Journal of Clinical Oncology, Vol 16, 41-47, Copyright © 1998 by American Society of Clinical Oncology
Maintenance of remission with human recombinant interferon alfa-2a in patients with stages III and IV low-grade malignant non-Hodgkin's lymphoma. European Organization for Research and Treatment of Cancer Lymphoma Cooperative Group
A Hagenbeek, P Carde, JH Meerwaldt, R Somers, J Thomas, R De Bock, JM Raemaekers, A van Hoof, C De Wolf-Peeters and M van Glabbeke
The Dr Daniel den Hoed Cancer Center, Rotterdam, The Netherlands. A.Hagenbeek@ab.azu.nl
PURPOSE: Interferon alfa has shown significant activity in patients with
low-grade malignant non-Hodgkin's lymphoma (NHL). In 1985, we initiated a
prospective randomized study in which the potential benefit of interferon
alfa given as maintenance treatment was investigated after tumor load
reduction was achieved with chemoradiotherapy in patients with advanced
low-grade malignant non-Hodgkin's lymphoma. PATIENTS AND METHODS: The study
involved 347 patients with stage III or IV disease, 315 satisfying the
eligibility criteria. All were treated with a regimen of cyclophosphamide,
vincristine, and prednisone (CVP) given every 3 weeks for eight cycles.
Thereafter, patients were eligible for iceberg irradiation. Finally, all
patients were completely restaged, and responding and stable-disease
patients were then randomized, 122 to interferon alfa-2a maintenance, 3
million U three times weekly for 1 year; and 120 to no further treatment.
RESULTS: Seventy-nine percent of the patients response to CVP, ie, 45%
complete remissions (CR) and 34% partial remissions (PR). In the group of
randomized patients, the response rate after CVP plus or minus radiotherapy
was 90%. As compared with control patients, patients in the interferon
(IFN) maintenance group had a tendency toward a prolonged time to
progression (TTP) (median, 132 v 87 weeks; P = .054, adjusted for response
to CVP). However, overall survival was similar in both groups. Interferon
was well tolerated. The median dose of IFN actually received corresponded
to 90% of the planned cumulative dose. The treatment had to be stopped
because of toxicity in 16 patients (15% of the patients in whom IFN was
started). CONCLUSION: Interferon maintenance treatment in the phase of
minimal residual disease of patients with advanced low-grade malignant NHL
increased TTP at the borderline of statistical significance, without
remarkable toxicity. However, overall survival was not influenced.
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