Combined cyclophosphamide vincristine, and prednisone therapy of malignant lymphoma.

Abstract

A combination of intravenous cyclophosphamide and vincristine (Oncovin) and oral prednisone (COP) was given every 2 weeks to 262 patients with disseminated Hodgkin's disease, lymphosarcoma, reticulum cell sarcoma, and follicular lymphoma. A complete remission was produced in 36% of patients with Hodgkin's disease, 50% of patients with lymphosarcoma, and 39% of patients with reticulum cell sarcoma. These remission rates are significantly superior to those produced by single agents. Patients who achieved a complete remission were randomly allocated to monthly COP (maintained remission) or to no treatment (unmaintained remission). The median duration of maintained remission was longer than unmaintained remission for Hodgkin's disease (42 weeks vs. 19 weeks) and lymphosarcoma (49 weeks vs. 21 weeks) but not for reticulum cell sarcoma (24 weeks vs. 25 weeks). The duration of remission for patients with little or no prior therapy was compared to that for patients in a similar study in which single agents were used.4 For lymphosarcoma and reticulum cell sarcoma, remissions maintained with COP were longer than remissions maintained with cyclophosphamide. For Hodgkin's disease and lymphosarcoma, unmaintained remissions after COP induction were longer than after single agent induction. All parameters of response, that is, complete remission rate, duration of remission, and survival were adversely affected by major prior treatment with radiotherapy and chemotherapy. The initial response to treatment correlated positively with survival. The survival of patients with lymphosarcoma or reticulum cell sarcoma receiving COP treatment was significantly superior to a comparable group of patients treated sequentially with single agents.