Survival in patients with intermediate or high grade non-Hodgkin’s lymphoma: meta-analysis of randomized studies comparing third generation regimens with CHOP

Abstract

SummaryIn patients with intermediate or high grade non-Hodgkin lymphoma (NHL), third generation chemotherapy regimens have been introduced to improve survival in comparison with the standard CHOP regimen. However, most studies have found no difference between these two treatments. We conducted a meta-analysis to assess the effectiveness of third generation regimens as compared with CHOP. Our study included the randomized controlled trials published in English from 1970 to 1999. After a Medline search, 5 trials were found to meet our inclusion criteria. A total of 1982 patients, that were enrolled in these trials, were included in the survival meta-analysis. Our methodology retrieved patient-level information from all of these subjects; survival up to 9 years after randomization was compared between the two treatment options. The results of our meta-analysis showed that, in comparison with CHOP, third generation chemotherapy did not prolong survival at levels of statistical significance (chi-square by log-rank test = 1.44, P = 0.23). The relative death risk for third generation regimens vs. CHOP was 0.92 (95%CI: 0.80 to 1.06; P = 0.26). We conclude that, on the basis of our meta-analysis, third generation regimens do not confer any survival benefit to patients with intermediate or high grade NHL as compared with CHOP.

No Long-Term Increase in Sperm Aneuploidy Rates after Anticancer Therapy

“…Chemotherapy for non-Hodgkin's lymphoma usually involves several drugs and frequently combines cyclophosphamide, doxorubicin, vincristine, and prednisone (13,56). The two patients received these types of drugs combined with others and presented sperm aneuploidy rates similar to the controls.…”

“…Patients with lowstage seminoma are usually treated with radiation of the retroperitoneal and ipsilateral pelvic lymph nodes (4,7,9), whereas patients with nonseminomatous tumors or advanced seminomas receive a cisplatin-based chemotherapy, with standard protocols, including cisplatin, etoposide, and bleomycin (3,6,10). For Hodgkin's disease and non-Hodgkin's lymphomas, the treatment is usually based on chemotherapy with or without radiotherapy (11)(12)(13)(14)(15)(16)(17)(18). These new treatment protocols have greatly increased the patients' survival rates, which now exceed 90% for testicular cancers (7,19) and for most cases of Hodgkin's disease (20,21).…”

Apoptosis-Regulating Proteins and Prognosis in Diffuse Large B Cell Non-Hodgkin’s Lymphomas

“…Patients were classified according to the classification of the University of Michigan, Ann Arbor, Mich., USA. Patients were treated with standard protocols, according to age: patients over 60 years old or with poor performance status were treated with CHOP (21 patients) and young patients with third-generation regimens (12 patients) (MACOP-B, VACOP-B or F-MACHOP) [25]. Complete remission (CR) was defined as the normalization of physical and radiological findings, 4 weeks after the last cycle of chemotherapy.…”

Current trends in large cell lymphoma

“…However, a metaanalysis of five randomized controlled trials, involving over 1900 patients, failed to show any survival benefit of thirdgeneration regimens over standard CHOP. 43 In a cooperative group setting, the ECOG conducted a randomized trial comparing CHOP to the second-generation m-BACOD (lowdose methotrexate with leukovorin rescue, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone), and found no difference in response or survival, but increased toxicity with m-BACOD. 44 That CHOP was equivalent to the newer regimens was conclusively demonstrated by Fisher et al 42 in the SWOG trial 8516.…”