Combined cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) improves response rates but not survival and has lower hematologic toxicity compared with combined mitoxantrone, chlorambucil, and prednisone (MCP) in follicular and mantle cell lymphomas: results of a prospective randomized trial of the German Low-Grade Lymphoma Study Group.
BACKGROUND
In patients with advanced-stage follicular lymphoma (FL) and mantle cell lymphoma (MCL), conventional chemotherapy remains a noncurative approach, and no major improvement in overall survival has been achieved in recent decades.


METHODS
The German Low-Grade Lymphoma Study Group performed a randomized trial comparing combined cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) chemotherapy with combined mitoxantrone, chlorambucil, and prednisone (MCP) chemotherapy as first-line therapy for patients with advanced-stage FL or MCL.


RESULTS
Three hundred sixty-three patients with advanced-stage FL (n = 277 patients) or MCL (n = 86 patients) entered the trial and were evaluable fully. CHOP resulted in a significantly higher overall response rate in patients with FL (91% vs. 82%; P = .026) and a similar tendency in patients with MCL (87% vs. 73%; P = .080). However, no significant differences were observed in the time to treatment failure or in overall survival. CHOP produced significantly more nonhematologic toxicities, whereas MCP was associated with more severe hematologic side effects. The proportion of patients who successfully underwent peripheral blood stem cell collection was significantly lower after MCP (44% vs. 93% after CHOP; P = .0003).


CONCLUSIONS
Taking into account that, currently, chemotherapy regularly is combined with rituximab as first-line therapy for FL and MCL, the data from this study may have an impact on the type of chemotherapy to be applied in such combinations. Particularly in younger, high-risk patients who are candidates for autologous stem cell transplantation, CHOP should be preferred over MCP.
Nickenig
Christina
C
Department of Internal Medicine III, Ludwig-Maximilians University, Munich Grosshadern, Germany.
Dreyling
Martin
M
Hoster
Eva
E
Pfreundschuh
Michael
M
Trumper
Lorenz
L
Reiser
Marcel
M
Wandt
Hannes
H
Lengfelder
Eva
E
Unterhalt
Michael
M
Hiddemann
Wolfgang
W
D000328:Adult; D000368:Aged; D000380:Agranulocytosis / Q000139:chemically induced; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002699:Chlorambucil / Q000009:adverse effects / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D005858:Germany; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy*; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008942:Mitoxantrone / Q000009:adverse effects / Q000627:therapeutic use; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D015996:Survival Rate; D013921:Thrombocytopenia / Q000139:chemically induced; D013997:Time Factors; D016896:Treatment Outcome; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use
D002699:Chlorambucil; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D008942:Mitoxantrone; D011241:Prednisone