22 Patients were treated with ABVD, 19 (18 stage IV B 1 stage III B) could be evaluated. No patient with impaired but 7 of 13 patients with intact bone-marrow function achieved a complete remission. A complete remission was also achieved by all 4 patients with a treatment- and disease-free interval but only by 3 of 15 without a free interval. Pretreatment, histology, duration of disease, and age showed no clear prognostic significance with respect to induction of remission. Toxicity was severe especially in patients over 50 years of age. 2 patients discontinued therapy because of gastro-intestinal toxicity. 2 of 8 died of treatment-related causes (1 leukemia, 1 sudden cardiac death). In 3 patients with high-dose mediastinal irradiation a pneumonitis secondary to bleomycin contributed significantly to death. Our results suggest that ABVD is an effective salvage-regimen for some subgroups of MOPP-failures.

In a recently published review of the literature [40] we came to the conclusion that the Ann-Arbor staging classification is of limited prognostic value for chemotherapy of Hodgkin's disease (Table 2). Four risk factors accounted for impaired complete remission rates: stage IVB, lymphocyte depletion or not classifiable histologic type, previous chemotherapy, and older age. Fifty-eight evaluable patients were treated with COPP; 23 reached a complete remission (40%). Disease-free survival was 31%, overall survival 49% after five years [33]. Besides the known risk factors, impaired bone marrow function (leucocyte counts less than 4 X 10(9)/l, platelet counts less than 100 X 10(9)/l) at the start of therapy was associated with poor treatment results: none of six patients achieved a complete remission [41]. Eleven of 16 patients with no and 11 of 23 patients with one risk factor achieved a complete remission, as did only one patient with more than one risk factor. Survival rates after 30 months were: 87% with no, 66% with one, 36% with two, and 13% with more than two risk factors. We can conclude from our results that the prognosis of patients undergoing chemotherapy for Hodgkin's disease depends on the number of risk factors.

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