The treatment of disseminated non-Hodgkin's lymphoma of unfavourable histology.

Forty-eight consecutive previously untreated adults with advanced non-Hodgkin's lymphoma (NHL) of unfavourable histological type were referred to the Department of medical Oncology at St. Bartholomew's Hospital, london, between 1972 and 1977. They received adriamycin, vincristine, prednisolone and L-asparaginase (OPAL) initially, and those in whom complete remission was achieved proceeded to cranial irradiation and intrathecal methotrexate, followed by continuous oral maintenance chemotherapy comprising weekly methotrexate, cyclophosphamide, and daily 6-mercaptopurine for 3 years. Complete remission was achieved in 24 of the 48 (50%). The median duration of remission was 10 months, none patients continuing without relapse for between 3 and 7 years. The median survival was 9 months, 12 patients being alive and disease-free (three in second remission) after between 3 1/2 and 8 1/2 years. The prognosis was significantly better in patients with nodal stages II and III (disease) than in those with stage IV, for both response (P = less than 0.05) and survival (P = 0.002). Patients in whom complete remission was achieved survived significantly longer than those in whom it was not, regardless of stage. These results confirm our preliminary observations with this treatment programme that a proportion of patients with stage II and II unfavourable histology NHL may be curable although the outlook for stage IV remains poor.