Chemotherapy as definitive treatment of stage I-II large cell and diffuse mixed lymphomas

Combination chemotherapy with adriamycin-containing regimens is effective in the management of advanced lymphomas. In view of this, we treated 43 patients with clinical stage I-II large cell or diffuse mixed lymphoma with chemotherapy. Routine staging laparotomies were not done and radiotherapy was not used in these patients. The CR rate for the combined stage I-II presentations is 90%. Of 11 patients with stage I presentations, only one has relapsed (at 64 months), and he expired 11 months after the recurrence. Of the 28 patients with stage II presentations who achieved a CR, seven have relapsed but three of these have achieved a second CR and remain in remission. Late relapses were common in this group of stage I-II presentations. Four of eight relapses occurring in patients who achieved disease-free status took place greater than 24 months after initiation of therapy. Chemotherapy alone appears to be adequate for treatment of stage I large cell lymphoma, although larger numbers of patients might be required to definitely make this conclusion. Close to 2/3 of patients with stage II presentations appear to have been cured with the use of chemotherapy alone. The failures occurred mostly in those with bulky disease. It is possible that radiotherapy given after chemotherapy could consolidate these bulky areas of disease and thus prevent local relapses.