Final Results of Cooperative Study of VEPA [Vincristine, Cyclophosphamide (Endoxan), Prednisolone and Adriamycin] Therapy in Advanced Adult Non-Hodgkin's Lymphoma: Relation Between T- or B-Cell Phenotype and Response

One hundred previously untreated adult patients with advancednon-Hodgkin's lymphomas were treated with VEPA (vincristine,cyclophosphamide, prednisolone and adriamycin in combination)therapy. The overall complete remission rate was 52%. The completeremission rate was markedly higher in the patients with lineage-undeterminedlymphomas (72.2%) as well as in the patients with B(non-T)-celllymphomas (58.5%) than in the patients with T-cell lymphomas(36.6%). The median duration of complete remission has not beenreached for lineage-undetermined lymphomas and most (77%) ofthe patients have been in remission for more than 2-yr, whilethe median duration of complete remission for B(non-T)-celltype was 16 mo with a 3-yr remission rate of 14%, and medianduration for the T-cell type was only 4 mo with a 2-yr remissionrate of 15% or less. Both complete remission and cell lineageof lymphomas markedly affected the survival period. Of the patientswho were not induced into complete remission, about 90% diedwithin 12 mo regardless of the cell lineage of the lymphoma,and their median survival was only 5–7 mo. On the otherhand, more than 90% of the patients with lineage-undeterminedlymphomas who were induced into complete remission are stillalive after 36 mo. Median survival was 37 mo and the 3-yr survivalrate was 56.1% in the case of B(non-T)-cell lymphoma with completeremission. Even in the T-cell lymphomas, significantly (a fewmonths) longer survival time will be expected in the patientsin complete remission. These facts indicate that complete remissioninduced by VEPA therapy contributes greatly to longer survivalof the patients, but its contribution is limited by the celllineage of the lymphoma. B(non-T)-cell lymphoma as well as lineage-undeterminedlymphoma responded well to VEPA therapy and some of the patientsmay be cured. On the other hand, T-cell lymphoma responded poorlyto VEPA therapy.