Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)
Lymphoma refers to a malignancy of the lymphatic system. The lymphatic system is a network of nodes (knots of tissue) connected by vessels. Together, the lymph nodes drain fluid and waste products from the body. The lymph nodes act as tiny filters, removing foreign organisms and cells.
Lymphocytes, are a type of white blood cell that helps fight infections caused by bacteria, viruses, or fungi. The lymph node function is to prevent infections from entering the bloodstream. When the lymphatic...
ACVBP: doxorubicin plus cyclophosphamide plus vindesine plus bleomycin plus prednisone.
CHOP: cyclophosphamide plus doxorubicin plus vincristine plus prednisone.
CNOP: cyclophosphamide plus mitoxantrone plus vincristine plus prednisone.
m-BACOD: methotrexate plus bleomycin plus doxorubicin plus cyclophosphamide plus vincristine plus dexamethasone plus leucovorin.
MACOP-B: methotrexate plus doxorubicin plus cyclophosphamide plus vincristine plus prednisone fixed dose plus bleomycin plus leucovorin.
ProMACE CytaBOM: prednisone plus doxorubicin plus cyclophosphamide plus etoposide plus cytarabine plus bleomycin plus vincristine plus methotrexate plus leucovorin.
R-CHOP: Rituximab, an anti-CD20 monoclonal antibody, plus cyclophosphamide plus doxorubicin plus vincristine plus prednisone.
The treatment of choice for patients with advanced stages of aggressive non-Hodgkin lymphoma (NHL) is combination chemotherapy, either alone or supplemented by local-field radiation therapy.
Doxorubicin-based combination chemotherapy produces long-term disease-free survival in 35% to 45% of patients.[2,3,4] Higher cure rates have been reported in single-institution studies than in cooperative group trials.
A prospective randomized trial of four regimens (CHOP, ProMACE CytaBOM, m-BACOD, and MACOP-B) for patients with diffuse large B-cell lymphoma showed no difference in overall survival (OS) or time-to-treatment failure (TTF) at 3 years.[Level of evidence: 1iiA] Other randomized trials have confirmed no advantage among the standard doxorubicin-based combinations versus CHOP.;[Level of evidence: 1iiA] A randomized clinical trial failed to demonstrate a beneficial effect of adjuvant radiation therapy in advanced-stage aggressive NHL.
The combination of rituximab and CHOP (R-CHOP) showed improvement in event-free survival (EFS) and OS compared with CHOP alone in 399 advanced-stage patients with diffuse large B-cell lymphoma older than 60 years (EFS = 57% vs. 38%, P = .002, and OS = 70% vs. 57%, P = .007 at 2 y).[Level of evidence: 1iiA] At 5-years' median follow-up, the OS of patients who received R-CHOP compared with patients who received CHOP was 58% versus 45%, P < .007. Similarly, for 326 evaluable patients younger than 61 years, R-CHOP showed improvement in EFS and OS compared to CHOP alone (EFS = 79% vs. 59%, P = .001, and OS = 93% vs. 84%, P = .001 at 3 years).[Level of evidence: 1iiA] These two studies established R-CHOP as the standard regimen for newly diagnosed patients with diffuse large B-cell lymphoma.
A preliminary study using CHOP with or without etoposide for patients older than 60 years suggested improvement in EFS and OS for treatment delivered every 2 weeks versus the standard 3-week regimen. A randomized study (DSHNHL-1999-1A) of 1,222 patients older than 60 years compared R-CHOP given every 2 weeks for six or eight cycles to CHOP given every 2 weeks for six or eight cycles. With a median follow-up of 35 months, the EFS favored R-CHOP given every 2 weeks for six or eight cycles (EFS, relative risk [RR] = 0.5 [0.40-0.65], P < .001). The OS favored R-CHOP for only six cycles because of increased toxicity in the eight-cycle arm (RR of death = 0.63 [0.46-0.85], P = .003).[Level of evidence: 1iiA] There was no comparison to standard R-CHOP or CHOP given every 3 weeks.