FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 352:1197-1205 March 24, 2005 Number 12 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Armitage, J. O. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Chemoradiotherapy is standard treatment for localized aggressive lymphoma. To determine the optimal therapy for nonelderly persons with low-risk localized lymphoma, we conducted a randomized trial comparing chemoradiotherapy with chemotherapy alone.

Methods Previously untreated patients less than 61 years old with localized stage I or II aggressive lymphoma and no adverse prognostic factors according to the International Prognostic Index were randomly assigned to three cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus involved-field radiotherapy (329 patients) or chemotherapy alone with dose-intensified doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (ACVBP) plus sequential consolidation (318 patients).

Results With a median follow-up of 7.7 years, event-free and overall survival rates were significantly higher in the group given chemotherapy alone than in the group given CHOP plus radiotherapy (P<0.001 and P=0.001, respectively). The five-year estimates of event-free survival were 82 percent (95 percent confidence interval, 78 to 87 percent) for patients receiving chemotherapy alone and 74 percent (95 percent confidence interval, 69 to 78 percent) for those receiving chemoradiotherapy. The respective five-year estimates of overall survival were 90 percent (95 percent confidence interval, 87 to 93 percent) and 81 percent (95 percent confidence interval, 77 to 86 percent). In a multivariate analysis, event-free and overall survival rates were affected by treatment group, independently of tumor stage and the presence or absence of bulky disease.

Conclusions In patients under 61 years of age, chemotherapy with three cycles of ACVBP followed by sequential consolidation is superior to three cycles of CHOP plus radiotherapy for the treatment of low-risk localized lymphoma.

Source Information

From the Hôpital Henri Mondor, Assistance Publique–Hôpitaux de Paris, Créteil (F.R., E.L.); Clinique Victor Hugo, Le Mans (G.G.); Hôpital Hôtel-Dieu, Assistance Publique–Hôpitaux de Paris, Paris (T.J.M.); Hôpital Saint-Louis, Assistance Publique–Hôpitaux de Paris, Paris (P.B.); Centre Hospitalier Lyon Sud, Pierre-Bénite (B.C.); Centre Hospitalier de Lens, Lens (P.M.); Institut Gustave Roussy, Villejuif (C.F.); Centre Hospitalier Brabois, Vandoeuvre lès Nancy, Nancy (P.L.); Hôpital Purpan, Toulouse (G.L.); and Centre Henri Becquerel, Rouen (H.T.) — all in France; and the Cliniques Universitaires de Mont Godinne, Yvoir, Belgium (A.B.).

Address reprint requests to Dr. Reyes at the Service d'Hématologie Clinique, Hôpital Henri Mondor, 94010 Créteil, France, or at felix.reyes{at}hmn.ap-hop-paris.fr.

Full Text of this Article

Related Letters:

Treatment of Localized Lymphoma
Tanvetyanon T., Adli M., Sevinc A., Kalender M. E., Hoecht S., Hinkelbein W., Reyes F., Tilly H.
Extract | Full Text | PDF  
N Engl J Med 2005; 352:2449-2451, Jun 9, 2005. Correspondence

This article has been cited by other articles:

