Long-term results of combined chemotherapy-radiotherapy approach in Hodgkin's disease: superiority of ABVD plus radiotherapy versus MOPP plus radiotherapy.

Abstract

In an attempt to reduce some of the delayed sequelae associated with combined modality therapy in Hodgkin's disease, we randomly tested stages IIB, IIIA, and IIIB MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) v ABVD (Adriamycin, bleomycin, vinblastine, and dacarbazine). In 232 previously untreated patients, three cycles of either combination preceded and followed extensive irradiation. The complete remission rate was 80.7% following MOPP and 92.4% following ABVD (P less than .02). The 7-year results indicated that ABVD was superior to MOPP in terms of freedom from progression (80.8% v 62.8%; P less than .002), relapse-free survival (87.7% v 77.2%; P = .06), and overall survival (77.4% v 67.9%; P = .03). Moreover, the comparative iatrogenic morbidity showed that irreversible gonadal dysfunction as well as acute leukemia occurred only in patients subjected to MOPP, while cardiopulmonary studies failed to document significant laboratory differences between the two treatment groups. Present findings indicate that ABVD followed by extensive irradiation represents a valid therapeutic alternative to the widely used alkylating agent-containing regimens plus radiotherapy.

VIP (etoposide, ifosfamide and cisplatinum) as a salvage intensification program in relapsed or refractory Hodgkin’s disease

“…1-5 Despite optimal initial treatment, 20-50% of patients fail to enter remission or will relapse after achieving a complete response. [1][2][3][4][5][6][7] It has long been stated that patients who relapse after a first remission can be divided into two groups according to the length of their first remission. When patients relapse more than 1 year after the end of their first-line therapy, as many as 85% of them achieve a second complete remission when the same drug combination is used.…”

Hodgkin's Disease

“…Retrospective analyses have reported that combination therapy yields better relapse-free survival and overall survival than does chemotherapy alone (15,62,(70)(71)(72)(73). It is difficult to compare the results from chemotherapy alone with results from combination therapy since the composition of patient data varies from study to study.…”

Classical Hodgkin's lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up

“…In addition, RT (30)(31)(32)(33)(34)(35)(36) to residual nodal disease may be recommended in patients with a very good partial response after first-line chemotherapy with ABVD, Stanford V or BEACOPP regimens for advanced disease, and in patients with residual disease after salvage therapy with ASCT. In primary refractory disease, RT may have only a palliative role.…”

“…51 The 25-year updated results of MOPP regimens indicate a cure rate of about 50%. 52 After the introduction of the ABVD chemotherapy, a randomized study 33 demonstrated that MOPP+RT+MOPP was inferior to ABVD+RT+ABVD and two randomized studies 34,35 that MOPP alone was inferior in terms of failure free survival compared to the alternating use of MOPP and ABVD. The alternating MOPP and ABVD approach has therefore become the standard of therapy; randomized trials failed to demonstrate any difference between the alternating and the hybrid modality.…”

“…To reach their conclusions, the experts have analyzed the results of randomized clinical trials, either as full papers [33][34][35][36][37][38][39][40][41][42][43][44][45] or abstracts, [46][47][48] and of meta-analyses of randomized clinical trials. 49,50 Evidence for the efficacy of chemotherapy to cure advanced Hodgkin's lymphoma has derived from studies initiated more than 35 years ago, with the introduction into the clinical practice of MOPP (mechlorethamine, vincristine, procarbazine, prednisone) chemotherapy.…”