Risk factors in intermediate and high grade non-hodgkin's lymphomas of adults: a need for a new staging system

ABSTRACT

This study included 120 adult patients of intermediate and grade non- Hodgkin's lymphoma [NLH] in clinical stages II, III and IV. They were treated at Kasr-El-Aini Center of Oncology Nuclear Medicine [NEMROCK] during the period 1984-1987 inclusive. All patients were prospectively treated using 4 different chemotherapy regimens MEVP [31 patients], COPP/M [23 patients], COPP/A-V [26 patients] and CHOP [40 patients]. The clinical characteristics and prognostic factors in the four groups were comparable. Fifty% [59 patients] of the whole study group attained complete remission [CR]. The highest CR was achieved with CHOP regimen [58%] and the lowest was with MEVP [39%], the difference was statistically insignificant [P > 0.05]. One third of CR relapsed during the follow-up period and two thirds remained disease free for a median of 5 years and a range of 2 to 6 years. Eleven possible risk factors were teated for their correlation with survival. Five factors were tested for their correlation with survival. Five factors were identified to affect survival significantly. When these five factors were subjected to stepwise regression analysis, only the quality of initial response and performance to status sustained their prognostic significance. These factors were used to classify patients into three risk groups [low, intermediate, and high], the 5-year survival were 79%, 36%, 17% respectively. When Ann-Arbor staging system was used, no significant difference in 5 years survival was detected between stages II, III, and IV. The significance of Ann-Arbor staging system as a prognostic indictor is questioned in G2, G3 NHL. A new staging system is proposed