[back] Chemotherapy

"About 62,500 Americans will be diagnosed with lymphoma in 1998 (7,100 cases of Hodgkin's disease and 55,400 cases of non-Hodgkin's lymphoma.)  An estimated 26,300 persons will die of lymphoma in the U.S. in 1998 (non-Hodgkin's lymphoma, 24,900; Hodgkin's disease, 1,400). "

1. Hodgkin's disease

7,100 cases of Hodgkin's disease--deaths 1,400

"The survival rate for Hodgkin's disease in African Americans is 74 percent. In children, the survival rate for Hodgkin's disease is 94 percent."

Childhood Hodgkin's Disease 

About 10% to 15% of all cases (852) of Hodgkin's are diagnosed in children 16 and under

"A study of over 10,000 patients shows clearly that chemo’s supposedly strong track record with Hodgkin’s disease (lymphoma) is actually a lie. Patients who underwent chemo were 14 times more likely to develop leukemia and 6 times more likely to develop cancers of the bones, joints, and soft tissues than those patients who did not undergo chemotherapy (NCI Journal 87:10)."—John Diamond

Children who are successfully treated for Hodgkin's disease are 18 times more likely later to develop secondary malignant tumours. Girls face a 35 per cent chance of developing breast cancer by the time they are 40----which is 75 times greater than the average. The risk of leukemia increased markedly four years after the ending of successful treatment, and reached a plateau after 14 years, but the risk of developing solid tumours remained high and approached 30 per cent at 30 years (New Eng J Med, March 21, 1996)

2. Non-Hodgkin's Lymphoma (NCI info: )

"Cases of the Non-Hodgkin's lymphoma (about 55,400 in the US this year, 1998?) far outweigh cases of Hodgkin's Disease (7,100 cases in the US this year--1998?)".

Adult Non-Hodgkin's Lymphoma (52,630 cases)


Childhood Non-Hodgkin's lymphoma/lymphoblastic lymphoma

"In the US, childhood Non-Hodgkin's lymphomas make up about 5% (2,770) of the 55,400 cases of NHL diagnosed each year."  

"NHL is the third most common childhood malignancy and accounts for approximately 6% of cancers in children less than 20 years of age..........More than 60% of children with NHL will survive at least 5 years with modern chemotherapy."

Patients with stage IV disease (bone marrow or central nervous system (CNS) involvement) have a long-term survival rate of 45%-75%


Results of treatment with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) for non-Hodgkin's aggressive lymphoma analyzed according to the International Prognostic Index."

The overall survival rate (2 yr) of 23 patients in the L+LI risk group was 52.1% and of 17 patients in H+HI risk group was 11.7% and this difference was statistically significant (P<0.05). Our results indicated that the CHOP regimen is not effective in the HI+H risk groups of patients with aggressive NHL.

This says CHOP only achieved a 52.1% survival rate after two years in the low and low-intermediate risk groups. It also says that 11.7% survival in the high and high-intermediate risk group was not an improvement over untreated aggressive NHL.   Since the H+HI group has three times the risk factor of the L+LI group, 35% (3*11.7%) or more of the L+LI group were expected to survive 2 years without any treatment at all. At best, the CHOP study shows only a 17% improvement in the survival rate at 2 years.

How can you claim that CHOP "has a CURE rate of over 50%" complete remission for 5 years, when 48% of the low+low-intermediate group are already dead at 2 years, and when 68% of all groups combined are dead at 2 years? Get serious.

Campbell C, et al. Delivery of full dose CHOP chemotherapy to elderly patients with aggressive non-Hodgkin's lymphoma without G-CSF support. Leuk Lymphoma. 1999 Sep;35(1-2):119-27. [MEDLINE record in process] PMID: 10512169; UI: 99440720.

