The effect of intensive intermittent maintenance therapy in advanced low-grade non-Hodgkin's lymphoma

One hundred and eleven patients with low-grade histology non-Hodgkin's lymphoma achieving a restaged complete response to one of three induction therapies on Eastern Cooperative Oncology Group (ECOG) protocol EST 2474 were randomized to receive either maintenance treatment with BCNU, cyclophosphamide, vincristine, and prednisone (BCVP) given every 6 weeks for an additional 18 months or no further therapy. Overall toxicity was moderate. The median progression-free survival (PFS) on maintenance therapy was 3.2 years versus 2.0 years for those observed without treatment (P = 0.02). Progression-free survival was significantly shorter for patients with nodular and diffuse pattern (ND), histiocytic or mixed histology compared with pure nodular lymphocytic, or poorly differentiated counterpart (P = 0.0007), thus confirming the prognostic significance of histologic subtypes. However, the overall survival of patients was not improved by maintenance treatment, suggesting that therapy upon relapse was an equally effective alternative clinical strategy.