Journal of Clinical Oncology, Vol 10, 219-227, Copyright © 1992 by American Society of Clinical Oncology
MACOP-B treatment in diffuse large-cell lymphoma: identification of prognostic groups in an Italian multicenter study
U Vitolo, M Bertini, E Brusamolino, GB Cavallero, B Comotti, E Gallo, R Ghio, A Levis, G Luxi and V Meneghini
Divisione di Ematologia, Ospedale Molinette, Torino, Italy.
PURPOSE: The prognosis of advanced-stage diffuse large-cell lymphoma (DLCL)
has improved with the use of the third-generation regimens such as
methotrexate with leucovorin, doxorubicin, cyclophosphamide, vincristine,
prednisone, and bleomycin (MACOP-B). However, different results have been
reported. Therefore, we started a cooperative study to confirm the efficacy
of MACOP-B. An analysis of prognostic factors was also performed to
identify poor-prognosis patients. PATIENTS AND METHODS: Between June 1986
and March 1989, 180 patients with advanced- stage DLCL were treated with
MACOP-B. MACOP-B was given according to the original scheme. Numerous
clinical features possibly predictive for complete response (CR),
disease-free survival (DFS), and survival were analyzed in univariate and
multivariate analyses. RESULTS: One hundred twenty-seven patients (71%)
achieved a complete remission, 20 (11%) achieved a partial remission, 24
(13%) had unchanged or progressive disease, and nine (5%) died due to
toxicity. With a median follow-up of 28 months, 71% of 127 CRs remain in
first remission. Predicted 3-year survival for all 180 patients is 60%, and
3-year DFS for the 127 CRs is 67%. Overall toxicity was acceptable, with
mucositis being the most frequent severe side effect. A multivariate
regression analysis identified lactate dehydrogenase (LDH) level, bone
marrow involvement, and tumor burden as independent risk factors for
survival. These factors were also important for achievement of remission
and DFS and allowed us to identify three distinct risk groups of patients
with good, intermediate, and poor prognosis, with 3-year survival rates of
80%, 59%, and %29, respectively. CONCLUSIONS: These results confirm the
effectiveness of MACOP-B in advanced-stage DLCL at low or intermediate
risk; however, high-risk patients are in urgent need of new therapeutic
approaches. A better definition of prognostic features would allow a more
reliable comparison of different treatment regimens, as well as an
effective tailoring of therapy by prognostic groups.