Sixty eligible patients were identified. 31 received CHOP +/- radiation (XRT), 9 other curative treatment and 20, palliative treatment.........During 141 cycles of CHOP. 17 (12%) episodes of febrile neutropenia (FN) occurred in 14 (45%) patients and other grade 3/4 toxicity occurred in <10% of patients. There were 3 (10%) toxic deaths. Sixteen (52%) patients required a total of 29 admissions to hospital for FN (59%) or other causes. Of the 31 patients, 16 (52%) achieved a complete remission (CR), 7 (23%) a partial remission-1 (PR-1), 2 (6%) a partial remission-2 (PR-2), 1 (3%) had no response (NR), 2 (6%) had progressive disease and 3 (10%) were not evaluable (NE). The median progression free survival (PFS) and overall survival (OS) were (16+) months and (24.5) months respectively. We found that physician biases resulted in the selection of; younger patients (median 71 vs. 80 years), patients with a better ECOG performance status (> or =2, 13% vs. 50%) and patients with less co-morbid illness (42% vs. 90%) for attempt at curative treatment with CHOP chemotherapy. Age was never the sole reason for offering palliative treatment. In conclusion, a subset of patients over the age of 65 with aggressive NHL, who have a good performance status and minimal co-morbid illness can tolerate full dose CHOP chemotherapy without G-CSF support. Future strategies should emphasize full dose treatment with curative intent with minimization of both hematologic and non-hematologic toxicity. Clinical studies are required to determine whether routine G-CSF support will reduce toxicity or improve outcome in this group of patients.


Epelbaum R, et al.   Full dose CHOP chemotherapy in elderly patients with non-Hodgkin's lymphoma. Acta Oncol. 1995;34(1):87-91. PMID: 7865241; UI: 95169419.

Twenty-eight previously untreated elderly patients (median age 73 years, range 65-88) with aggressive non-Hodgkin's lymphoma were treated with full-dose CHOP chemotherapy between 1989 and 1992. The median of the average relative dose intensity (ARDI) was calculated for the initial cycles needed to achieve a maximal response or to determine progression of disease (1-6 cycles, median 4), as well as for the whole treatment course. For patients aged 65-74, both ARDIs were 0.89. A comparable group of 36 elderly patients who received reduced doses of CHOP from the start, served as a historical control. There was an increase of 11% and 29% in the ARDIs of the full-dose CHOP as compared with the reduced CHOP, in the initial cycles and for the whole treatment course respectively. Grade III-IV leukopenia was the main toxicity observed in 57% of the patients, and 7 patients were hospitalized for fever and leukopenia. There was no treatment-related death. It is concluded that CHOP chemotherapy without initial dose reduction is feasible in patients aged 65-74 years, resulting in high actual dose intensity with a reasonable degree of toxicity. Publication Types:Clinical trial PMID: 7865241, UI: 95169419



Meyer RM, et al. A phase I trial of standard and cyclophosphamide dose-escalated CHOP with granulocyte colony stimulating factor in elderly patients with non-Hodgkin's lymphoma. Leuk Lymphoma. 1998 Aug;30(5-6):591-600. PMID: 9711921; UI: 98375739.       
..........Eight patients (80%) completed 6 cycles of standard CHOP plus G-CSF. Therapy was stopped prematurely in 2 patients due to pneumonia (1) and disease progression (1). Six of 11 patients (55%) given CHOP with cyclophosphamide 900 mg/m2 (CHOP-900) completed treatment. Therapy was stopped in 5 patients due to a toxic death from infection (1), cumulative fatigue (3), and pneumonitis (1). Further dose escalations were not attempted due to the inability to complete 6 treatment cycles in 45% of CHOP-900 cases. The received dose intensities of cyclophosphamide relative to standard CHOP measured over the actual time on therapy were 96% with standard CHOP and 115% with CHOP-900. At 3 years, progression free survival is 40% with standard CHOP and 82% with CHOP-900; overall survivals are 40% and 91% respectively. Neutropenia of < 1.0 x 10(9)/L occurred in 47% of treatment cycles with standard CHOP and in 77% with CHOP-900. In both groups, the mean duration of neutropenia was < 2 days. From these studies we conclude that, standard CHOP with G-CSF can be safely given to elderly patients. Escalating the dose of cyclophos
Aziz Z, et al.  Non-Hodgkin's lymphoma in Pakistan: a clinicopathological profile of 175 patients. JPMA J Pak Med Assoc. 1999 Jan;49(1):11-5. PMID: 10463009; UI: 99392278.         [See Related Articles]

