CVP—Remission—maintenance in stage I or II non-Hodgkin's lymphomasPreliminary results of a randomized study

Abstract

The effect of adjuvant combination chemotherapy when given to non-laparotomized patients in remission after radiotherapy in stage I or II non-Hodgkin's lymphoma was studied in a prospective randomized multicenter study. Locally extended field radiotherapy was given to a target absorbed dose of 40 Gy in 20 fractions. Fifty-five patients who were in complete remission 6 weeks after conclusion of radiotherapy were randomized to either no further therapy or to 9 cycles of CVP (cyclophosphamide + vincristine + prednisolone). The relapse-free survival at 30 months was 41% for patients without and 86% for patients with adjuvant chemotherapy (p = 0.02). The survival was the same for both treatment arms, being 90% at 30 months. Fifteen patients have relapsed, 14 of them with extensions and 1 with a recurrence within the radiation target volume. Analysis of subgroups showed that adjuvant chemotherapy in the present series significantly prolonged the relapse-free survival in diffuse histiocytic lymphoma.

Nodal Follicular Lymphoma

“…The EORTC initiated a randomized phase III trial with low-dose total-body irradiation (TBI, 1,5 Gy) and IFI (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) Gy) versus IFI (26-40 Gy) alone based on promising phase II data [44]. This study aims to confirm the postulated direct or indirect influence of low-dose TBI on apoptosis and bcl-2 regulation potentially leading to enhanced OS.…”

“…Randomized trials with small patient numbers in the 1970s/1980s and recently published data from nonrandomized trials did not confer a definitive OS advantage with additional/ adjuvant chemotherapy in patients with early-stage FL [3,14,24,26,31,34,60]. However, a retrospective analysis from the M.D.…”

Centroblastic-Centrocytic Non-Hodgkin's Lymphoma Stage I–III: Patterns of Failure Following Radiotherapy

“…The addition of chemotherapy to local or extended radio-therapy has been reported not to improve results for overall survival or relapse free survival in Stages I or II low-grade NHL [4,22,24,30,45,55].…”

The importance of radiotherapy on diffuse large B cell lymphoma treatment: a current review

“…This molecular distinction has prognostic implications for patients that R-CHOP therapy, as the ABC subtype exhibiting 3 years of progression-free survival (PFS) of 40 vs 75 % (p<0.001), compared with GCB subtype [10,11,17,18].…”

“…However, in GCB DLBCL type, the overexpression of BCL2 is related to the presence of the t (14,18) translocation, whereas in ABC DLBCL, this overexpression is promoted by other mechanisms, such as transcriptional upregulation and gene amplification [31]. Moreover, in patients following R-CHOP treatment [10,11,17], the overexpression of BCL2 appears to pertain negative prognostic impact in GCB DLBCL whereas in ABC DLBCL, rituximab mediates BCL2 downregulation [32]. On this way, the use of BCL2 inhibitors appears to be a promising therapy for DLBCL, namely in GCB subtype [33].…”