Comparative study of two drug combination in non-Hodgkin's lymphoma
Somoza, N.; Morgenfeld, M.C.; Magnasco, J.; Pavlovsky, S.; Cavagnaro, F.J.; Saslavsky, J.; de Maria, H.; Macchi, A.; Suárez, A.
Sangre 23(4): 418-425
1978
ISSN/ISBN: 0036-4355 PMID: 705564 Document Number: 3920
In the first GAT LA's trial with combination chemotherapy (COPP): cyclophosphamide. rincristine, prednisone and procarbazine, 79 % complete remissions were obtained in non Hodgkin's lymphoma; remaining after 48 months in complete remission 44 % of the patients. With the purpose of exploring new combinations equally effective than COPP, but less toxic, more economic and easy to administer a controlled clinical trial was designed to evaluate cyclophosphamide, vinblastine, procarbazine and prednisone (CVPP) vs. CCNU. cyclophosphamide, vinblastine, procarbazine and prednisone (CCVPP). A total of 191 patients were included with non Hodgkin's lymphoma, from whom/66 were evaluable. Ninety eigth patients were males and 68 females. The ages ranged between 15 and 60 years. The following schemes were employed: CVPP, cyclophosnhamide, 600 mg/m2 vinblastine, 6 mg/m2 procarbazine, 100 mg/m2 oral day 1 to 14: nrednisone. 40 mg/m2 oral day 1 to 14. Then rest from day 15 to 28. It was compared with CCVPP using the same drugs with the addinn of CCNU, 75 mg/m2 oral on day 1 of alternate cycles 1, 3 and 5. All the patients completed 6 cycles. As maintenance therapy they did a cycle every 2 months the first year, every 4 months the second year and every 6 months the third year. Patients with stage I and II A were initially treated with supradiaphragmatic radiotherapy in mantle or inverted Y according to localization and then received maintenance chemotherapy. Patients with stage III and IV A and I, II, III and IV 13 were included directly in chemotherapy and randomized for both schemes. Out of 83 patients treated with CVPP 41 (49 %) achieved complete remission, while from 83 patients treated with CCVPP 46 (55 %) achieved complete remission. The difference was not significant. No significant differences were observed comparing both combinations in relation to age, sex, clinical stage, presence or absence of symptoms, histologic type, structure and the existence or not of previous therany. There were only found significative differences in the percentage of complete remissions for stage III, 42% vs. 72% (P<0.005) being superior the CCVPP. Forty two percent of the patients treated with CCVPP and 53 % with CVPP remain in complete remission. A total of 46 patients out of 83 treated with CVPP died compared with 48 out of 83 treated with CCVPP. After 48 months remain alive 36 % and 37 % respectively. The difference was not significant. We conclude that the inclusion of CCNU to the combination cyclophosphamide, vinblastine, procarbazine and prednisone did not increase significantly the percentage of complete remissions, the duration of same or the survival. Both schemes showed to be inferior to COPP in an historical comparison of our collaborative group.
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