Malignant lymphoma. II Prognostic factors and response to treatment of 473 patients at the National Cancer Institute

Abstract

Treatment results were reviewed in 473 consecutively staged and treated patients at the National Cancer Institute over a 22-year period from 1953 to 1975. Responses correlated with histologic pattern and stage of disease. Complete responses to radiotherapy were frequent in CS I (86%) or PS I (91%). CS II (70%) or PS II (69%) nodular lymphoma patients. Similar treatment regimens were less effective in diffuse lymphoma patients, CS I (53%) or PS I (57%) and CS II (50%) or PS II (51%). Using chemotherapy or combined modality approaches, complete responses were obtained in a high proportion of advanced nodular disease patients, CS III (51%) or PS (59%), CS IV (44%), or PS IV (46%). With the introduction of combination chemotherapy and/or modern radiotherapeutic techniques, 52% CS III and 63% PS III, and 47% CS IV and 46% PS IV patients achieved a complete response. Patients with nodular lymphoma tend to have higher complete response rates and longer survivals than their counterparts with diffuse histologic types (P less than 0.05). Patients with nodular lymphocytic lymphoma had a better survival than those with mixed or "histiocytic" histologic types (P less than 0.03). Patients with diffuse well differentiated lymphocytic lymphoma survived significantly longer than patients with other diffuse histologic types (P less than 0.05). Percentage and prominence of nodularity were not of prognostic significance in those patients with combined nodular and diffuse patterns of disease. When compared by histologic type, patient sex did not appear to be an important prognostic factor. The presence of B-symptoms was associated with a poorer survival in patients with nodular disease (P less than 0.05) and in patients with diffuse disease (P less than 0.001). Over the years of this study, survival appears to have improved in each histologic subtype except DPDL.