Major Prognostic Factors of Adult Patients with Advanced B-Cell Lymphoma Treated with Vincristine, Cyclophosphamide, Prednisone and Doxorubicin (VEPA) or VEPA plus Methotrexate (VEPA-M)

Eighty-two adult patients with advanced B-lymphoma, treatedbetween 1981 and 1983 with VEPA (vincristine, cyclophosphamide,prednisolone and doxorubicin) or VEPA-M (VEPA plus methotrexate)in a prospective randomized fashion, were evaluated for pretreatmentcharacteristics. The overall complete response (CR) and the4-year survival rates were 74% and 45%, respectively. The relapserate was 51%. Stage of disease only was negatively associatedwith the CR rate in a multivariate analysis. The primary extranodaltumor site other than upper gastrointestinal (GI) tract andhigh grade pathology were found to affect disease-free survivaladversely in a Cox proportional hazards model. Poor performancestatus, advanced stage, primary extranodal tumor site otherthan upper GI tract, advanced age, high grade pathology andprior therapy by either surgery or radiation, were significantlyassociated with shortened survival in a Cox proportional hazardsmodel. These results indicate advanced B-lymphoma in Japan tobe generally similar to advanced non-Hodgkin's lymphoma in theWest in terms of prognostic factor characteristics, but theimportance of the primary site in predicting survival has notbeen reported in the West. Also, the lack of a survival plateauin patients with diffuse large cell lymphoma indicates moreintensive chemotherapy regimens than VEPA or VEPA-M to be needed.It was also found that the significant prognostic factors inpatients with advanced B-lymphoma were very different from thosewith T-lymphoma. The five factors: pathology, stage, primarysite, age, prior therapy by surgery or radiation, for whichthe risk ratio was more than 2.3, were used to construct a modelcontaining 23 categories of patients running an increasing riskof shortened survival; this divided patients into three groups.The CR and 4-year survival rates of low-, moderate- and high-riskgroups were 90% and 74%, 74% and 58%, and 50% and 5%, respectively.The risk-grouping provides indications for determining optimaltherapy for individual patients and the need for new therapeutictrials in patients at high risk.