Chemotherapy Alone May Be An Efficient Alternative in the Treatment of Early Stage Hodgkin's Disease if Optimal Radiotherapy is Not Available

Abstract

Because radiotherapy (RT) equipment technology in some developing countries is outdated, its side effects are more frequent and severe and its efficacy suboptimal, whereas chemotherapy (CT) meeting international standards is generally more consistent. With this in mind, we treated 29 patients with stages I and II Hodgkin's disease with the MOPP or the MOPP/ABV hybrid schedule without prior staging laparotomy. The complete remission rate was 96%: five patients relapsed and of these, two died and three were rescued with CT, in one case followed by an autologous stem cell autograft. The median follow-up is 54 months (range 9 to 126), the overall survival of the group 88% at 126 months, and the relapse-free survival 72% at 110 months. Conventional CT alone has been shown to be useful in achieving acceptable long-term results. This observation could be important in circumstances where RT is unavailable or of suboptimal quality.

Role of bone marrow examination in staging Hodgkin's disease: experience in México

“…Some authors support this view (Webb & Silver, 1968), while others think that routine bone marrow biopsy may be unnecessary (Bennet, Gralnick & de Vita, 1968;Macintyre et al, 1987;Doll et al, 1989;Abrahamsen et al, 1992;Munker et al, 1995;Mahoney et al, 1998;Kanaev et al, 2001). It is clear that the probability of obtaining a positive bone marrow biopsy in HD is higher in the presence of advanced disease (clinical stage III), B symptoms, lymphocyte-depleted or mixed-cellularity histology (Stein et al, 1999;Ruiz-Argü elles et al, 1997), age over 40 years, increased erythrocyte sedimentation rate, anaemia and leukocytosis (Kanaev et al, 2001). It is therefore possible that only HD patients with one or more of these risk factors should have bone marrow biopsy.…”

“…Six courses of chemotherapy were delivered, one every 28 days, of either mechlorethamine–Oncovin–Procarbazine–prednisolone (MOPP) (mustine 6 mg/m 2 , i.v., days 1 and 8; vincristine 1.4 mg/m 2 , i.v., days 1 and 8; procarbazine 100 mg/m 2 , p.o., days 1–7; prednisone 40 mg/m 2 , p.o., days 1–14), MOPP/ABV hybrid schedule (mustine 6 mg/m 2 , i.v., day 1; vincristine 1.4 mg/m 2 , i.v., day 1; procarbazine 100 mg/m 2 , p.o., days 1–7; prednisone 40 mg/m 2 , p.o., days 1–14; doxorubicin 35 mg/m 2 , i.v., day 8; bleomycin 10 U/m 2 , i.v., day 8 and vinblastine 6 mg/m 2 , i.v., day 8) or ABVD (doxorubicin 35 mg/m 2 , i.v., days 1 and 14; bleomycin 10 units/m 2 , i.v., days 1 and 14; vinblastine 6 mg/m 2 , i.v., days 1 and 14; dacarbazine 350 mg/m 2 , i.v., days 1 and 14) (Ruiz‐Argüelles, Gómez‐Almaguer & Apreza‐Molina, 1997). If residual lymph‐node enlargement was observed in either the chest X‐ray films or in computed tomography studies at the end of six cycles, three additional courses of the same schedule were delivered.…”