Select Excerpts from the Interview*

CD 2, Track 9

DR LOVE: What’s your usual approach to initial treatment of aggressive lymphoma in younger patients?

DR COIFFIER: Currently, for a young patient with aggressive lymphoma, we don’t use R-CHOP, we use a more advanced chemotherapy called ACVBP.

The ACVBP regimen is complicated (3.1). That’s one of the reasons it’s not really utilized in the United States. The regimen has two parts: One part consists of dose-dense, dose-intense CHOP, using higher doses of cyclophosphamide and doxorubicin given every two weeks for three or four cycles according to the treatment setting. This is followed by sequential consolidation chemotherapy, which consists of several agents — first methotrexate, then ifosfamide, etoposide and cytarabine — every two weeks for four months. The total length of treatment is six months.

DR LOVE: Would you review the study of ACVBP versus CHOP that was recently published in The New England Journal of Medicine?

DR COIFFIER: That study included patients with localized lymphoma, but there are other studies of ACVBP in different patient populations.

The objective of our study was to demonstrate whether dose-intense chemotherapy was better than the standard three-weekly CHOP followed by radiation therapy. Patients in one arm received three cycles of CHOP followed by involved-field radiation therapy. In the other arm, patients received ACVBP and sequential consolidation chemotherapy without radiation therapy.

ACVBP with sequential consolidation chemotherapy was better than CHOP with radiation therapy in the intent-to-treat population (3.2). If you look at the data for patients without a large tumor mass, ACVBP was also better. We have previously published similar findings in Blood (Tilly 2003), in which we evaluated Stage III and IV patients and compared ACVBP to eight cycles of CHOP.

The study was initiated before the availability of rituximab. At the time, ACVBP was better than eight cycles of CHOP. We now know that R-CHOP is much better than CHOP, so the question is, Is R-ACVBP the same or better than R-CHOP? We are currently investigating this question, but we do not have the results.

CD 2, Track 13

DR LOVE: How do you approach patients with follicular lymphoma?

DR COIFFIER: I first evaluate the criteria for requiring treatment. I use criteria that are nearly the same everywhere for high tumor burden. If the patient does not have any of those criteria, I do nothing (watch and wait). If the patient has one criterion, he or she needs to be treated. In that case, I usually propose R-CHOP. I think there’s some benefit in adding doxorubicin. If you compare the different studies, I think R-CHOP was better than R-CVP, and the duration of the response is better. So I prefer to use R-CHOP in patients up to 70 years of age. After that, R-CVP may be good treatment. If the patient shows a good response, but not a complete response — that is, persisting low involvement in any case — I do maintenance therapy with rituximab.

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* Conducted on May 16, 2005