Submitted July 14, 2006
Accepted November 17, 2006
Intensified CHOP of 12-weeks duration (I-CHOP) plus G-CSF compared with standard CHOP of 24-weeks duration (CHOP-21) for patients with intermediate-risk aggressive non-Hodgkin's Lymphoma. A phase III trial of the Dutch-Belgian Hemato-Oncology Cooperative Group (HOVON)
Leo F Verdonck*, Annelise Notenboom, Daphne D de Jong, Marius A MacKenzie, Gregor E.G. Verhoef, Mark H.H. Kramer, Gert J Ossenkoppele, Jeanette K Doorduijn, Pieter Sonneveld, and Gustaaf W van Imhoff
University Medical Center, Netherlands
HOVON Data Center, Erasmus Medical Center, Netherlands
Netherlands Cancer Institute, Netherlands
University Hospital Gasthuisberg, Belgium
Meander Medical Center, Netherlands
VU Medical Center, Netherlands
Erasmus Medical Center, Netherlands
* Corresponding author; email: l.f.verdonck{at}umcutrecht.nl.
Optimal dose and timing of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy for aggressive non-Hodgkin's lymphoma (NHL) is still an unresolved issue. We assessed whether dose intensifications with cyclophosphamide and doxorubicin might improve outcome in younger patients with intermediate-risk aggressive NHL. Previously untreated patients were assigned to receive either 8 courses of standard CHOP (n=239) or 6 courses of intensified (I)-CHOP (n= 238). Although there was a tendency in favour of I-CHOP for overall survival (OS), disease-free survival (DFS), and event-free survival (EFS), the differences were not significant .However, although these analyses were not planned, when the intermediate-risk group was divided into low-intermediate and high-intermediate risk patients according to the International Prognostic Index (IPI), low-intermediate risk patients had improved 6 year OS (67% versus 52% ; p=0.05), DFS (58% versus 45% ; p=0.06), and EFS ( 41 % versus 30%; p=0.21) when they were treated with I-CHOP compared with standard CHOP. On the other hand, high-intermediate risk patients seem to have no benefit of I-CHOP. Although clinically relevant side-effects occurred more often in the I-CHOP arm, treatment-related mortality was similar. These data suggest that I-CHOP might be preferable to standard CHOP in younger patients with low-intermediate risk aggressive NHL.
