Randomized trial with two CHOP-B regimens (with doxorubicin or epirubicin) in poor prognosis non-Hodgkin's lymphomas

A randomized trial of doxorubicin (Adriamycin) or epirubicin on 31 patients with non-Hodgkin's lymphomas, all previously untreated with chemotherapy and all with unfavourable histology and/or bulky disease and/or systemic symptoms, is presented. They were randomly assigned to combination chemotherapy, either CHOP-B regimen (15 patients) with doxorubicin 50 mg/m² or CHOP-B regimen (12 patients) with epirubicin 50-60 mg/m² replacing the doxorubicin. Four patients, two from each regimen had only one cycle of therapy and were therefore excluded, not all withdrawals being due to side-effects of the chemotherapy. They were all given three cycles of chemotherapy, one every 21 days, followed by radiation therapy on involved fields and three additional cycles of chemotherapy. In Stages III-IV the patients were treated with chemotherapy until complete response was obtained, then a further two cycles of chemotherapy. Complete remission was seen in 10/15 (67%) of patients on CHOP-B (i.e. with doxorubicin) and in 17/12 (58%) of those on CEOP-B (i.e. with epirubicin). Details are tabulated of results at Stages I and II and at Stages III and IV. Because of the small number of patients in this study, no definite conclusions can be drawn. Toxicity generally was lower in the group with epirubicin than with doxorubicin. No conclusions are drawn about the lower cardiotoxicity of the epirubicin group (CEOP-B), but in view of their lower haematological toxicity it is suggested that an increased dosage of epirubicin may be considered.