MOPP/ABV hybrid program: combination chemotherapy based on early introduction of seven effective drugs for advanced Hodgkin's disease.

Seventy patients with advanced Hodgkin's disease, 54 with new disease, and 16 in first relapse after initial radiotherapy, have been treated with a seven-drug, 8-month program: MOPP (nitrogen mustard, vincristine, procarbazine, prednisone)/ABV (Adriamycin [Adria Laboratories of Canada, Mississauga, Ontario], bleomycin, vinblastine) hybrid. A single involved field of radiotherapy was given to selected partial responders after 6 months of chemotherapy. Forty-six of the 52 (88%) evaluable new-disease patients and 14 of the 16 (87%) evaluable patients with relapsing disease reached a complete response. The actuarial overall survival at 49 months for the patients with new disease was 90% (median follow-up from diagnosis was 27 months). For the patients with relapsing disease, the actuarial survival at 54 months was 79% (median follow-up from diagnosis was 27 months). The actuarial relapse-free survival at 41 months for complete responders was 93% for patients with new disease (median follow-up after treatment was 20 months) and 80% for those with relapsing disease (median follow-up after treatment was 27 months). Toxicity was moderate, with two treatment-related deaths and eight episodes of serious infection. These results compare favorably with the best results reported in the literature. Furthermore, they were achieved with a moderate level of toxicity, high drug delivery rates, and a relatively short duration of treatment. The efficacy and toxicity data of the MOPP/ABV hybrid program will now be evaluated in a prospectively randomized multicenter study.

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Radiotherapy with curative intent: an option in selected patients relapsing after chemotherapy for advanced Hodgkin's disease.

Journal of Clinical Oncology ◽

10.1200/jco.1987.5.4.550 ◽

1987 ◽

Vol 5 (4) ◽

pp. 550-555 ◽

Cited By ~ 80

Author(s):

M Roach ◽

D S Kapp ◽

S A Rosenberg ◽

R T Hoppe

Keyword(s):

Radiation Therapy ◽

Combination Chemotherapy ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Complete Response ◽

Curative Intent ◽

Major Toxicity ◽

Disease Free ◽

Advanced Hodgkin’S Disease

Thirteen patients who had relapsed or failed to obtain a complete remission after combination chemotherapy for the treatment of advanced Hodgkin's disease were treated with subtotal or total lymphoid irradiation with curative intent. Twelve of the 13 patients achieved a complete response (CR). Five of the 12 CRs subsequently relapsed at 3, 9, 9, 12, and 19 months. One patient died of leukemia 11 months following radiotherapy. The actuarial relapse-free survival at 1 year was 60%, and six patients (50%) remain disease-free with a median follow-up of 34 months (range, 10 to 115 months) following the completion of radiotherapy. Patients who failed to obtain a CR to their initial chemotherapy, whose chemotherapy CR was of short duration, or who relapsed initially in extranodal sites, tended to have a worse outcome with radiotherapy. Patients who had long disease-free intervals after initial chemotherapy or relapsed only in nodal sites tended to do relatively well. Radiation therapy was well tolerated with no major toxicity. Potentially curative radiation therapy should be considered an option in the management of selected patients who relapse following combination chemotherapy for advanced Hodgkin's disease.

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Stanford V and Radiotherapy for Locally Extensive and Advanced Hodgkin’s Disease: Mature Results of a Prospective Clinical Trial

Journal of Clinical Oncology ◽

10.1200/jco.2002.20.3.630 ◽

2002 ◽

Vol 20 (3) ◽

pp. 630-637 ◽

Cited By ~ 31

Author(s):

Sandra J. Horning ◽

Richard T. Hoppe ◽

Sheila Breslin ◽

Nancy L. Bartlett ◽

B. William Brown ◽

...

Keyword(s):

Hodgkin's Disease ◽

Chemotherapy Regimen ◽

Hodgkin’S Disease ◽

Prognostic Score ◽

Secondary Leukemia ◽

Bulky Disease ◽

Standard Doxorubicin ◽

Splenic Disease ◽

Advanced Hodgkin’S Disease

PURPOSE: To provide more mature data on the efficacy and complications of a brief, dose-intense chemotherapy regimen plus radiation therapy (RT) to bulky disease sites for locally extensive and advanced-stage Hodgkin’s disease. PATIENTS AND METHODS: One hundred forty-two patients with stage III or IV or locally extensive mediastinal stage I or II Hodgkin’s disease received Stanford V chemotherapy for 12 weeks followed by 36-Gy RT to initial sites of bulky (≥ 5 cm) or macroscopic splenic disease. Freedom from progression (FFP), overall survival (OS), and freedom from second relapse (FF2R) were determined using life-table estimates. Outcomes were analyzed according to the international prognostic score. Late effects of treatment were recorded in follow-up. RESULTS: With a median follow-up of 5.4 years, the 5-year FFP was 89% and the OS was 96%. No patient progressed during treatment, and there were no treatment-related deaths. FFP was significantly superior among patients with a prognostic score of 0 to 2 compared with those with a score of 3 and higher (94% v 75%, P < .0001). No secondary leukemia was observed. To date, there have been 42 pregnancies after treatment. Among 16 patients who relapsed, the FF2R was 69% at 5 years. CONCLUSION: These data confirm our preliminary report that Stanford V chemotherapy with RT to bulky disease sites is highly effective in locally extensive and advanced Hodgkin’s disease. It is most important to compare this approach with standard doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy in the ongoing intergroup trial (E2496) to determine whether Stanford V with or without RT represents a therapeutic advance.

