Comparison of different treatment strategies for diffuse large-cell lymphomas: a decision analysis

There are more than 20 drug combinations in use for the treatment of diffuse large-cell non-Hodgkin's lymphoma (NHL). New treatments have been developed without prior comparison in clinical trials. The authors devised a Markov-process model to compare the efficacy of a first-generation combination chemotherapy regimen (CHOP) with that of a third-generation regimen (MACOP-B) using currently available data. For a typical 57-year-old male patient, life expectancy with MACOP-B was 12.1 years, compared with 8.3 years with CHOP. The remission rate after initial treatment and the functional status after the first remission is achieved were the most important determinants of life expectancy. It was still possible for CHOP to become better strategy provided that the initial remission rate with MACOP-B were lower than 50% or that functional status after remission was achieved were less than 66%. The analysis suggests that the most effective therapeutic regimen for diffuse large-cell lymphoma must not only result in a high remission rate but also cause minimal late sequelae. These two parameters were incorporated into the nomogram, which can serve as a basis for comparison of the efficacy of any chemotherapeutic regimen in non-Hodgkin's lymphoma.