Combined cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) improves response rates but not survival and has lower hematologic toxicity compared with combined mitoxantrone, chlorambucil, and prednisone (MCP) in follicular and mantle cell lymphomas

Abstract

BACKGROUND.In patients with advanced‐stage follicular lymphoma (FL) and mantle cell lymphoma (MCL), conventional chemotherapy remains a noncurative approach, and no major improvement in overall survival has been achieved in recent decades.METHODS.The German Low‐Grade Lymphoma Study Group performed a randomized trial comparing combined cyclophosphamide, vincristine, doxorubicin, and prednisone (CHOP) chemotherapy with combined mitoxantrone, chlorambucil, and prednisone (MCP) chemotherapy as first‐line therapy for patients with advanced‐stage FL or MCL.RESULTS.Three hundred sixty‐three patients with advanced‐stage FL (n = 277 patients) or MCL (n = 86 patients) entered the trial and were evaluable fully. CHOP resulted in a significantly higher overall response rate in patients with FL (91% vs. 82%; P = .026) and a similar tendency in patients with MCL (87% vs. 73%; P = .080). However, no significant differences were observed in the time to treatment failure or in overall survival. CHOP produced significantly more nonhematologic toxicities, whereas MCP was associated with more severe hematologic side effects. The proportion of patients who successfully underwent peripheral blood stem cell collection was significantly lower after MCP (44% vs. 93% after CHOP; P = .0003).CONCLUSIONS.Taking into account that, currently, chemotherapy regularly is combined with rituximab as first‐line therapy for FL and MCL, the data from this study may have an impact on the type of chemotherapy to be applied in such combinations. Particularly in younger, high‐risk patients who are candidates for autologous stem cell transplantation, CHOP should be preferred over MCP. Cancer 2006. © 2006 American Cancer Society.

A new prognostic index (MIPI) for patients with advanced-stage mantle cell lymphoma

“…Exclusion criteria comprised serious concomitant diseases, bad performance status, or significant impairment of organ function. [21][22][23] The initial diagnostic work-up comprised a bone marrow biopsy, ultrasound examination of the abdomen, and computed tomography (CT) scans of chest and abdomen. Normal organ function was assured by the respective laboratory tests, as well as by echocardiograms and electrocardiograms.…”

“…The GLSG1996 trial 21 compared the response rates of initial chemotherapy with CHOP (cyclophosphamide, hydroxy-daunorubicin, vincristine and prednisone) and MCP (mitoxantrone, chlorambucil, prednisone). In 2000, the GLSG2000 trial 22 was initiated to assess the additional efficacy of incorporating the monoclonal CD20-antibody rituximab to primary CHOP in terms of time-to-treatment failure.…”

“…23 Detailed study design and results of the respective trials have been published previously. [21][22][23] Candidate prognostic factors and outcome parameters All baseline variables were considered as candidate prognostic factors, namely age, sex, Eastern Cooperative Oncology Group (ECOG) performance status, 24 Ann Arbor stage, presence of B-symptoms, bone marrow involvement, spleen involvement, number of involved nodal areas, number of extranodal sites, size of largest involved lymph node, and laboratory parameters such as white blood cell (WBC), lymphocyte, granulocyte, monocyte, and platelet counts, hemoglobin (Hb), lactate dehydrogenase (LDH), albumin, and serum ␤ 2 -microglobulin levels. Because upper limits of normal (ULN) differed considerably between laboratories for LDH, albumin, and ␤ 2 -microglobulin, ratios to ULN were calculated.…”

Validation, revision and extension of the Mantle Cell Lymphoma International Prognostic Index in a population-based setting

“…Furthermore all three trials [16][17][18] that formed the basis for the original study excluded patients with serious concomitant diseases, poor performance status, or significant impairment of organ function. 1 We found the prognostic value of age to be independent of the presence of co-morbidity and performance status and might, therefore, reflect unknown co-morbid or pathophysiological conditions more frequently encountered in elderly patients with subsequent less tolerance of treatment.…”

“…Thus Hoster et al limited their investigation to patients with advanced stage MCL managed with standardized treatment options (CHOP, 56%; R-CHOP, 31%; and MCP, 11%). [16][17][18] The original data were also limited to patients who should have tolerated moderately intensive chemotherapy. In our study the proportion of unselected patients receiving moderately intensive treatment was obviously lower than in trial-based studies, such as those on which the original publication was based.…”