
patients were human immunodeficiency virus (HIV)-positive. Complete
responses were achieved in 54% of all patients and 52% of those with DLCL.
With follow-up extending to 36 months, 45% of all DLCL patients are alive,
and 50% are still living, if the HIV-positive patients are excluded from
the analysis. Chemotherapy was quite toxic. Seventy-five percent of
patients had severe mucositis, 42% had peripheral neuropathy, 50% required
hospitalization, and 54% experienced leukopenia with a WBC count below
1,000/microL. Seven percent (five patients) died of toxicity related to the
chemotherapy. Our analysis of prognostic parameters indicated that B
symptoms, a performance status below 80, and, to a lesser extent, elevation
of serum lactic acid dehydrogenase (LDH) (in HIV-negative DLCL patients)
were associated with an inferior survival. Advanced age, sex, and bulky
disease were not found to have a statistically significant effect on
survival. Our preliminary results indicate that MACOP-B chemotherapy is an
effective regimen for high- and intermediate-grade lymphomas. However, the
survival for patients with DLCL treated with MACOP-B is no different than
that achieved with previous regimens at our institution.
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