***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The purpose of this study was to evaluate the role of interferon as initial and maintenance therapy in patients with newly diagnosed follicular lymphoma . Between 1984 and 1994 , 204 patients with newly diagnosed Stage III or Stage IV follicular lymphoma were r and omized to receive either , Chlorambucil ( CB ) : 10 mg daily for 6 weeks , followed by a 2-week interval , with 3 subsequent 2-week treatment periods at the same dose , separated by 2-week intervals , or , CB given concurrently with interferon ( IFN ) . IFN was given at a dose of 3 × 106units thrice weekly , subcutaneously , throughout the 18-week treatment period . Responding patients were subsequently r and omized to receive maintenance IFN at the dose and schedule described above , or to expectant management . The overall response rate was 161/204 ( 78 % ) , complete remission being achieved in 24 % of patients . Neither the addition of IFN to the initial treatment , nor the use of maintenance IFN influenced response rate , remission duration or survival . This study was undertaken to determine whether IFN , given in combination with , and then subsequent to , CB would alter the clinical course of patients with follicular lymphoma . Disappointingly , this objective was not achieved , no advantage having been demonstrated for the addition of IFN . © 2001 Cancer Research Campaign BACKGROUND Interferon alfa and cytotoxic drugs have synergistic effects in patients with non-Hodgkin 's lymphoma . In 1986 , we design ed a clinical trial to evaluate the benefit of concomitant administration of recombinant interferon alfa with a regimen containing doxorubicin in patients with follicular non-Hodgkin 's lymphoma . METHODS The trial involved 242 patients with advanced low- grade follicular non-Hodgkin 's lymphoma selected on the basis of clinical , radiographic , and biologic criteria . All patients were treated with a regimen consisting of cyclophosphamide , doxorubicin , teniposide , and prednisone ( CHVP ) , given monthly for six cycles and then every two months for one year . After r and omization , 123 patients also received interferon alfa-2b  at a dosage of 5 million units three times weekly for 18 months . The remaining 119 patients received chemotherapy alone . RESULTS As compared with the patients treated with CHVP only , the patients treated with CHVP plus interferon alfa had a higher overall rate of response ( 85 percent vs. 69 percent , P = 0.006 ) , a longer median event-free survival ( 34 months vs. 19 months , P < 0.001 ) , and a higher rate of survival at 3 years ( 86 percent vs. 69 percent , P = 0.02 ) . Granulocyte toxicity was greater in the patients treated with CHVP plus interferon alfa than in those treated with CHVP alone . There were no treatment-related deaths . Interferon alfa had to be stopped because of toxic effects ( fatigue and hepatitis ) in 13 patients ( 11 percent ) . CONCLUSIONS The addition of interferon alfa to a regimen containing doxorubicin increased the rate of response , event-free survival , and overall survival in patients with advanced follicular non-Hodgkin 's lymphoma , without serious toxicity , although some patients were unable to tolerate the side effects Since 1985 the combination of chlorambucil ( 10 mg daily , initially for six weeks , then alternating fortnights for 12 weeks ) and interferon-alpha 2b ( Schering-Plough ; 2 x 10(6 ) U/m2 three times weekly by subcutaneous injection for 18 weeks ) has been compared in a r and omised trial with chlorambucil alone in previously untreated patients with stage III or IV follicular lymphoma . Responding patients have subsequently been r and omised to receive maintenance interferon-alpha 2b or no further treatment .  Of the 124 treated patients , 108 are evaluable for response with a median follow-up of 30 months . The major toxicity was myelosuppression which was more frequent with chlorambucil and IFN alpha 2b in combination than with chlorambucil alone ( P less than 0.01 ) . There was no treatment-related mortality . Actuarial survival at three years is 75 % for all patients , regardless of therapy . There was no significant difference in response rate according to initial therapy . For the 60 patients achieving a good response to initial therapy who have entered the second part of the trial , there has been a significant prolongation of remission duration in favour of maintenance IFN-alpha 2b ( median not yet reached versus two years for the ' no treatment ' arm , P less than 0.015 ) . Fewest relapses have been seen in patients who received IFN-alpha 2b throughout . Accrual to this trial