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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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The eight-drug/radiation therapy program (MOPP/ABDV/RT) for advanced Hodgkin's disease. A follow-up report

Cancer ◽

10.1002/1097-0142(19800715)46:2<233::aid-cncr2820460202>3.0.co;2-c ◽

1980 ◽

Vol 46 (2) ◽

pp. 233-240 ◽

Cited By ~ 33

Author(s):

David J. Straus ◽

Jane Myers ◽

Sharon Passe ◽

Charles W. Young ◽

Lourdes Z. Nisce ◽

...

Keyword(s):

Radiation Therapy ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Therapy Program ◽

Advanced Hodgkin’S Disease

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ChlVPP/PABlOE and radiotherapy in advanced Hodgkin's disease. The Central Lymphoma Group.

Journal of Clinical Oncology ◽

10.1200/jco.1994.12.4.779 ◽

1994 ◽

Vol 12 (4) ◽

pp. 779-787 ◽

Cited By ~ 19

Author(s):

M H Cullen ◽

N S Stuart ◽

C Woodroffe ◽

A Murphy ◽

J Fletcher ◽

...

Keyword(s):

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Nausea And Vomiting ◽

Actuarial Survival ◽

Bulky Disease ◽

The United Kingdom ◽

Group B ◽

Leukemia Group ◽

Treatment Of Infection ◽

Advanced Hodgkin’S Disease

PURPOSE The United Kingdom Central Lymphoma Group (CLG) has modified mechlorethamine, vincristine, procarbazine, and prednisone/doxorubicin, bleomycin, vinblastine, and dacarbazine (MOPP/ABVD) by substituting mechlorethamine with chlorambucil and dacarbazine with etoposide in the treatment of patients with advanced Hodgkin's disease (HD). Prednisolone is included in the bleomycin-containing combination, and the vinca alkaloids have been switched to balance the myelotoxicity of the two component regimens. PATIENTS AND METHODS The resulting ChlVPP/PABlOE regimen is as follows: on days 1 to 14, chlorambucil 6 mg/m2 orally, procarbazine 100 mg/m2 orally, and prednisolone 30 mg/m2 orally; on days 1 and 8, vinblastine 6 mg/m2 intravenously (i.v.); on day 29, doxorubicin 40 mg/m2 i.v.; on days 29 and 36, vincristine 1.4 mg/m2 (maximum, 2 mg) i.v., and bleomycin 10 mg/m2 i.v.; on days 30, 31, and 32, etoposide 200 mg/m2/d orally; on days 29 to 43, inclusive, prednisolone, 30 mg/m2 orally. The second full cycle restarts on day 50. Treatment continues to maximum response plus two full cycles, but with a minimum of three full cycles. Radiotherapy is administered, after chemotherapy, to sites of previously bulky disease. Since 1983, 216 patients with previously untreated, advanced Hodgkin's disease (HD) have entered this study. RESULTS The complete remission (CR) rate after chemotherapy was 73% (95% confidence interval [CI], 67% to 79%), and after additional radiotherapy was 85% (95% CI, 80% to 90%). The failure-free survival (FFS) rate at 5 years was 68% (95% CI, 61% to 74%), and the overall actuarial survival at 5 years was 78% (95% CI, 72% to 84%). The CR rate in patients in the poorer prognostic categories was high: 81% in patients with albumin levels less than 37 g/L, 79% in patients older than 40 years of age, 84% in stages IIIB plus i.v. disease, and 79% in patients presenting with B symptoms. As expected, nausea and vomiting were not major problems, although infection, often in the context of myelosuppression, complicated almost half the cases, and 29% of patients required admission at some stage for treatment of infection. CONCLUSION In this multicenter study, ChlVPP/PABlOE produced results comparable to those reported for MOPP/ABVD, but with less nausea and vomiting. Treatment duration was shorter than in the original MOPP/ABVD regimen, and than that used in the Cancer and Leukemia Group B (CALGB) trial. It will now be compared with PABlOE alone.

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Radiation therapy salvage of Hodgkin's disease following chemotherapy failure.

Journal of Clinical Oncology ◽

10.1200/jco.1987.5.1.38 ◽

1987 ◽

Vol 5 (1) ◽

pp. 38-45 ◽

Cited By ~ 65

Author(s):

K A Fox ◽

S M Lippman ◽

J R Cassady ◽

R S Heusinkveld ◽

T P Miller

Keyword(s):

Combination Chemotherapy ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Statistical Significance ◽

Disease Free Survival ◽

Complete Response ◽

Salvage Radiotherapy ◽

Wide Field ◽

Response To Chemotherapy ◽

Advanced Hodgkin’S Disease

Between 1972 and 1984, 17 patients with advanced Hodgkin's disease failing intensive combination chemotherapy in previously unirradiated nodal and/or pulmonary sites were treated with salvage radiotherapy. Treatment consisted of comprehensive wide field radiotherapy to all known areas of disease. Doses administered to these fields ranged from 1,700 to 5,000 rad, with only three patients (18%) receiving less than 3,000 rad to any field. With a median follow-up of over 4 years, 88% achieved a complete response, with median actuarial disease-free survival (DFS) of 19 months (range, 4 to 61+). Actuarial median survival was 64 months, with a range of 4 to 134+ months. Nine patients (53%) are currently alive with three (18%) in continuous complete remission (CR) for 24, 30, and 61 months. In addition, four patients relapsing after salvage radiotherapy are now in CR following additional therapy. Patients younger than 35 years of age had a significantly increased overall survival when compared with older patients (P less than .005). An initial complete response to chemotherapy lasting 12 or more months appeared to be a favorable prognostic factor, although small patient numbers preclude statistical significance. Comprehensive salvage radiotherapy is of significant benefit in patients with advanced Hodgkin's disease relapsing after combination chemotherapy in nodal and/or pulmonary sites.

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