Prospective multicenter trial for the response-adapted treatment of high-grade malignant non-Hodgkin's lymphomas: Updated results of the COP-BLAM/IMVP-16 protocol with randomized adjuvant radiotherapy

Abstract

In a prospective multicenter trial the efficiency of the response-adapted COP-BLAM/IMVP-16 protocol to induce complete remissions (CR) in high-grade malignant non-Hodgkin's lymphomas as well as the prognostic relevance of adjuvant radiotherapy were investigated. From 1986-1989, 548 patients (median age 56 years) with stage II-IV (Ann Arbor) disease were treated with five cycles of COP-BLAM followed by two cycles of IMVP-16. If only a partial remission was obtained at the time of first restaging (RS) after three cycles (delayed response), treatment was switched to IMVP-16 (two to five courses) immediately. Patients achieving CR by the second RS after chemotherapy were randomized to adjuvant radiotherapy or observation. Responses to chemotherapy were 63% CR in patients completing the second RS (N = 350) or 72% if patients achieving late CR by consolidating radiotherapy are added; responses were 58% or 65% if all deaths prior to the second RS are included (N = 50). Overall and relapse-free survival were 71% and 68% at one year and 63% and 61% at two years. Multivariate risk factor analysis proved the early (by first RS) CR response to possess predominant prognostic relevance for survival. A significant advantage of adjuvant radiotherapy over no further treatment for duration of CR is not yet discernible. These results emphasize the importance of a rapidly achieved CR, thus contributing to the design of future trials.

FDG‐PET after 1 cycle of therapy predicts outcome in diffuse large cell lymphoma and classic Hodgkin disease

“…The explanation for a more favorable NPV obtained with the early scan would be that rapidity of achieving a complete response implies chemosensitivity of the tumor. Because high chemosensitivity usually translates into higher CR, this finding is probably a harbinger of sustained CR 23–25. In a seminal study of DLCL, Armitage et al reported when therapy was adjusted according to the response after 3 cycles in NHL, 73% of the patients achieved a CR 23.…”

Deep venous thrombosis and pulmonary artery embolism in high‐grade non Hodgkin's lymphoma: incidence, causes and prognostic relevance

“…Clinical data on VTE in HG-NHL were provided by the "Response-adapted COP-BLAM/IMVP-16 trial for Ann Arbor stage 11-IV HG-NHL with randomised adjuvant radiotherapy". The design of this prospective national multicentre study has been reported in detail elsewhere (12). In brief, 593 patients, aged 16-75 years, with previously untreated HG-NHL presenting with stage 11-IV disease (Ann Arbor classification) were treated with the COP-BLAM (13), but without dose escalation, and the IMVP-16 (14) regimens.…”

Impact on Survival Through Consolidation Radiotherapy for Diffuse Large B-Cell Lymphoma: A Comprehensive Meta-Analysis

“…One trial was stopped early when the benefit of rituximab became evident, 12 or as a result of a planned interim analysis. 17 Older trials included lymphomas classified by the Kiel classification 18 or included DLBCLs according to the Working Formulation. 19 Six of the trials included patients with localized disease only, but five of the 11 trials included also advanced stages.…”