A randomized prospective comparison of chemotherapy to total body
irradiation as initial treatment for the indolent lymphoproliferative
diseases
P Jacobs and HS King
One hundred eight consecutive patients with indolent lymphoproliferative
diseases were stratified into chronic lymphocytic leukemia (CLL), stage III
and IV well-differentiated lymphocytic lymphoma (WDLL), and stage III and
IV follicular lymphoma (FL). Within each stratum, patients were
prospectively and randomly assigned to receive chemotherapy with
chlorambucil and prednisone (CP) or fractionated total body irradiation
(TBI). Morbidity from both regimens was negligible. Complete response (CR)
was defined as the resolution of organ enlargement and the return of blood
count to normal. The CR rate for the entire CP group (n = 54) was 59% and
that for the TBI group (n = 54), 52%; median survivals were 53 and 57
months respectively. In the 41 patients with CLL the CR rate for CP (n =
17) was 47% and that for TBI (n = 24), 50%; the median survival for CP was
48 months, and for TBI it was 51 months. In the 21 patients with WDLL the
CR rate for CP (n = 15) was 53% and that for TBI (n = 6), 67%; the median
survival for CP was 42 months and has not yet been reached for TBI. For the
46 patients with FL the CR rate for CP (n = 22) was 72% and that for TBI (n
= 24), 50%; the median survival was 55 months, and for TBI it was 56
months. None of the differences in CR or survival are statistically
significant (P greater than .05). In these indolent lymphoproliferative
diseases, CP and TBI are equally effective forms of initial treatment
irrespective of the end point being defined as CR or survival.
Volume 69,
Issue 6,
pp. 1642-1646,
06/01/1987
Copyright © 1987 by The American Society of Hematology