• Persky, D. O., Unger, J. M., Spier, C. M., Stea, B., LeBlanc, M., McCarty, M. J., Rimsza, L. M., Fisher, R. I., Miller, T. P. (2008). Phase II Study of Rituximab Plus Three Cycles of CHOP and Involved-Field Radiotherapy for Patients With Limited-Stage Aggressive B-Cell Lymphoma: Southwest Oncology Group Study 0014. JCO 26: 2258-2263 [Abstract] [Full Text]  
• Mourad, N., Mounier, N., Briere, J., Raffoux, E., Delmer, A., Feller, A., Meijer, C. J. L. M., Emile, J.-F., Bouabdallah, R., Bosly, A., Diebold, J., Haioun, C., Coiffier, B., Gisselbrecht, C., Gaulard, P. (2008). Clinical, biologic, and pathologic features in 157 patients with angioimmunoblastic T-cell lymphoma treated within the Groupe d'Etude des Lymphomes de l'Adulte (GELA) trials. Blood 111: 4463-4470 [Abstract] [Full Text]  
• Goodwin, K. D., Lewis, M. A., Long, E. C., Georgiadis, M. M. (2008). Crystal structure of DNA-bound Co(III){middle dot}bleomycin B2: Insights on intercalation and minor groove binding. Proc. Natl. Acad. Sci. USA 105: 5052-5056 [Abstract] [Full Text]  
• Pfreundschuh, M., Zwick, C., Zeynalova, S., Duhrsen, U., Pfluger, K.-H., Vrieling, T., Mesters, R., Mergenthaler, H.-G., Einsele, H., Bentz, M., Lengfelder, E., Trumper, L., Rube, C., Schmitz, N., Loeffler, M., On behalf of the German High-Grade Non-Hodgkin's L, (2008). Dose-escalated CHOEP for the treatment of young patients with aggressive non-Hodgkin's lymphoma: II. Results of the randomized high-CHOEP trial of the German High-Grade Non-Hodgkin's Lymphoma Study Group (DSHNHL). Ann Oncol 19: 545-552 [Abstract] [Full Text]  
• Ryan, G., Martinelli, G., Kuper-Hommel, M., Tsang, R., Pruneri, G., Yuen, K., Roos, D., Lennard, A., Devizzi, L., Crabb, S., Hossfeld, D., Pratt, G., Dell'Olio, M., Choo, S. P., Bociek, R. G., Radford, J., Lade, S., Gianni, A. M., Zucca, E., Cavalli, F., Seymour, J. F. (2008). Primary diffuse large B-cell lymphoma of the breast: prognostic factors and outcomes of a study by the International Extranodal Lymphoma Study Group. Ann Oncol 19: 233-241 [Abstract] [Full Text]  
• Schmitz, N., Dreger, P., Glass, B., Sureda, A. (2007). Allogeneic transplantation in lymphoma: current status. haematol 92: 1533-1548 [Abstract] [Full Text]  
• Gemici, C., Salepci, T. (2007). How Can We Determine the Role of Radiotherapy in the Treatment of Localized Aggressive Non-Hodgkin's Lymphoma?. JCO 25: 2857-2857 [Full Text]  
• Armitage, J. O. (2007). How I treat patients with diffuse large B-cell lymphoma. Blood 110: 29-36 [Full Text]  
• Bonnet, C., Fillet, G., Mounier, N., Ganem, G., Molina, T. J., Thieblemont, C., Ferme, C., Quesnel, B., Martin, C., Gisselbrecht, C., Tilly, H., Reyes, F. (2007). CHOP Alone Compared With CHOP Plus Radiotherapy for Localized Aggressive Lymphoma in Elderly Patients: A Study by the Groupe d'Etude des Lymphomes de l'Adulte. JCO 25: 787-792 [Abstract] [Full Text]  
• Ng, A. K., Mauch, P. M. (2007). Role of Radiation Therapy in Localized Aggressive Lymphoma. JCO 25: 757-759 [Full Text]  
• Bossard, C., Belhadj, K., Reyes, F., Martin-Garcia, N., Berger, F., Kummer, J. A., Briere, J., Baglin, A.-C., Cheze, S., Bosq, J., Ribrag, V., Gisselbrecht, C., Mounier, N., Gaulard, P. (2007). Expression of the granzyme B inhibitor PI9 predicts outcome in nasal NK/T-cell lymphoma: results of a Western series of 48 patients treated with first-line polychemotherapy within the Groupe d'Etude des Lymphomes de l'Adulte (GELA) trials. Blood 109: 2183-2189 [Abstract] [Full Text]  
• Sandlund, J. T. (2007). Should Adolescents with NHL Be Treated as Old Children or Young Adults?. ASH Education Book 2007: 297-303 [Abstract] [Full Text]  
• Dupuis, J., Emile, J.-F., Mounier, N., Gisselbrecht, C., Martin-Garcia, N., Petrella, T., Bouabdallah, R., Berger, F., Delmer, A., Coiffier, B., Reyes, F., Gaulard, P. (2006). Prognostic significance of Epstein-Barr virus in nodal peripheral T-cell lymphoma, unspecified: a Groupe d'Etude des Lymphomes de l'Adulte (GELA) study. Blood 108: 4163-4169 [Abstract] [Full Text]  
• Mounier, N., Spina, M., Gabarre, J., Raphael, M., Rizzardini, G., Golfier, J.-B., Vaccher, E., Carbone, A., Coiffier, B., Chichino, G., Bosly, A., Tirelli, U., Gisselbrecht, C., for the French-Italian cooperative group, (2006). AIDS-related non-Hodgkin lymphoma: final analysis of 485 patients treated with risk-adapted intensive chemotherapy. Blood 107: 3832-3840 [Abstract] [Full Text]  
• Coiffier, B. (2005). State-of-the-Art Therapeutics: Diffuse Large B-Cell Lymphoma. JCO 23: 6387-6393 [Abstract] [Full Text]  
• Kober, T., Skoetz, N., Trelle, S., Bohlius, J., Engert, A. (2005). Third Biannual Report of the Cochrane Haematological Malignancies Group. JNCI J Natl Cancer Inst 97: E2-E [Full Text]  
• Tanvetyanon, T., Adli, M., Sevinc, A., Kalender, M. E., Hoecht, S., Hinkelbein, W., Reyes, F., Tilly, H. (2005). Treatment of Localized Lymphoma. NEJM 352: 2449-2451 [Full Text]  
• Armitage, J. O. (2005). Defining the Stages of Aggressive Non-Hodgkin's Lymphoma -- A Work in Progress. NEJM 352: 1250-1252 [Full Text]