title: CHOP versus MACOP-B in aggressive lymphoma--a Nordic Lymphoma Group randomised trial.
abstract: BACKGROUND
  The long-term survival of patients with advanced stage aggressive lymphoma has not improved significantly during the last twenty years. In a randomised trial, the efficacy of MACOP-B, a six-drug weekly chemotherapy regimen, was compared to CHOP, the current standard regimen, in terms of overall and failure-free survival, toxicity and health related quality of life.
  
  
  METHODS
  Four hundred five patients with aggressive lymphoma, stage II-IV, age 18-67, were randomised to receive either 12 weeks of MACOP-B or 8 courses of CHOP over 24 weeks. Special emphasis was put in the definition of Ann Arbor stage in extranodal disease. A subset of 95 patients also entered a quality of life study, based on the EORTC QLQ-C30.
  
  
  RESULTS
  Thirty-one patients were ineligible. Among the remaining 374 patients, the median age was 52 years. According to the age-adjusted International Prognostic Index, 37% were 'high-intermediate' or 'high-risk' patients. No difference could be demonstrated, either in overall survival (60% at five years in the MACOP-B group and 59% in the CHOP group) or in failure-free survival (47% at five years with MACOP-B and 44% with CHOP). In terms of quality of life, physical function and global quality of life were more impaired in patients receiving MACOP-B, who also exhibited more non-haematological toxicity.
  
  
  CONCLUSIONS
  No superiority of MACOP-B compared to CHOP could be demonstrated. CHOP remains the treatment of choice in low-risk patients. At present, intensified or experimental treatment should be reserved for high-risk disease.
authors.affiliation: Department of Oncology, Jubileum Institute, Lund University Hospital, Sweden. Mats.Jerkeman@onk.lu.se
authors.forename: M
authors.initials: M
authors.lastname: Jerkeman
authors.forename: H
authors.initials: H
authors.lastname: Anderson
authors.forename: E
authors.initials: E
authors.lastname: Cavallin-Ståhl
authors.forename: M
authors.initials: M
authors.lastname: Dictor
authors.forename: H
authors.initials: H
authors.lastname: Hagberg
authors.forename: A
authors.initials: A
authors.lastname: Johnson
authors.forename: S
authors.initials: S
authors.lastname: Kaasa
authors.forename: S
authors.initials: S
authors.lastname: Kvaløy
authors.forename: C
authors.initials: C
authors.lastname: Sundström
authors.forename: M
authors.initials: M
authors.lastname: Akerman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D015999:Multivariate Analysis; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects; D011379:Prognosis; D011788:Quality of Life; D015996:Survival Rate; D013997:Time Factors; D017211:Treatment Failure; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D001761:Bleomycin; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D008727:Methotrexate