Investigation of the additive potential of teniposide and vincristine in non-Hodgkin's lymphoma. Australian and New Zealand Lymphoma Group.

Two hundred forty-seven patients with non-Hodgkin's lymphoma were randomized to receive doxorubicin, cyclophosphamide, and prednisolone in combination with vincristine (ACVP) or teniposide (ACTP) or both vincristine and teniposide (ACTVP). ACVP produced 44% complete remissions (CRs) and 32% partial remissions (PRs), whereas ACTP produced 46% CRs and 33% PRs and ACTVP produced 47% CRs and 36% PRs. Survival and relapse-free survival were also comparable for the three arms. The majority (59%) of patients had diffuse large cell lymphoma. Within this group, CR was achieved in 52% and no significant difference was observed in the response rates, survival, or relapse-free survival for the three treatment arms. Toxic effects occurred with equivalent frequency in the three regimens, except for neurotoxicity and myelosuppression. Moderate to severe neurotoxicity occurred in 20% of ACTVP-treated patients and in 8% of ACVP-treated patients but was not seen in any of the ACTP-treated patients (P = 0.0004). Severe myelosuppression occurred in 27% of ACTVP-treated patients and in 22% of ACTP-treated patients but only in 8% of ACVP-treated patients (P = 0.02), indicating an increased risk of myelosuppression for the combinations including teniposide. These results confirm our previous findings that teniposide can replace vincristine in the treatment of non-Hodgkin's lymphoma, with freedom from neurotoxicity and comparable survival and response rates. However, the combined use of teniposide and vincristine in the schedule as described has not increased response rates or survival but has instead added to neurotoxicity.