A randomised study comparing weekly alternating chemotherapy with three-weekly chemotherapy in advanced high grade non-Hodgkins lymphoma

INTERVENTION: 1. Regimen CAPOMET: Combination chemotherapy with CAPOMET (cyclophosphamide, adriamycin, prednisolone, vincristine, methotrexate and etoposide). A weekly regimen repeated every 4 weeks with the more myelotoxic combinations cyclophosphamide and adriamycin, methotrexate and etoposide alternating with the more marrow sparing combination prednisolone and vincristine, but ending with cyclophosphamide and adriamycin. Chemotherapy should be continued until complete remission plus 8 weeks with a minimum of 12 weeks of treatment. 2. Regimen CHOP‐Methotrexate: Three weekly cycle of combination chemotherapy, CHOP‐methotrexate (cyclophosphamide, adriamycin, prednisolone, vincristine and methotrexate) repeated until complete remission plus three cycles for a minimum of five cycles. CONDITION: Lymphoma (non‐Hodgkins) ; Cancer ; Lymphoma (non‐Hodgkins) PRIMARY OUTCOME: Not provided at time of registration SECONDARY OUTCOME: Not provided at time of registration INCLUSION CRITERIA: 1. High grade pathology, malignant lymphoma classified as: Centroblastic; Lymphoblastic; Immunoblastic; True histocytic; High grade unclassified 2. Advanced (stage III or IV, extensive abdominal or otherwise bulky stage II disease) 3. No specific age limit but considered able to tolerate either treatment regimen 4. No previous radiotherapy, chemotherapy or immunotherapy 5. No previous malignancy, except adequately treated basal cell carcinoma or in‐situ carcinoma of cervix 6. No serious medical or psychological condition precluding adequate treatment 7. Able to tolerate daily fluid intake of at least 2 litres 8. Ability of participating clinician to support patients with severe marrow hypoplasia