CHEOP (Chop + Etoposide): the New Standard Regimen for Younger Patients with Low Risk (Low LDH) Aggressive Non-Hodgkin's Lymphoma (NHL)

Reviewer: Walter F. Sall, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: December 10, 2001

Presenter: Michael G. Pfreundlschuh
Presenter's Affiliation:
Type of Session: Scientific


  • Low Risk (normal LDH)aggressive NHL has classically been treated with CHOP chemotherapy given on a 21 day dosing schedule.
  • The objective of this trial was to investigate the use of shorter 14 day treatment intervals with or without the addition of Etoposide in an attempt to improve treatment outcome.
  • This is an interim analysis of the German NHL B-1 trial.

    Materials and Methods

  • 860 patients enrolled from 1994-2000. 659 were evaluable for this interim analysis. median age was 48. 31% has stage 3/4 disease.
  • 36% had bulky disease and received 36Gy to these areas
  • Patients randomized to one of four arms: 6 cycles each of: 21 day CHOP, 14 day CHOP, 6 day CHEOP or 14 day CHEOP. Relative dose intensity was > 95% for all arms.
  • Primary end point was time to treatment failure.


  • CR rate was 89.3% in both CHEOP arms vs. 83.9% in both CHOP arms. Better time to treatment failure was also seen in both CHEOP arms vs. CHOP.
  • There was no difference in CR rates between the 2-weekly and 3-weekly regimens.
  • The addition of etoposide appeared to compensate for the presence of one adverse prognostic factor.
  • No overall survival benefit has yet been demonstrated for any arm.
  • There was no significant difference in Grade 3/4 toxicities among the treatment groups. No increase in secondary malignancies were seen with the addition of etoposide. Etoposide receiving patients did require significantly more transfusions.

    Author's Conclusions

  • In low risk, aggressive NHL, the addition of etoposide to CHOP significantly improves results as measured by response rates and time to treatment failure.
  • Reduction of time interval between treatment courses from 3 to 2 weeks has no impact on outcome.
  • The authors now consider CHEOP-21 the new standard of care for this subtype of NHL in young patients.

    Clinical/Scientific Implications
    This interim analysis shows early data supporting the addition of etoposide to CHOP chemotherapy for the treatment of low risk, aggressive NHL. As no survival benefit has yet been demonstrated, futher patient follow-up is required before the true benefits of this regimen become known. The possible equivalent benefit, potentially with lower toxicity, of the addition of Rituxumab to CHOP chemotherapy in this population also needs to be studied and currently is being evaluated in several randomized trials.

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