Bulky disease is an adverse prognostic factor in patients treated with chemotherapy comprised of cyclophosphamide, doxorubicin, vincristine, and prednisone with or without radiotherapy for aggressive lymphoma.
BACKGROUND
In the current study, the authors analyzed prognostic factors in patients with aggressive lymphoma treated with a chemotherapy regimen comprised of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with or without radiotherapy.


METHODS
Between September 1988 and December 1996, 294 patients with newly diagnosed, clinical Ann Arbor Stage I-IV, aggressive lymphoma were enrolled on 2 protocols at The University of Texas M. D. Anderson Cancer Center. Patients on these studies had a relatively favorable prognosis; 100% had M. D. Anderson tumor scores <or= 2 and 95%% had International Prognostic Indices (IPIs) <or= 2. Treatment was comprised of 5 +/- 1 (mean +/- the standard deviation) cycles of CHOP chemotherapy with or without involved-field radiotherapy to a total dose of 40.1 +/- 3.3 grays (mean +/- the standard deviation).


RESULTS
The median length of follow-up was 61 months. Three factors were found to retain independent prognostic significance on multivariate analysis in terms of progression-free survival: > 1 extranodal site of disease (P < 0.001), bulky disease (>or= 7 cm) (P = 0.005), and an at least 10% elevation in the serum lactate dehydrogenase (LDH) level (P = 0.007). Patient age > 60 years (P = 0.001), bulky disease (P = 0.016), and an at least 10% elevation in the serum LDH level (P = 0.040) also were found to be independent prognostic factors for overall survival.


CONCLUSIONS
The independent prognostic factors in the current study suggest that either the M. D. Anderson tumor score system or the IPI can be used to select which aggressive lymphoma patients are at high risk for disease recurrence based on their having more than two adverse factors and who consequently are candidates for more intensive frontline therapy. Involved-field radiotherapy should be considered in those patients with bulky lymphomas.
Wilder
R B
RB
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA. rwilder@mdanderson.org
Rodriguez
M A
MA
Ha
C S
CS
Pro
B
B
Hess
M A
MA
Cabanillas
F
F
Cox
J D
JD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage*; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008223:Lymphoma / Q000188:drug therapy* / Q000473:pathology* / Q000532:radiotherapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods; D011241:Prednisone / Q000008:administration & dosage*; D011379:Prognosis; D014750:Vincristine / Q000008:administration & dosage*
D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D007770:L-Lactate Dehydrogenase; D011241:Prednisone