.......A retrospective and prospective analysis was performed on 175 patients over 14 years age who presented to the Department of Oncology between August 1994 and December 1996. ..... The IPI was applied to patients with aggressive lymphomas and age adjusted index to patients < 60 years, complete remission (CR), disease free survival (DFS) and overall survival (OS) were calculated. RESULTS: All 175 patients were evaluable. Median age of our patients was 45 years. Male to female ratio was 1.9:1. Seventeen (9.7%) patients were classified as low grade lymphomas while 158 (91.3%) had intermediate and high grade NHL. Large cell lymphoma was present in 30.9% patients. CHOP (cyclophosphamide 650 mg/m2 day 1, vincristine 1.4 mg/m2 day 1, doxorubicin--45 mg/m2 day 1 and prednisone 100 mg/m2 day 1-5) was the most common chemotherapy regimen used. Advanced stage (74.9%) > B symptoms (51%) and extranodal involvement (74.3%) were present. One hundred sixty-seven patients were evaluable for response of which 42.8% achieved CR. Median DFS was 19 months and median OS was 22 months. The IPI was applicable to 153 patients and age adjusted IPI to 124 of 153 patients. CONCLUSION: Aggressive histology, extranodal diseases, B symptoms and advanced disease are common. International index and age adjusted international index predicted outcome accurately in various risk groups.

Bremnes RM, et al. High-grade non-Hodgkin's lymphoma treated in northern Norway--treatment, outcome, and prognostic factors. Acta Oncol. 1999;38(1):117-24. PMID: 10090699; UI: 99189108.          [See Related Articles]

In an unselected group of patients with high-grade non-Hodgkin's lymphoma (HG-NHL) treated at our institution during a 10-year period (1986-1995), we studied treatment outcome and influence of possible prognostic factors. 187 HG-NHL patients were analysed retrospectively with regard to personal, treatment and disease-specific characteristics. Median age was 65 years and the male:female ratio was 1.2:1. Over a median follow-up of 57 months the overall response rate was 87% (complete response 72%, partial response 15%). The 2- and 5-year cumulative disease-specific survival rates were 64+/-4% (mean +/- SEM) and 48+/-5%, respectively. In a univariate analysis, the following variables were associated with prognosis in terms of survival: Patient age, clinical stage, performance status, bone-marrow infiltration, haemoglobin, erythrocyte sedimentation rate, lactate dehydrogenase (LDH), and serum albumin. In multivariate analyses, patient age, performance status, LDH, and haemoglobin came out as independent prognostic factors for survival. PMID: 10090699, UI: 99189108

Guo XM, et al.  [Clinical observation on 112 cases with non-Hodgkin's lymphoma treated by Chinese herbs combined with chemotherapy]. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih. 1997 Jun;17(6):325-7. Chinese. PMID: 9863121; UI: 99080256.         [See Related Articles]

OBJECTIVE: To seek for the effective therapeutical method in treating non-Hodgkin's lymphoma (NHL). METHODS: One hundred and sixty seven patients with non-Hodgkin's lymphoma were randomly divided into two groups, the treatment group, which consisted of 112 cases using Chinese herbs combined with chemotherapy and 55 cases of control group were treated by chemotherapy only. RESULTS: The effective rate (CR + PR) in the combined group was 91.96% and survival rates of 1-, 3- and 5-year were 85.7%, 54.5% and 29.5% respectively, and median survival time was 554 days. In control group the effective rate was 72.73% and 1-, 3- and 5-year survival rates were 76.4%, 38.2% and 18.2% respectively, and the median survival time was 465 days. The difference of effective rates or 3-year survival rates between two groups was significant (P < 0.05). In the combined group the activity of NK cell, OKT3, OKT4 and ratio of OKT4/OKT8 were obviously raised after treatment (P < 0.01). And the level of platelet adhesion rate and the blood viscosity markedly decreased (P < 0.01), but in the control group the values of these indexes did not distinctly change. CONCLUSION: Chinese herbs could enhance the immunologic function and improve the viscosity of blood of the patients with NHL. The side effect in the combination therapy group was less and milder than that in the chemotherapy group. These showed that Chinese herbs combined with chemotherapy was a safe and effective method for treating NHL and deserve to be recommended.


