EORTC Lymphoma Group experience

Of the nine randomized trials that the EORTC Lymphoma Group has conducted since 1964, five were selected that have tested modern therapies and provided similar results in term of event-free survival with treatment failure, progression, relapse, and death considered as events.15-17'26'32 Overall, 3141 cases were available including 347 (11%) cases with advanced stage disease and low IPI score (0-2 adverse factors present). The distributions of the clinical and biological patient characteristics were similar within the five series except for bulky disease and the number of nodal areas involved that were significantly more often present among stage III-IV cases. Factors considered in the multivariate analysis included age, gender, topography, clinical stage, mediastinal involvement, bulky disease, B symptoms, erythrocyte sedimentation rate, leukocyte count, neutrophil count, hemoglobin, and histologic subtype. In the final model performed on 2775 cases with all information available, four factors remained significant after stratification on treatment type: age more than or equal to 50 years, male gender, B symptoms, and neutrophil count more than or equal to 8000/mm3. The corresponding coefficients ranged between 1.30 and 1.52, and a score was derived that considered the number of adverse factors present, i.e., 0-4. There were 23% of cases with no adverse factor, 45% with one factor, 25% with two factors, and 7% with three or four factors. The proportion of cases with three to four adverse factors was less than 1% in cases with early stage favorable prognostic features (1090 cases) according to the EORTC scoring system (Table 70.2), 12% in cases with early stage unfavorable prognostic features (1366 cases), and 11% in those with advanced stage and low IPI score (319 cases). While the progression-free survival curves of cases with zero, one, or two adverse factors did not significantly differ, that of cases with three to four factors was significantly lower. The 8-year progression-free survival rates were 86, 83, 80, and 68% in the four groups, respectively (P < 0.001) (unpublished data).

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