Prognostic factors in stage I and II high and intermediate grade non-Hodgkin's lymphoma

Between 1975 and 1986, the Manchester Lymphoma Group treated 127 patients with localized (Stages I/II) high and intermediate grade non-Hodgkin's lymphoma (NHL) on one of three protocols of combined involved field radiotherapy and chemotherapy. The study included patients with widespread bulky abdominal disease providing there was no apparent spread outside the abdomen and the liver was not involved with metastatic disease. The median duration of follow-up was 70 months. The complete response rate was 86% and the overall 5-year survival was 70%. The 5-year relapse-free survival of the complete responders was 80%. Cox model multivariate analysis showed that bulk disease (greater than 5 cm), low serum albumin and gut involvement were the pretreatment factors associated with shorter survival. When remission status was included in the model the attainment of a complete response was the major determinant of long-term survival but bulk disease and gut involvement were still significant adverse predictors for survival. These factors need to be assessed when analysing results of therapy in NHL and in the design of future treatment strategies.