Survival advantage of ACVBP compared to CHOP chemoradiotherapy in patients with lymphoma

The ACVBP regimen with sequential consolidation improves event free and overall survival compared to CHOP and radiotherapy in patients with localised aggressive lymphoma, according to a randomised trial from the Groups d'Etude des Lymphomes de l'Adulte (GELA). A standard treatment for localised aggressive lymphoma is chemoradiotherapy with doxorubicin, cyclophosphamide, vincristine and prednisone (CHOP). This randomised trial from 86 participating centres included patients who were newly diagnosed with low-risk aggressive stage I or II lymphoma and were younger than 61 years. The chemoradiotherapy group, of 329 patients, was given three cycles of CHOP and involved field radiotherapy one month after the last cycle of CHOP, at 40 Gy. The chemotherapy group, of 318 patients, received an induction phase of doxorubicin, cyclophosphamide, vindesine, bleomycin and prednisone followed by sequential consolidation (ACVBP). Treatment was given on an ambulatory basis in both groups. Complete response occurred in 93% of patients on chemotherapy alone and 92% on chemoradiotherapy. There were no treatment-related deaths but grade 3 infections were seen in the 11% and grade 4 infections in 1% of the chemotherapy group and grade 3 infections in 1% of the chemoradiotherapy group. After median follow-up of 7.7 years, five-year estimated event-free survival was 82% in chemotherapy and 74% in chemoradiotherapy group (p The authors concluded that the theoretical dose intensity of doxorubicin and cyclophosphamide in 95% of patients in the chemotherapy group was at least 150% higher than that given by three cycles of CHOP. Three cycles of ACVBP and sequential consolidation improved event free and overall survival compared to CHOP and radiotherapy. They noted that event-free survival could be improved and that a trial of rituximab and ACVBP in young adults with localised low-risk aggressive lymphoma is now being carried out.Reference...