Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Long-term follow-up of CHOP-treated non-Hodgkin lymphoma of high-grade malignancy

Summary

The long-term outcome of 116 NHL patients (38 CB, 33 IB, 24 LB, 11 high-grade unclassified, 9 PTCL, 1 Ki-1 lymphoma — see list of abbreviations) treated with an age-adjusted CHOP regimen from 1980–85 was evaluated. The median age was 64 years. Of these patients 28% had significant comorbidity. CB patients had the best outcome; the median survival was not reached after 110 months. However, the differences in survival of all histological entities are not significant (P=0.08). Fifty-six percent of the patients had clinical stages I–II. The CR rate of all 116 patients was 47%. After a median follow-up of 58 months, 30% of the patients are alive and disease-free. Of 14 relapses 11 occurred within 2 years. The median time period before relapse was 9 months. Salvage therapy failed, as none of the IB and LB patients achieved CR. Five CB patients had CR with second-line therapy, four had PR after induction therapy, one patient relapsed after 30 months. Of the CR patients 15% developed second or third neoplasms. Only one instance of acute myeloblastic leukemia was observed. These results indicate that age-adjusted CHOP is a welltolerated therapy.

This is a preview of subscription content, log in to check access.

Abbreviations

NHL:

Non-Hodgkin lymphoma

CHOP:

Cyclophosphamide hydroxyldaunomycin Oncovin® prednisone

CR:

Complete remission

PR:

Partial remission

Nr:

Non response

CB:

Centroblastic lymphoma

IB:

Immunoblastic lymphoma

LB:

Lymphoblastic lymphoma

PTCL:

Anaplastic large-cell peripheral T-cell lymphoma

ABMT:

Autologous bone marrow transplantation

ALL:

Acute lymphoblastic leukemia

AML:

Acute myeloblastic leukemia

References

  1. 1.

    Armitage JO, Corder MP, Leimert JT, Dick FR, Elliott TE (1980) Advanced diffuse histiocytic lymphoma treated with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) without maintenance therapy. Cancer Treat Rep 64: 649–654

  2. 2.

    Armitage JO, Potter JF (1984) Aggressive chemotherapy for diffuse histologic lymphoma in the elderly: Increased complication with advancing age. J Am Geriatr Soc 32: 269–273

  3. 3.

    Brittinger G, Bartels H, Common H, Dühmke E, Fülle HH, Gunzer U, Gyenes T, Heinz R, König E, Meusers P, Paukstat M, Pralle H et al. (1984) Clinical and prognostic relevance of the Kiel classification of non-Hodgkin lymphomas. Results of a prospective multicenter study by the Kiel Lymphoma Study Group. Hematol Oncol 2: 269–306

  4. 4.

    Brittinger G, Engelhard M (1988) Trends der Chemotherapie von Non-Hodgkin-Lymphomen. In: Lutz D, Heinz R, Nowotny H, Stacher A (eds) Leukämien und Lymphome. Fortschritte und Hoffnungen. Urban und Schwarzenberg, München Wien Baltimore, pp 110–115

  5. 5.

    Carbone PP, Kaplan NS, Musshoff K, Smithies DW, Tubiana M (1971) Report of the Committee on Hodgkin's Disease Staging Classification. Cancer Res 31: 1860–1861

  6. 6.

    Coltman CA, Dahlberg J, Jones SE, Miller TP, Dana BM, McKelvey EM, Hartsock RJ, Dixon DO (1986) CHOP is curative in thirty percent of patients with diffuse large cell lymphoma: a twelve year South West Oncology Group Follow Up. Proc ASCO 5: 774 (abstr)

  7. 7.

    Engelhard M, Schilling Ch v., Pfreundschuh M, Diehl V, Brittinger G, Ho A, Gerhartz H, Lengfelder E, Nowicki L, Seibt H, Siegert W, Wendt F, Zwingers Th, Feller AC, Stein H, Lennert K (1988) Large anaplastic lymphoma (LCAL, Kil lymphoma): Up dated analysis of a retrospective study and preliminary results of a prospective trial. Blut 57: 220 (abstr 173)

  8. 8.

    Fisher RI, De Vita VT, Hubbard SM, Longo DL, Wesley R, Chabner BR, Young RC (1983) Diffuse aggressive lymphomas: Increased survival after alternating flexible sequences of PROMACE and MOPP chemotherapy. Ann Int Med 92: 304–309

  9. 9.

    Gerard-Marchant R, Hamlin U, Lennert K, Rilke A, Stanfeld AG, v Unnik JAM (1974) Classification of non-Hodgkin's lymphomas. Lancet II: 406–408

  10. 10.

    Gerhartz HH, Thiel E, Hiller E, Nerl CH, Wilmanns W, Huhn D (1986) Vergleich der CHOP und COP-BLAM-Chemotherapie hochmaligner Non-Hodgkin-Lymphome. Dtsch Med Wochenschr 111: 1511–1515

  11. 11.

