Intensified CHOP of 12-weeks duration (I-CHOP) plus G-CSF compared with standard CHOP of 24-weeks duration (CHOP-21) for patients with intermediate-risk aggressive non-Hodgkin's Lymphoma. A phase III trial of the Dutch-Belgian Hemato-Oncology Cooperative Group (HOVON)
Verdonck, Leo F × Notenboom, Annelise de Jong, Daphne D Mackenzie, Marius A Verhoef, Gregor Kramer, Mark H H Ossenkoppele, Gert J Doorduijn, Jeanette K Sonneveld, Pieter van Imhoff, Gustaaf W #
Blood vol:1 issue:109 (7) pages:2759-2766
Optimal dose and timing of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy for aggressive non-Hodgkin's lymphoma (NHL) is still an unresolved issue. We assessed whether dose intensifications with cyclophosphamide and doxorubicin might improve outcome in younger patients with intermediate-risk aggressive NHL. Previously untreated patients were assigned to receive either 8 courses of standard CHOP (n=239) or 6 courses of intensified (I)-CHOP (n= 238). Although there was a tendency in favour of I-CHOP for overall survival (OS), disease-free survival (DFS), and event-free survival (EFS), the differences were not significant .However, although these analyses were not planned, when the intermediate-risk group was divided into low-intermediate and high-intermediate risk patients according to the International Prognostic Index (IPI), low-intermediate risk patients had improved 6 year OS (67% versus 52% ; p=0.05), DFS (58% versus 45% ; p=0.06), and EFS ( 41 % versus 30%; p=0.21) when they were treated with I-CHOP compared with standard CHOP. On the other hand, high-intermediate risk patients seem to have no benefit of I-CHOP. Although clinically relevant side-effects occurred more often in the I-CHOP arm, treatment-related mortality was similar. These data suggest that I-CHOP might be preferable to standard CHOP in younger patients with low-intermediate risk aggressive NHL.