Dipartimento di Oncologia, Azienda Ospedaliera Santo Spirito, Pescara, Italy.
At present we report the results of a prospective, non-randomized open trial,
conducted on follicular lymphoma (FL) patients by the Gruppo Italiano per lo
Studio dei Linfomi (GISL), after a median follow-up of 62.6 months.
Seventy-three patients with FL were registered to the study and treated with
combination chemotherapy consisting of cyclophosphamide, epidoxorubicin,
vincristine, bleomycin and prednisone, weekly administered every 4 weeks. After
chemotherapy, involved-field radiotherapy was delivered in case of either
localized, bulky and extranodal disease at presentation or limited residual
disease at the end of chemotherapy. Patient received four or eight chemotherapy
courses in case of localized or advanced disease, respectively. The overall
response rate at the end of the treatment program was 97.3%, with 78.1% CR and
19.2% PR. CR rate was 94.3 and 63.1% in stage I-II and III-IV, respectively (p =
0.006). Beside the stage, response rate was significantly influenced by bone
marrow involvement, and the number of extranodal sites. Relapse free survival
was 60.8% at 5 years in the whole series; in localized disease it was 70.3 vs.
44.8% in advanced disease (p = 0.044). Relapse free survival was significantly
influenced by stage, bone marrow involvement, number of extranodal sites and
International Prognostic Index (IPI) score. The overall 5-year survival rate was
90.2%; being 95.6% for patients with stage I-II and 85.1% for those III-IV (p =
0.0133). In addition, both IPI and Italian Lymphoma Intergroup (ILI) score had a
significant impact on survival. The toxicity profile of the treatment was
acceptable. From the results of this prospective study it is possible to
conclude that this regimen and the whole treatment program is effective as first
line therapy for the general population of FL. In particular the BACOP schedule
is a valid anthracycline-containing regimen, and in this respect suitable to be
considered as a treatment option.