This study was designed twelve years ago to compare the efficacy and the long-term survival of two very different therapeutic approaches towards previously untreated patients with indolent lymphoma: observation or delayed therapy (watch and wait) vs. initial intensive combination chemotherapy with ProMACE/MOPP flexitherapy to complete remission, followed by consolidative modified total nodal irradiation. To date there are no significant differences in disease-free survival or overall survival, although there are differences in complete response rates between the two randomized groups with 76% of patients randomized to intensive therapy achieving a complete response compared to a CR rate of 37% in those treated after a period of observation. The median follow-up time is eight years, shorter than the median survival (10 years) of patients with these diagnoses. Continued follow-up may show a benefit for a subset of patients. Longer follow-up is necessary to determine if there is a survival difference between the different treatment approaches. Patients randomized to the WW arm will continue to be crossed over and treated per protocol.
