Comparison of a Second-Generation Combination Chemotherapeutic Regimen (m-BACOD) with a Standard Regimen (CHOP) for Advanced Diffuse Non-Hodgkin's Lymphoma

Leo I. Gordon*, David Harrington, Janet Andersen, Joseph Colgan, John Glick, Richard Neiman, Risa Mann, Gene D. Resnick, Maurice Barcos, Arlan Gottlieb, Michael O'connell

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

318 Scopus citations


In 1984, the Eastern Cooperative Oncology Group began a randomized controlled clinical trial of patients with advanced (stage III or IV) diffuse mixed or diffuse large-cell lymphoma to determine whether complete-remission rates, survival, and toxicity differed when patients were treated with a chemotherapeutic regimen containing cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), as compared with a regimen containing bleomycin, doxorubicin, cyclophosphamide, vincristine, dexamethasone, methotrexate, and leucovorin (m-BACOD). From July 1984 through January 1988, 392 patients were enrolled, 325 of whom (83 percent) were eligible for the analysis and capable of being evaluated. The extent of disease was defined according to standard staging techniques, including bilateral bone-core biopsies in 88 percent of patients. Randomization was stratified according to age (<60 or ≤60 years), performance status (0, 1, or other), stage (III or IV), and histologic presentation (diffuse mixed or diffuse large-cell lymphoma). After a median follow-up of four years, there were no significant differences in rates of complete remission, time to treatment failure, disease-free survival, or overall survival in the patients treated with CHOP as compared with those treated with m-BACOD. However, there was more severe and life-threatening pulmonary, infectious, and hematologic toxicity associated with the m-BACOD regimen. In an attempt to measure the importance of dose intensity in the 325 patients who could be analyzed, we retrospectively calculated dose intensity (measured in milligrams per square meter of body-surface area per week) and normalized dose intensity (defined as a percentage of the prescribed dose) for all drugs. The median normalized dose intensity for both cyclophosphamide and doxorubicin was found to be greater in the patients treated with CHOP than in those treated with m-BACOD. For patients with stage III or IV diffuse mixed or diffuse large-cell lymphoma, CHOP is superior to m-BACOD, but the role of dose intensity is not yet clear. (N Engl J Med 1992;327:1342–9.), THERE has been considerable improvement in outcome among patients with diffuse large-cell and diffuse mixed lymphomas as a result of new regimens of combination chemotherapy.1 Such regimens result in complete remission in 40 to 80 percent of patients and are associated with long-term survival and possibly cure in half of all patients treated.1 For patients with clinical stage III or IV disease who have been treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), data compiled by Coltman et al. after a median follow-up of more than six years indicate that up to 32 percent of patients are now disease-free and…

Original languageEnglish (US)
Pages (from-to)1342-1349
Number of pages8
JournalNew England Journal of Medicine
Issue number19
StatePublished - Nov 5 1992

ASJC Scopus subject areas

  • Medicine(all)


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