Advanced Hodgkin disease (clinical stages IIIB and IV): Low relapse rate after brief chemotherapy followed by high‐dose total lymphoid irradiation

Abstract

From January 1980 to September 1986, 50 patients with Hodgkin disease, clinical stages (CS) IIIB (26 cases) and IVB (24 cases) were treated by three cycles of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) chemotherapy, followed by high-dose (40 Gy) (sub)total lymphoid irradiation, including the spleen. Ten patients (2 CS IIIB, 8 CS IVB) were in failure, and seven (4 CS IIIB, 3 CS IVB) died during their first complete remission (2 from treatment-related complications, 1 from unknown cause, 4 from insufficient supportive care and/or a shortage of health supplies); three patients (CS IIIB) relapsed (2 alive in second complete remission, 1 deceased). After 7 years, actuarial survival and relapse-free duration were, respectively, 64% for the 50 patients and 89% for the 40 patients in complete remission. Unfavourable outcome was observed in patients with pelvic nodal involvement. The low relapse rate (none in CS IVB) was the most striking result after brief chemotherapy followed by total lymphoid irradiation.

Twenty‐year disease and treatment‐associated mortality rates of patients with Hodgkin lymphoma of clinical stages IIIB and IV prospectively treated with 3‐month anthracycline‐based chemotherapy followed by extended high‐dose radiation

“…At that time, we believed that such a progression pattern opened up the possibility of considering the benefit of high‐dose lymph node consolidation radiotherapy. However, because radiotherapy was expected to be poorly tolerated after 6 to 8 cycles of chemotherapy, we decided to test the efficacy of 3 MOPP cycles followed by full‐dose (sub)total lymph node radiotherapy in a small series of patients with CS IIIB and IV HL 5. Because by the end of the 1970s the combination of doxorubicin (adriamycin; at a dose of 25 mg/m 2 intravenously [iv]), bleomycin (at a dose of 10 mg/m 2 iv), vinblastine (at a dose of 6 mg/m 2 iv), and dacarbazine (at a dose of 375 mg/m 2 iv) on Days 1 and 15 (ABVD)6 was suggested to be virtually more effective and less toxic7–11 than the MOPP regimen, we decided that our H81‐34 trial (October 1981‐December 1988) would start with the administration of 3 cycles of ABVD followed by extended high‐dose radiotherapy.…”