Analysis of long-term results and prognostic factors among 138 patients with advanced Hodgkin's disease treated with the alternating MOPP/ABVD chemotherapy

PURPOSE This study analyzed long-term results in patients with Hodgkin's disease who were resistant to or relapsed after first-line treatment with MOPP and ABVD. Response to salvage treatments and prognostic factors were also evaluated. PATIENTS AND METHODS The study population included 115 refractory or relapsed patients among a total of 415 patients treated with alternating or hybrid MOPP-ABVD followed by radiotherapy (25 to 30 Gy) to initial bulky sites. The median follow-up duration of the present series was 91 months. Thirty-nine of 115 patients (34%) showed disease progression while on primary treatment (induction failures); 48 relapsed after complete remissions that lasted < or = 12 months and 28 after complete remission that lasted more than 12 months from the end of all treatments. RESULTS At 8 years, the overall survival rate was 27%, being 54% and 28% in patients whose initial complete remission was longer or shorter than 12 months, respectively, and 8% in induction failures (P < .001). Response to first-line chemotherapy and disease extent at first progression significantly influenced long-term results, as well as the incidence and duration of complete remission. CONCLUSION The present data confirm previous observations that showed the main prognostic factors to influence outcome after salvage treatment are response duration to first-line therapy and disease extent at relapse. The results indicate that patients who relapse after the alternating MOPP/ABVD regimen have a prognosis similar to that of patients who relapse after a four-drug regimen (MOPP or ABVD alone). Re-treatment with initial chemotherapy seems the treatment of choice for patients who relapse after an initial complete remission that lasts greater than 12 months, while the real impact of high-dose chemotherapy or new regimens should be assessed in resistant patients.

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British National Lymphoma Investigation randomised study of MOPP (mustine, Oncovin, procarbazine, prednisolone) against LOPP (Leukeran substituted for mustine) in advanced Hodgkin's disease – long term results

British Journal of Cancer ◽

10.1038/bjc.1991.134 ◽

1991 ◽

Vol 63 (4) ◽

pp. 579-582 ◽

Cited By ~ 31

Author(s):

BW Hancock ◽

G Vaughan Hudson ◽

B Vaughan Hudson ◽

JL Haybittle ◽

MH Bennett ◽

...

Keyword(s):

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Long Term Results ◽

Randomised Study ◽

Advanced Hodgkin’S Disease

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Treatment of 49 Unrandomized Patients with Advanced Hodgkin's Disease

Tumori Journal ◽

10.1177/030089168306900515 ◽

1983 ◽

Vol 69 (5) ◽

pp. 463-467

Author(s):

Teodoro Chisesi ◽

Orlando Ricciardi ◽

Sandra Dal Fior ◽

Francesco Cappellari ◽

Franco Pozza ◽

...

Keyword(s):

Hodgkin's Disease ◽

Adjuvant Radiotherapy ◽

Hodgkin’S Disease ◽

Treatment Modalities ◽

Significant Difference ◽

Involved Field ◽

Involved Field Radiotherapy ◽

Abvd Chemotherapy ◽

Advanced Hodgkin’S Disease

Forty-nine patients with previously untreated advanced Hodgkin's disease were treated in our Institution between 1973 and 1981. Treatment modalities of these patients were reviewed, and they were divided into 3 groups according to the treatment employed: 13 patients received MOPP only, 22 patients received MOPP plus involved field radiotherapy, and 14 received alternating MOPP/ABVD chemotherapy. The response rates for the 3 groups were respectively 38.5%, 63.6% and 78.6%. A longer follow-up is needed to assess a significant difference in survival curves. The advantages of adjuvant radiotherapy and alternating non-cross-resistant drugs in advanced Hodgkin's disease are discussed.

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Randomized Comparison of ABVD and MOPP/ABV Hybrid for the Treatment of Advanced Hodgkin’s Disease: Report of an Intergroup Trial

Journal of Clinical Oncology ◽

10.1200/jco.2003.12.086 ◽

2003 ◽

Vol 21 (4) ◽

pp. 607-614 ◽

Cited By ~ 345

Author(s):

David B. Duggan ◽

Gina R. Petroni ◽

Jeffrey L. Johnson ◽

John H. Glick ◽

Richard I. Fisher ◽

...