    Gerhartz HH, Thiel E, Brittinger G, Dörken B, Engelhard M, Engert W, Enne W, Fuchs R, Hagen-Aukamp CH, Huhn D, Kabelitz K, Kaiser E, Kuse R, Lengfelder E, Schäfers M, Schlag D, Seibt H, Siegert W, Steiger HJ, Wilmanns W, Zurborn KH, Zwingers T, Lennert K (NHL-Study-Group) (1988) German-Austrian multicenter trial for aggressive non-Hodgkin lymphoma. COP-BLAM/IMVP-16 chemotherapy with randomized adjuvant radiotherapy. Blut 56: 139–142

  12. 12.

    Gulati SC, Shank B, Black P, Yopp J, Koziner B, Straus D, Filippa D, Kempin S, Castro-Malaspina H, Cunningham I, Berman E, Coleman M, Langleben A, Colvin OM, Fuks Z, O'Reilly R, Clarkson B (1988) Autologous bone-marrow transplantation for patients with poor-prognosis-lymphoma. J Clin Oncol 6: 1303–1313

  13. 13.

    Hahn UJ (1984) Allgemeine Besonderheiten der Pharmakotherapie in der Geriatrie. Therapiewoche 34: 722–732

  14. 14.

    Heinz R, Hanak H, Stacher A (1985) Progress in the management of high risk non-Hodgkin-lymphomas. Klin Wochenschr 63: 619–626

  15. 15.

    Heinz R, Neumann E, Aiginger P, Pont J, Schüller J, Wallner G, Hanak H, Radaszkiewicz T, Sinn E, Wirth H, Dittrich Ch, Schwarzmeier J, Kühböck J, Alth G, Honetz N, Stacher A (1985) CHOP-Firstline treatment in NHL with unfavorable prognosis. Evaluation of therapeutic response and factors influencing prognosis. Blut 50: 267

  16. 16.

    Heinz R, Pawlicki M, Losonczy H, Varbiro M, Benedek Sz, Konopka L, Krc I, Brugiatelli M (1986) Initial chemotherapy with an age-adjusted CHOP-schedule in non Hodgkins lymphomas with unfavorable prognosis. A study of the IGCI. Haematologica 71: 473–479

  17. 17.

    Heinz R, Dittrich Ch, Ludwig H, Kühböck J, Wirth M, Baumgartner G, Waldner R, Schüller J (1987) Resultate mit einer neuen Kombinationstherapie bestehend aus Etoposid-Ifosfamid-Mitoxantron-Bleomycin-Prednison (VIM/Bleo) bei fortgeschrittenen Non-Hodgkin-Lymphomen. FAC Band 6–9: 1529–1534

  18. 18.

    Hoelzer D, Thiel E, Löffler H, Büchner T, Ganser A, Heil G, Koch P, Freund M, Diedrich H, Rühl H et al. (1988) Prognostic factors in a multicenter study for treatment of acute lymphoblastic leukemia in adults. Blood 71: 123–131

  19. 19.

    Hoppe RT (1985) The role of radiation therapy in the management of non Hodgkin's lymphomas. Cancer 55: 2176–2183

  20. 20.

    Kalbfleisch JD, Prentice RL, Willey and Pus (1980) Statistical analysis of failure time datas, New York

  21. 21.

    Kaplan EL, Meier P (1958) Non parametric estimations from incomplete observations. J Am Stat ASS 53: 457–481

  22. 22.

    Kerrigan DP, Foucar K, Dressler L (1989) High grade non Hodgkin lymphoma relapsing as low grade follicular lymphoma. So-called downgraded lymphoma. Am J Hematol 30: 36–41

  23. 23.

    Klimo P, Connors JM (1985) MACOP-B chemotherapy for the treatment of diffuse large-cell lymphoma. Ann Intern Med 102: 596–602

  24. 24.

    Köppler H, Pflüger HH, Havemann K, Eschenbach I, Pfab R, Lennert K, Wellens W, Schmidt WD, Gassel WD, Kolb R, Häßler R, Schumacher K, Speth VG, Gropp C, Hirschmann WD, Gossmann HN, Öhl S, Druins P, Hossfeld DK, Bruntsch U (1988) Treatment of high grade non Hodgkin lymphoma results of a Phase II and a Phase III Trial. Blut 57: 220 (abstr 174)

  25. 25.

    Kuse R, Calavrezos A, Stellbrink HJ, Heilmann HP (1987) Langzeiterfolge bei 172 hochmalignen Nicht-Hodgkin-Lymphomen unter besonderer Berücksichtigung älterer Patienten. Dtsch Med Wochenschr 112: 335–340

  26. 26.

