Abstract
to the editor: Reyes and colleagues (March 24 issue) 1 should elaborate on the disadvantages, particularly the long-term side effects, of a regimen of doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (ACVBP) in comparison with a regimen of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). With an increased duration of parenteral chemotherapy (20, rather than 3, days), ACVBP has a complicated schedule and thus poses a compliance problem in nonresearch settings. Furthermore, in many centers, patients need hospitalization to ensure hydration during high-dose methotrexate therapy. ACVBP also causes more mucositis, neutropenia, and thrombocytopenia than does CHOP, and it increases the risk of myelodysplasia and leukemia. 2,3 Generally, treatment with etoposide plus repetitive administration of high-dose alkylating agents is strongly leukemogenic, 4 and a 20-year follow-up showed an increase in the incidence of myelodysplasia. 3
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