Keyword(s):

Overall Survival ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Hematologic Toxicity ◽

Standard Regimen ◽

Life Threatening ◽

P 16 ◽

Clinically Significant ◽

Advanced Hodgkin’S Disease

Purpose: In a series of trials, doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (MOPP/ABV) have been identified as effective treatments for Hodgkin’s disease. We compared these regimens as initial chemotherapy for Hodgkin’s disease. Patients and Methods: Adult patients (N = 856) with advanced Hodgkin’s disease were randomly assigned to treatment with ABVD or MOPP/ABV. The major end points were failure-free and overall survival, life-threatening acute toxicities, and serious long-term toxicities, including cardiomyopathy, pulmonary toxicity, myelodysplastic syndromes (MDS), and secondary malignancies. Results: The rates of complete remission (76% v 80%, P = .16), failure-free survival at 5 years (63% v 66%, P = .42), and overall survival at 5 years (82% v 81%, P = .82) were similar for ABVD and MOPP/ABV, respectively. Clinically significant acute pulmonary and hematologic toxicity were more common with MOPP/ABV (P = .060 and .001, respectively). There was no difference in cardiac toxicity. There were 24 deaths attributed to initial treatment: nine with ABVD and 15 with MOPP/ABV (P = .057). There have been 18 second malignancies associated with ABVD and 28 associated with MOPP/ABV (P = .13). Thirteen patients have developed MDS or acute leukemia: 11 were initially treated with MOPP/ABV, and two were initially treated with ABVD but subsequently received MOPP-containing regimens and radiotherapy before developing leukemia (P = .011). Conclusion: ABVD and the MOPP/ABV hybrid are effective therapies for Hodgkin’s disease. MOPP/ABV is associated with a greater incidence of acute toxicity, MDS, and leukemia. ABVD should be considered the standard regimen for treatment of advanced Hodgkin’s disease.

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Long-term Results of 100 Cases of Hodgkin's Disease treated with Chemoterapy

Tumori Journal ◽

10.1177/030089166705300203 ◽

1967 ◽

Vol 53 (2) ◽

pp. 111-128 ◽

Cited By ~ 3

Author(s):

Sergio Di Pietro

Keyword(s):

Survival Rate ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Clinical Stage ◽

Long Term Results ◽

Good Survival ◽

Fourth Stage ◽

X Ray ◽

The Third

Long-term results of 100 cases of Hodgkin's disease, treated with chemotherapy associated or not with X-ray therapy from 1949 to 1900, are reported. The median, survival rate was of 36 months: at 5 years the rate was 25 %. The survival rate at 5 years was 34,2 % for the 38 women and 19.3 % for the 62 men treated. Of 66 cases of the third clinical stage 31.6 % was alive at 5 years; the corresponding value for the 40 cases of the fourth stage was 15 %. The best survival rate was observed in the group of women of the third clinical stage with involvement of ilo-mediastinic lymph nodes in the first period of the disease (52.6% at 5 years). As to the four histological varieties of our cases, one can observe that the «paragranuloma» and the «scleronodular» types show a fairly good survival rate, not depending on the clinical stage, whereas the «polymorphous» and «sarcomatous» ones cause a more severe prognosis for the patients of the fourth clinical stage. The age of the patients, evidence or not of « systemic » symptoms, and the duration of the disease before the first treatment don't seem to have any significant influence on the survival rate. The best results were obtained with chemotherapy-X-ray therapy association in the group of patients of the third stage (survival rate of 39.5 % at 5 years). No difference is noted, on the contrary, between long-term results of chemotherapy alone and those of chemotherapy associated with X-therapy in the fourth stage.