Hattori M, et al.  [Low-grade non-Hodgkin's lymphoma: intensive combined chemotherapy]. Rinsho Ketsueki. 1996 Feb;37(2):101-8. Japanese. PMID: 8852026; UI: 97004715.  [See Related Articles]

The efficacy of various combination chemotherapies employed for the 37 patients with low-grade non-Hodgkin's lymphoma between 1981 and 1994 was evaluated retrospectively. The overall survival at 5 years was 68%. The 5-year survival of the 27 patients achieving complete response (CR) was 87%, which was significantly higher than that of 9 patients with partial response (p = 0.0005). The CR rate of stage III and IV patients was 64% for the 22 patients treated with ACOMP-B (D), and was 38% for 8 others treated with milder chemotherapy regimens including VEPA. The 22 advanced stage patients had a 5-year survival of 88% after the treatment with ACOMP-B (D) and 69% of them remained free of disease at 5 years. In this group no relapse occurred beyond 1.6 years after treatment. These findings suggest a possible role of third generation chemotherapy in the treatment of patients with advanced-stage low-grade non-Hodgkin's lymphoma.



Link MP, et al. Treatment of children and young adults with early-stage non-Hodgkin's lymphoma. N Engl J Med. 1997 Oct 30;337(18):1259-66. PMID: 9345074; UI: 97475835.          [See Related Articles]

BACKGROUND: Children and young adults with early-stage non-Hodgkin's lymphoma have an excellent prognosis, but treatment is prolonged and is associated with many side effects. We performed two studies to determine whether therapy could be simplified. METHODS: Between 1983 and 1991, we conducted two consecutive trials in children and young adults (age, <21 years) with early-stage non-Hodgkin's lymphoma. In the first trial, patients were treated for 9 weeks with induction chemotherapy consisting of vincristine, doxorubicin, cyclophosphamide, and prednisone, followed by 24 weeks of continuation chemotherapy with mercaptopurine and methotrexate. Half the patients were randomly assigned to receive involved-field irradiation. In the second trial, after the 9 weeks of induction chemotherapy, the patients were randomly assigned to receive 24 weeks of continuation chemotherapy or no further therapy. RESULTS: A total of 340 patients were enrolled in the two trials, 12 of whom did not have complete remissions. One hundred thirteen patients received nine weeks of chemotherapy without radiotherapy, 131 received eight months of chemotherapy without radiotherapy, and 67 received eight months of chemotherapy with radiotherapy. At five years, the projected rates of continuous complete remission were 89, 86, and 88 percent for the three groups, respectively. At five years, event-free survival among the patients with early-stage lymphoblastic lymphoma was inferior to that among the patients with other subtypes of lymphoma (63 percent vs. 88 percent, P<0.001). Continuation therapy was effective only in patients with lymphoblastic lymphoma. CONCLUSIONS: A nine-week chemotherapy regimen without irradiation of the primary sites of involvement is adequate therapy for most children and young adults with early-stage, nonlymphoblastic non-Hodgkin's lymphoma.


Kusumakumary P, et al.  Non-Hodgkin's lymphoma in children: disease pattern and survival. Pediatr Hematol Oncol. 1998 Nov-Dec;15(6):509-17. PMID: 9842644; UI: 99058791.   [See Related Articles]

The use of intensive chemotherapy and incorporation of prophylactic treatment of the central nervous system have dramatically improved the outcome of children with non-Hodgkin's lymphoma (NHL). The authors analyzed retrospectively the disease characteristics and survival data of 34 children with NHL during a 7-year period. There were 26 boys and 8 girls with a median age of 8 years. The primary sites were the abdomen (41%) and peripheral node (41%). Histopathologically lymphoblastic and undifferentiated lymphoma (small nonclaved cell lymphoma) were equally distributed (41%). Thirteen patients had localized disease (stage I and II) and 21 patients had advanced disease (stage III and IV). Surgical removal of the primary tumor was done in 6 patients with localized gastrointestinal lesions. All 34 patients received chemotherapy, either cyclophosphamide, vincristine, methotrexate, and prednisolone (COMP) or adriamycin, cyclophosphamide, vincristine, and prednisolone (ACOP). Thirty patients achieved complete remission (88.2%). The 5-year event-free survival rate was 64%. The results indicate that most children with localized disease can be cured by COMP chemotherapy, but more aggressive chemotherapy is necessary to improve survival in advanced-stage disease.