Risk factors in intermediate and high-grade non-Hodgkin's lymphomas of adults: a need for a new staging system

This study included 120 adult patients of intermediate and high-grade non-Hodgkin's lymphoma (NHL) in clinical stages II, III and IV. They were treated at Kasr El-Aini Center of Oncology and Nuclear Medicine (NEMROCK) during the period 1984-1987, inclusive. All patients were prospectively treated using four different chemotherapy regimens: MEVP (31 patients), COPP/M (23 patients), COPP/A-V (26 patients) and CHOP (40 patients). The clinical characteristics and prognostic factors in the four groups were comparable. Fifty percent (59 patients) of the whole study group attained complete remission (CR). The highest CR was achieved with the CHOP regimen (58%) and the lowest was with MEVP (39%); the difference was statistically insignificant (p greater than 0.05). One third of CR relapsed during the follow-up period and two thirds remained disease-free for a median of 5 years and a range of 2 to 6 years. Eleven possible risk factors were tested for their correlation with survival. Five factors were identified as affecting survival significantly. When these five factors were subjected to stepwise regression analysis, only the quality of initial response and performance status sustained their prognostic significance. These factors were used to classify patients into three risk groups (low, intermediate, and high); the 5-year survivals were 79%, 36%, 17% respectively. When the Ann-Arbor staging system was used, no significant difference in 5-year survival was detected between stages II, III, and IV. The significance of the Ann-Arbor staging system as a prognostic indicator is questioned in G2 and G3 NHL. A new staging system is proposed.