Search

The patients with the typical clinical course and pathology of Mycosis Fungoides (MF) were found also to have Hodgkin's Disease (HD), nodular sclerosing type. In two cases, HD was diagnosed 2 years after the diagnosis of MF; in the third case, both diseases were diagnosed simultaneously. Previous claims of MF transforming into second lymphomas are reviewed. The possible significance of our observed association of MF and HD is discussed.

Between 1974 and 1978, 315 eligible patients with advanced Hodgkin-s disease (HD) without prior chemotherapy were randomized to MOPP plus low-dose bleomycin or the same agents plus Adriamycin (in 1 of 2 schedules). The results of the two Adriamycin-containing schedules were similar and were, therefore, combined as „MOP-BAP and compared to MOPP-Bleo. All patients completed remission induction therapy with a median time on study of 47 months. Of 291 evaluable patients, the complete remission rate was 77% for 166 patients treated with MOP-BAP compared to 67% for 125 patients receiving MOPP-Bleo (P = 0.05, one-sided test). Among patients with more favorable pretreatment prognostic factors, MOP-BAP produced a higher CR rate than MOPP-Bleo (patients with hemoglobin ≥ 12 g/dl, 85 versus 67%, P = 0.01; those with a performance status of 70-100%, 81 versus 70%, P = 0.03; those without bone marrow involvement, 81 versus 68%, P = 0.03, those older than age of 40 years, 79 versus 62%, P = 0.03; those who were asymptomatic [A], 94 versus 77%, P = 0.04; and those without any prior therapy, 75 versus 63%, P = 0.04). CR duration and overall survival were similar for the two treatments. However, survival was better for patients with favorable pretreatment prognostic factors treated with MOP-BAP compared to MOPP-Bleo (those who were asymptomatic [P = 0.08], without bone marrow involvement [P = 0.04], and with nearly normal initial hemoglobin levels [P = 0.02]). MOP-BAP was associated with less nausea and vomiting and significantly less thrombocytopenia than MOPP-Bleo (P = 0.01). For patients with prognostically more favorable types of HD, the use of an initial Adriamycin-containing MOPP regimen (MOP-BAP) offers a higher complete remission rate, less acute toxicity and improved survival compared to MOPP-Bleo.

Between 1974 and 1977, 652 patients with non-Hodgkin's lymphoma without prior chemotherapy were randomized to 1 of 3 combination chemotherapy programs designed to induce complete remission (CR): COP-bleomycin (180 patients), CHOP-bleomycin (232 patients) or CHOP plus immunotherapy with Bacillus Calmette Guerin (BCG) (240 patients). With mature follow-up, the major effect of BCG immunotherapy was observed in patients with large cell lymphomas (diffuse or nodular "histiocytic") and not in other common lymphoma subtypes. CR rate for 65 patients with large cell lymphoma treated with CHOP-BCG was 68% compared to 48% in 61 patients treated with CHOP-bleomycin (P = 0.02) (two-tailed test) or 44% for 45 patients treated with COP-bleomycin (P = 0.02). CR duration for both CHOP-based regimens was similar and superior to that produced by COP-bleomycin (P = 0.03). Survival of patients with large cell lymphoma treated with CHOP-BCG was better than that observed with CHOP-bleomycin (P = 0.02) or COP-Bleomycin (P = 0.002). Although the explanation for the favorable effect of BCG remains unclear, further clinical trials to evaluate the combination of chemotherapy and other "biologic response modifiers" is warranted for patients with lymphoma.

As a part of an ongoing prospective controlled trial, the Southwest Oncology Group compared the results of treatment of advanced non-Hodgkin's lymphoma with two CHOP regimens (cyclophosphamide, adriamycin, vincristine and prednisone with either low-dose bleomycin or BCG by scarification) to a COP regimen (cyclophosphamide, vincristine and prednisone) with low-dose bleomycin (COP-Bleo). The study design emphasized histopathology review and systematic restaging to define complete remission (CR). Confirmed rates of CR for 443 evaluable patients were 59% for 286 patients receiving the CHOP regimens and 59% for 157 patients receiving COP-Bleo. Rates of CR were higher for patients with nodular lymphoma (69%) compared to those with diffuse lymphoma (54%) (p = 0.005). For patients with nodular lymphoma there was no difference in CR rates according to treatment. For patients with diffuse lymphomas the CR rate was higher with the CHOP programs (58%) than with COP-Bleo (44%) (p = 0.10). Overall duration of CR and survival was significantly longer for patients with nodular lymphoma compared to diffuse lymphoma (p < 0.01). At this time, remission duration and survival were similar regardless of induction regimen used in patients with nodular lymphoma. However, in patients with diffuse lymphoma, the duration of CR and overall survival were improved by treatment with the CHOP regimens compared to COP-Bleo (p = 0.02). Thus, in this controlled study we have demonstrated that initial combination chemotherapy employing the CHOP regimen was a superior remission induction therapy for patients with diffuse lymphoma. Cancer 43:417–425, 1979.