Combination chemotherapy with cyclophosphamide, vincristine, prednisone and the contribution of adriamycin in the treatment of adult non-Hodgkin's lymphomas. A report of 131 cases

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Abstract
Between January 1973 and January 1979, 131 patients with malignant non‐Hodgkin's lymphomas (107 lymphocytic lymphomas, 24 histiocytic lymphomas) were treated with cyclophosphamide‐vincristinprednisone (CVP) either alone or combined with Adriamycin (CVP‐A). Stage I and II lymphocytic lymphomas were all treated by CVP combined with radiotherapy. The survival curve for this group of patients plateaued at 89% from the 12th to the 60th month, which was the endpoint of the study. For Stage III and IV nodular lymphocytic lymphomas, actuarial survival was 69% at five years in the CVP‐treated group as compared to 54% at three years in the group treated with CVP‐A. For Stage III and IV diffuse lymphocytic lymphomas, the complete response rate and median survival were respectively 25% and 24 months in patients treated with CVP, as compared to 67% (P < 0.01) and 26 months in the group treated with CVP‐A. For histiocytic lymphomas, the complete response rate was 50% in the CVP‐treated group as compared to 83% in the group treated with CVP‐A. Most remarkable was the fact that while in the CVP treated group median survival was only 17 months, the small group of patients treated with CVP‐A exhibited considerably improved survival with a horizontal survival curve at 90% after 36 months (12 patients). These results show that the CVP protocol remains an excellent treatment for nodular lymphocytic lymphomas. The addition of Adriamycin (CVP‐A) as well as its inclusion in other drugs combination, has raised hopes for remissions of long duration and even for cures in patients with histiocytic lymphomas. Finally, in diffuse lymphocytic lymphomas, efforts will have to be pursued to improve the prognosis which remains poor despite the increased complete response rate achieved by the addition of Adriamycin.