Treatment of low‐grade non‐Hodgkin's lymphomas: Assessment of doxorubicin in a controlled trial

From 1981 to 1984 a randomized clinical trial was conducted to evaluate the role of doxorubicin in low grade malignancy non-Hodgkin's lymphoma (NHL). One hundred and thirteen patients were treated by an induction regimen including cyclophosphamide 400 mg/m2 day 1 and 8, vincristine 1.4 mg/m2 day 1 and 8, procarbazine 80 mg/m2 day 1 to 14, prednisone 60 mg/m2 day 1 to 5 (PCOP regimen) randomly associated to doxorubicin: 20 mg/m2 day 1 and 8 (PACOP regimen). Maintenance therapy consisted of 12 monthly courses of chlorambucil 10 mg/m2 for 5 days or association of cyclophosphamide 300 mg/m2 for 3 days, vincristine 1.4 mg/m2 day 1 and prednisone 60 mg/m2 for 5 days. Complete response (CR) was obtained in 51 patients (45 per cent), in 30 patients after induction regimen and in 21 patients after maintenance therapy, without difference according to regimens. Bone marrow involvement (p=0.02) and number of involved nodal sites (p=0.001) were found to influence probability of achieving CR. The median time to progression was estimated to 39 months without difference between regimens. Median overall survival is not reached with a median follow-up of 53 months. Multivariate regression analysis permits observation of negative influence on survival of three parameters: initial bone marrow involvement, age over 50 years and incomplete response to treatment. The initial adjunction of doxorubicin did not seem to influence the appearance of histologic progression.