    Kyle RA (1984) Second malignancies associated with chemotherapy. In: Perry MC Yarbro JW (eds) Toxicity of chemotherapy. Grune and Stratton, New York, pp 479–506

  27. 27.

    Laurence J, Coleman M, Allen S (1982) Combination chemotherapy of advanced diffuse histiocytic lymphoma with the six drug COP-BLAM regimen. Am J Intern Med 97: 190–195

  28. 28.

    Lee R, Cabanillas F, Bodey GP, Freireich EJ (1986) A 10-year update of CHOP-bleo in the treatment of diffuse large-cell lymphoma. J Clin Oncol 4: 1455–1461

  29. 29.

    McKelvey EM, Gottlieb JA, Wilson HE, Haut A, Talley RW, Stephens R, Lane M, Gamble JF, Jones SE, Grozea PN, Gutterman J, Coltman C, Moon TE (1976) Hydroxyldaunomycin (adriamycin) combination chemotherapy in malignant lymphoma. Cancer 38: 1484–1493

  30. 30.

    Meusers P (1988) Risikoadaptierte Primärtherapie maligner Lymphome. In: Lutz D, Heinz R, Nowotny H, Stacher A (eds) Leukämien und Lymphome, Fortschritte und Hoffnungen. Urban und Schwarzenberg, München Wien Baltimore, p 158

  31. 31.

    Miller TP, Jones SE (1979) Chemotherapy of localized histiocytic lymphoma. Lancet I: 358–360

  32. 32.

    Möstl M, Heinz R, Fortelny A (1986) Sekundärneoplasien im Rahmen der chronisch lymphatischen Leukämie. In: Lutz D, Heinz R, Nowotny H, Stacher A (eds) Leukämien und Lymphome, Fortschritte und Hoffnungen. Urban und Schwarzenberg, München Wien Baltimore, pp 131

  33. 33.

    Pedersen-Bjergaard J, Ersboll J, Hansen VL, Sorensen BL, Christoffersen K, Hou-Jensen K, Nissen NI, Knudsen JB, Hansen MM (1988) Carcinoma of the urinary bladder after treatment with cyclophosphamide for non-Hodgkin's lymphoma. N Engl J Med 318: 1028–1032

  34. 34.

    Pees HW, Riehm HJ, Schwamborn J (1985) Effective treatment of lymphomas of Burkitt's type and B-ALL in adults. Blut 50: 213–218

  35. 35.

    Philip T, Armitage JO, Spitzer G, Chauvin F, Jagannath S, Cahn JY, Colombat P, Goldstone AH, Gorin NC, Flesh M, Laporte JP, Maraninchi D, Pico J, Bosly A, Anderson C, Schots R, Biron P, Cabanillas F, Dicke K (1987) High-dose therapy and autologous bone marrow transplantation after failure of conventional chemotherapy in adults with intermediate-grade or high-grade non-Hodgkin's lymphoma. New Engl J Med 316: 1493–1498

  36. 36.

    Rosenberg SA (1982) The non-Hodgkin's lymphoma pathologic classification project: National Cancer Institute sponsered study of classification of non-Hodgkin's lymphomas. Summary and description of a working formulation for clinical usage. Cancer 49: 2112–2135

  37. 37.

    Suchi T, Lennert K, Tu LY, Kikuchi M, Sato E, Stansfeld AG, Feller AC (1987) Histopathology and immunohistochemistry of peripheral T cell lymphomas: a proposal for their classification. J Clin Pathol 40: 995–1015

  38. 38.

    Steinke B, Krüger HU, Kraft H, Heim ME, Günther E, Arnold H, Busch FW (1988) Response — oriented therapy with CHOP and VIM-bleo in high-grade malignant non-Hodgkin's lymphomas. Blut 56: 269–271

  39. 39.

    Takvorian T, Canellos GP, Ritz J, Freedman AS, Anderson KC, Mauch P, Tarbell N, Coral F, Daley H, Yeap B, Schlossman SF, Nadler LM (1987) Prolonged disease-free survival after autologous bone marrow transplantation in patients with non-Hodgkin's lymphoma with a poor prognosis. New Engl J Med 316: 1499–1505

  40. 40.

    Wilmanns W, Binsack T, Javer H (1985) Zytostatische Polychemotherapie im höheren Lebensalter. Dtsch Med Wochenschr 110: 1959–1962

  41. 41.

    Ziegler JL (1977) Treatment results of 54 American patients with Burkitt's lymphoma are similar to the African experiences. N Engl J Med 297: 75–80

Download references

Author information

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Heinz, R. Long-term follow-up of CHOP-treated non-Hodgkin lymphoma of high-grade malignancy. Blut 60, 68–75 (1990). https://doi.org/10.1007/BF01720510

Download citation

Key words

  • NHL high-grade malignancy
  • CHOP
  • Dose reduction
  • Long-term follow-up
  • Secondary malignancy