Chemotherapy in the management of stage III/IV grade 1 non-Hodgkin's lymphomas (Report no 17).

This report describes two comparisons of combination chemotherapy (COP) with chlorambucil in the management of Stages III, IV Grade 1 non-Hodgkin's lymphoma. The first prospective randomised study was carried out by the BNLI between 1974 and 1976. In 1976, initial analyses of 90 assessable patients indicated that COP was more effective than chlorambucil but it was considered by the BNLI collaborators that chlorambucil should not be discarded because it was not much more acceptable to both patients and doctors. Long-term follow-up of this early trial indicated that the decision not to give up chlorambucil was justified. Examination of the results in 1980, which included 130 assessable cases, showed identical recurrence-free survival rates in the two groups. In the second study starting in 1977, the initial comparison was between chlorambucil and COP, but if progressive improvement was not achieved by three months the patient was regarded as a non-responder and switched to the other arm. Patients were also drawn for maintenance (with chlorambucil) or not at the time for entry into the trial. Analysis of the first 180 patients show similar complete remission rates, actuarial survival rates and recurrence-free survival rates. There seems no advantage in using COP as first-line treatment rather than single agent chlorambucil, provided that non-responders are treated subsequently with combination chemotherapy.