CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS Intensive conventional chemotherapy (ACVBP regimen) compared with standard CHOP for poor-prognosis aggressive non-Hodgkin lymphoma

We conducted a randomized trial to com-pare the intensive conventional chemo-therapy regimen ACVBP (doxorubicin, cy-clophosphamide, vindesine, bleomycin, prednisone) with standard CHOP (cyclo-phosphamide, doxorubicin, vincristine, and prednisone) in previously untreated patients with poor-risk aggressive lym-phoma. Patients aged 61 to 69 years who had aggressive non-Hodgkin lymphoma with at least one prognostic factor of the age-adjusted international prognostic in-dex (IPI) were included. ACVBP consisted of an induction phase of intensified che-motherapy and central nervous system (CNS) prophylaxis followed by a sequen-tial consolidation phase. Of the 708 pa-tients registered for the study, 635 were eligible. The rate of complete response was 58 % in the ACVBP group and 56 % in the CHOP group (P .5). Treatment-related death occurred in 13 % of the ACVBP group and 7 % of the CHOP group (P .014). At 5 years, the event-free sur-vival was 39 % in the ACVBP group and 29 % in the CHOP group (P .005). The overall survival was significantly longer for patients treated with ACVBP, at 5 years it was 46 % compared with 38 % for patients treated with CHOP (P .036). CNS progressions or relapses were more frequent in the CHOP group (P .004). Despite higher toxicity, the ACVBP regi-men, used as first-line treatment for pa-tients with poor-risk aggressive lym-phoma, is superior to standard CHOP with regard to both event-free survival and overall survival. (Blood. 2003;102