continues ; this preliminary analysis indicates that maintenance IFN-alpha 2b may extend remission duration in follicular lymphoma PURPOSE To compare progression-free survival ( PFS ) , overall survival ( OS ) , and toxicity of a doxorubicin-containing regimen administered alone or in combination with interferon alfa-2b ( IFNalpha ) in patients with low- grade follicular lymphoma ( FL ) and poor prognostic factors . PATIENTS AND METHODS Two hundred sixty-eight patients with advanced-stage FL received cyclophosphamide , doxorubicin , teniposide , and prednisone ( CHVP ) monthly for 6 months , then every 2 months for 12 months . After r and omization , 242 patients were evaluated for efficacy : 119 received CHVP alone , and 123 also received IFNalpha at a dose of 5 million units three times weekly for 18 months . RESULTS After a 6-year median follow-up , the patients treated with CHVP + IFNalpha showed significantly longer median PFS than those who received CHVP alone ( 2.9 years v 1.5 years , respectively ; P = .0002 ) and significantly longer median OS ( not reached v 5.6 years , respectively ; P = .008 ) . Although some side effects , which included neutropenia , asthenia , fever , elevated serum transaminase levels , flu-like symptoms , and thrombocytopenia , were more frequently observed in patients who received the combination regimen , these reactions were moderate . IFNalpha was withdrawn because of toxicity in 10 % of the patients , and a dosage reduction or temporary suspension was required in 28 % . CONCLUSION With long-term follow-up of 6 years , these results confirm that the addition of IFNalpha to a doxorubicin-containing regimen for patients with advanced-stage and clinical ly aggressive FL not only increased PFS , as in most other similar trials , but also prolonged OS . Toxicity was moderate . The beneficial effects of this combined chemotherapy and IFNalpha regimen on OS probably reflect the selection of FL patients with poor prognostic factors The addition of a brief alpha interferon regimen to each CHOP induction cycle , plus one year of alpha interferon thrice weekly maintenance therapy , has no early effect on response rates or survival in patients with Intermediate or High grade cell NHL . Background : The CHOP ( Cyclophosphamide , Adriamycin , Vincristine , Prednisone ) regimen is the most widely used first-line therapy for patients with Intermediate or High Grade ( IG/HG ) non-Hodgkin 's lymphoma ( NHL ) .  Alpha 2b interferon ( INF ) enhances response rates and improves survival in low- grade NHL . The International Oncology Study Group ( IOSG ) conducted a prospect i ve r and omized study comparing CHOP alone or combined with INF in patients with IG/HG-NHL . The primary study aim was to compare the objective response rates in these patient cohorts . Patients and Methods : Patients with a confirmed diagnosis of measurable NHL of International Working Formulation ( IWF ) groups D to H histology were r and omized to receive CHOP alone or CHOP with 5Mu INF SC for 5 days on days 22 to 26 of each 28 day cycle with INF 5 million units ( Mu ) given three times per week sub-cutaneously for 52 weeks in those patients who responded to CHOP plus INF . Results : The overall response rates were equivalent in both groups : CHOP alone ( 214 patients ) 81 % ( complete 55 % , partial 26 % ) ; CHOP plus INF ( 221 patients ) 80 % ( complete 54 % , partial 26 % ) . At 36 months , the actuarial survival rate was equivalent in both groups . Conclusions : There is no apparent early advantage in terms of response or survival conferred by adding the study INF regimen to CHOP therapy for patients with IG/HG-NHL The activity of fludarabine monophosphate ( FLU ) and alpha-interferon ( alpha-IFN ) in low- grade non-Hodgkin 's lymphoma ( LG-NHL ) and B-cell chronic lymphocytic leukemia ( B-CLL ) has been demonstrated in several clinical trials . In a study of 137 previously treated patients , of whom 77 had B-CLL and 60 with LG-NHL , we used FLU as salvage chemotherapy . Dosages of 25 mg/m2 were given in 30-min infusions for 5 consecutive d. Treatment was repeated every 28 d depending on the patient 's clinical status for a maximum of 6 cycles . Entrance to the alpha-IFN maintenance portion of the study depended on patient response to initial FLU . All patients who had obtained a complete or partial response after the FLU therapy were r and omized to receive alpha-IFN or no further therapy . The alpha-IFN dose was 3x10(6 ) units 3 times per wk until disease progression . At 4 yr with a median follow-up of 22 months the percentage of patients with persistent response ranged between 20 % and 30 % among all the responders . Thirty-five ( 45 % ) B-CLL patients achieved major responses ( complete/partial response ) , as did 29 ( 48 % ) of those with LG-NHL . Among the 64 patients who achieved a good response to initial therapy and who have entered the second part of the trial , there has been a rate of prolongation of remission in favour of maintenance alpha-IFN ( p=0.02 ) . FLU therapy is an effective drug inducing remission in pretreated B-CLL and LH-NHL patients . However , as with other therapeutic modalities , remission is rarely maintained beyond 2 yr . So far , maintenance alpha-IFN has not been shown to produce significantly longer remission after treatment with FLU in LG-NHL , and there is no trend towards prolonged remission in B-CLL patients . The role of FLU needs to be further evaluated in the management of lymphoproliferative disorders by introducing it in combination with other drugs ( alpha-IFN ) in the induction phase and in maintenance treatment The past decade has seen the rise of evidence -based medicine , a movement that has focused attention on the importance of using clinical studies for empirical demonstration of the efficacy of medical interventions . Increasingly , physicians are being called on to assess such studies to help them make clinical decisions and underst and the rationale behind recommended practice s. This type of assessment requires an underst and ing of research methods that until recently was not expected of physicians . These research methods include statistical techniques used to assist in drawing conclusions . However , the methods of statistical inference in current use are not evidence -based and thus have contributed to a widespread misperception . The misperception is that absent any consideration of biological plausibility and prior evidence , statistical methods can provide a number that by itself reflects a probability of reaching erroneous conclusions . This belief has damaged the quality of scientific reasoning and discourse , primarily by making it difficult to underst and how the strength of the evidence in a particular study can be related to and combined with the strength of other evidence ( from other laboratory or clinical studies , scientific reasoning , or clinical experience ) . This results in many knowledge cl aims that do not st and the test of time ( 1 , 2 ) . A pair of articles in this issue examines this problem in some depth and proposes a partial solution . In this article , I explore the historical and logical foundations of the dominant school of medical statistics , sometimes referred to as frequentist statistics , which might be described as error-based . I explicate the logical fallacy at the heart of this system and the reason that it maintains such a tenacious hold on the minds of investigators , policymakers , and journal editors . In the second article ( 3 ) , I present an  evidence -based approach  derived from Bayesian statistical methods , an alternative perspective that has been one of the most active areas of biostatistical development during the past 20 years . Bayesian methods have started to make inroads into medical journals ; Annals , for example , has included a section on Bayesian data interpretation in its Information for Authors section since 1 July 1997 . The perspective on Bayesian methods offered here will differ somewhat from that in previous presentations in other medical journals . It will focus not on the controversial use of these methods in measuring belief but rather on how they measure the weight of quantitative evidence . We will see how reporting an index called the Bayes factor ( which in its simplest form is also called a likelihood ratio ) instead of the P value can facilitate the integration of statistical summaries and biological knowledge and lead to a better underst and ing of the role of scientific judgment in the interpretation of medical research . An Example of the Problem A recent r and omized , controlled trial of  hydrocortisone treatment for the chronic fatigue syndrome showed a treatment effect that neared the threshold for statistical significance , P=0.06 ( 4 ) . The discussion section began , hydrocortisone treatment was associated with an improvement in symptoms This is the first such study to demonstrate improvement with a drug treatment of [ the chronic fat 
    Output:
    
There is evidence that addition of IFN as maintenance therapy for FL improves progression-free survival .
A net benefit for overall survival is less evident .
In the included studies , IFN was associated with significant toxicities that may have a major impact on a patient 's quality of life