MOPP chemotherapy plus irradiation for Hodgkin's disease, stages IA TO IIIB. Long‐term results of the prospective trial H72 (1972–1976, 334 patients)

Abstract

From April 1972 to December 1976, 334 patients with Hodgkin's disease, CS IA-IIIB, were prospectively treated with combined chemotherapy and radiation. The 166 stages IA and II2A were clinically staged only; the 168 other patients were randomized to clinical or pathological staging. All patients received 3 or 6 cycles of MOPP followed by Mantle field with or without mediastinal irradiation and/or inverted Y or lumbo-aortic field according to initial stage, presentation and protocol. At completion of therapy, 317 patients were in complete remission. Twenty-six patients relapsed and 43 died including 5 with leukemia and 6 with infection. Overall 12-year survival and relapse-free rates are 86.6 +/- 3.08 per cent and 91.5 +/- 3.2 per cent respectively (IA: 95.3 and 95.3 per cent; IIA: 87.8 and 92.1 per cent; IIIA: 83.3 and 100 per cent; IB, IIB: 81.7 and 89.2 per cent; IIIB: 67.8 and 73.7 per cent). The randomized comparison between clinical staging plus 6 cycles of MOPP and laparotomy staging plus 3 cycles of MOPP in final stage II3+A, IB, IIB patients showed no significant 12-year survival differences (90.8 versus 85.6 per cent). With this combined modality treatment policy, high survival rates are obtained using only 3 cycles of MOPP and radiotherapy in CS IA, II2A and in PS II3+, IB, IIB. Laparotomy staging may be unnecessary if 6 cycles of MOPP are employed before irradiation in CS IIA, IB, IIB disease and if 3 cycles of MOPP are followed by irradiation in CSIA and II2A disease. Mediastinal irradiation can be avoided in patients with supradiaphragmatic disease without mediastinal involvement.

POG 8625: A Randomized Trial Comparing Chemotherapy With Chemoradiotherapy for Children and Adolescents With Stages I, IIA, IIIA1 Hodgkin Disease

“…Although, the response of early-stage HD to conventional combined modality therapy had been excellent, [27][28][29][30][31][32] concerns over late effects of therapy on young growing children resulted in efforts to design treatment programs for children and adolescents with HD that would reduce toxicity without jeopardizing response rate and survival. The first step taken by pediatric oncologists to limit toxicity was to reduce the amount of radiation by increased reliance on effective chemotherapy.…”

Comparison of initial characteristics and long-term outcome of patients with lymphocyte-predominant Hodgkin lymphoma and classical Hodgkin lymphoma at clinical stages IA and IIA prospectively treated by brief anthracycline-based chemotherapies plus extended high-dose irradiation

“…14 This is also seemingly possible in early cHL after brief CT; although the disease was initially present at staging laparotomy in 30% to 40% of the patients with supradiaphragmatic disease, 31 the rate of infradiaphragmatic relapse was only 5.1% in this group of patients after 3 cycles of MOPP (mechlorethamine, vincristine, procarbazine, prednisone) plus supradiaphragmatic RT alone. 32 On the other hand, because by definition patients with LPHL express the CD20 marker on their malignant cell population, the use of a therapeutic anti-CD20 monoclonal antibody such as rituximab is a legitimate option. Its efficacy alone or in combination with ABVD has started to be evaluated in small groups of patients with LPHL.…”

Hodgkin's Disease

“…Seventy-five percent of these patients had relapsed within 5 years, and therefore chemotherapy is recommended in these patients (16). Other studies draw similar conclusions (8,24,25). A non-randomized study from Stanford argues that TNI yields similar results with combination therapy in patients with moderate, general symptoms who demonstrate no other unfavorable signs (26).…”

“…Likewise, another meta-analysis of 22 studies involving slightly more than 2000 patients could not show clearly better survival for combination therapy compared to radiotherapy alone (34). Several authors argue that when combination therapy is used, fewer chemotherapy cycles than the conventional number are required (25,32). It has also been shown that the extent of irradiation can be reduced and less toxic cytostatic regimens can be used in combination therapy without negatively affecting the results (35).…”