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Low-Dose Radiation Is Sufficient for the Noninvolved Extended-Field Treatment in Favorable Early-Stage Hodgkin’s Disease: Long-Term Results of a Randomized Trial of Radiotherapy Alone

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.11.2905 ◽

2001 ◽

Vol 19 (11) ◽

pp. 2905-2914 ◽

Cited By ~ 82

Author(s):

Eckhart Dühmke ◽

Jeremy Franklin ◽

Michael Pfreundschuh ◽

Susanne Sehlen ◽

Norman Willich ◽

...

Keyword(s):

Hodgkin's Disease ◽

Early Stage ◽

Hodgkin’S Disease ◽

Survival Rates ◽

Long Term Results ◽

Good Survival ◽

Protocol Violation ◽

Extended Field ◽

Splenic Disease

PURPOSE: To show that radiotherapy (RT) dose to the noninvolved extended field (EF) can be reduced without loss of efficacy in patients with early-stage Hodgkin’s disease (HD). PATIENTS AND METHODS: During 1988 to 1994, pathologically staged patients with stage I or II disease who were without risk factors (large mediastinal mass, extranodal lesions, massive splenic disease, elevated erythrocyte sedimentation rate, or three or more involved areas) were recruited from various centers. All patients received 40 Gy total fractionated dose to the involved field areas but were randomly assigned to receive either 40 Gy (arm A) or 30 Gy (arm B) total fractionated dose for the clinically noninvolved EF. No chemotherapy was given. RT films were prospectively reviewed for protocol violations and recurrences retrospectively related to the applied RT. RESULTS: Of 382 recruited patients, 376 were eligible for randomized comparison, 190 in arm A and 186 in arm B. Complete remission was attained in 98% of patients in each arm. With a median follow-up of 86 months, 7-year relapse-free survival (RFS) rates were 78% (arm A) and 83% (arm B) (P = .093). The upper 95% confidence limit for the possible inferiority of arm B in RFS was 4%. Corresponding overall survival rates were 91% (arm A) and 96% (arm B) (P = .16). The most common causes of death (n = 27) were cardiorespiratory disease/pulmonary embolisms (seven), second malignancy (six), and HD (five). Protocol violation was associated with significantly poorer RFS. Nonirradiated nodes were involved in 42 of 52 reviewed relapses, infield areas in 18, marginal areas in 17, and extranodal sites in 16. CONCLUSION: EF-RT alone attains good survival rates in favorable early-stage HD. The 30-Gy dose is adequate for clinically noninvolved areas. Protocol violation worsens the subsequent prognosis. Relapse patterns suggest that systemic therapy can reduce the 20% long-term relapse rate.

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Allogeneic marrow transplantation for refractory Hodgkin's disease.

Journal of Clinical Oncology ◽

10.1200/jco.1989.7.8.1039 ◽

1989 ◽

Vol 7 (8) ◽

pp. 1039-1045 ◽

Cited By ~ 50

Author(s):

G L Phillips ◽

D E Reece ◽

M J Barnett ◽

J M Connors ◽

J W Fay ◽

...

Keyword(s):

Patient Selection ◽

Hodgkin's Disease ◽

Marrow Transplantation ◽

Lymphoproliferative Disorder ◽

Hodgkin’S Disease ◽

Substantial Toxicity ◽

Allogeneic Marrow Transplantation ◽

Allogeneic Marrow ◽

Advanced Hodgkin’S Disease

Eight patients with refractory Hodgkin's disease received intensive combination chemotherapy conditioning with cyclophosphamide, carmustine (BCNU), and etoposide (VP 16-213), and allogeneic marrow transplants. All patients achieved complete responses. Three patients relapsed; two died of Hodgkin's disease and one of chronic graft-v-host disease (GVHD) and infection. In all, four patients died due to transplant-related toxicity. One patient developed a fatal B-cell lymphoproliferative disorder soon after transplantation, and died without evidence of Hodgkin's disease. One patient is alive and free of progression 29 months after transplantation. These data indicate that allogeneic marrow transplantation may be considered as therapy for selected patients with advanced Hodgkin's disease and, despite substantial toxicity, will occasionally result in long-term responses. Better patient selection would likely improve results.

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