Studies on combination chemotherapy for malignant lymphomaPart II. Combination chemotherapy in malignant lymphoma: Results of a long-term follow-up

Results of combination chemotherapy for malignant lymphoma between 1973 and 1982 were analysed. In this series there were 17 patients with Hodgkin's disease (HD) and 109 patients with non-Hodgkin's lymphoma (NHL). None of the patients had prior chemotherapy. The two basic treatment programs in this series were BVCP or BCOP (combination of bleomycin, vincristine, cyclophosphafamide and prednisolone) and AVIP(combination of adriamycin, vincristine, ifosfamide and prednisolone). Of the 17 HD patients, 14 (82%) were effectively treated and achieved complete remission(CR). Six of the 14 patients relapsed between 15 and 65 months, while the remaining 8 patients have been disease-free between 8 and 126 months. The projected median CR duration was 65 months. No recurrent disease has occurred among 5 patients who were given AVIP as intensification therapy, suggesting the usefulness of adriamycin in the treatment of HD. Complete responders survived significantly longer than partial responders: 83% of the former survived 5 years, but none of the latter survived that long. Of the 109 patients with NHL, 25 patients had diffuse medium cell type histology(DM) and 43 patients had diffuse large cell type histology(DL). For DM, the CR rate was 64%, and the median response duration was 10 months. Of the 16 CRs, 9 have relapsed so far; however, the remaining 7 have been disease free for 12 to 95 months. For DL, the CR rate was 63% and the median remission duration was 43 months. Of the 27 CRs, 13 have relapsed so far, but the remaining 14 have been disease free for 13 to 115 months. The median survival time was 75 months for DM, and 23 months for DL. Complete responders lived significantly longer than partial or none-responders in DL. Prognostic factors were analysed in DM and DL patients. Among the chemotherapy effect, stage, constitutional symptoms, serum LDH, C-reactive protein (CRP), lymphocyte count of peripheral blood, and erythrocyte sedimentation rate(ESR), a CRP over 3+ and ESR over 30mm/hr were defined as poor prognostic factors for DM. Remission induction failure and CRP over 3+ were defined as poor prognostic factors for DL. Sixteen (6 HD and 10 NHL) of 72 complete responders (14 HD and 58 NHL) were disease free for at least 2 years after cessation of all treatment, suggesting that HD as well as NHL is curable by intensive combination chemotherapy.