Long-term results and competing risk analysis of the H89 trial in patients with advanced-stage Hodgkin lymphoma: a study by the Groupe d'Etude des Lymphomes de l'Adulte (GELA)

Abstract

From 1989 to 1996, 533 eligible patients with stage IIIB/IV Hodgkin lymphoma (HL) were randomly assigned to receive 6 cycles of hybrid MOPP/ABV (mechlorethamine, vincristine, procarbazine, prednisone/Adriamycin [doxorubicin], bleomycin, vinblastine; n ‫؍‬ 266) or ABVPP (doxorubicin, bleomycin, vinblastine, procarbazine, prednisone; n ‫؍‬ 267). Patients in complete remission (CR) or partial response of at least 75% after 6 cycles received 2 cycles of consolidation chemotherapy (CT) (n ‫؍‬ 208) or subtotal nodal irradiation (RT) (n ‫؍‬ 210). A better survival probability was observed after ABVPP alone: the 10-year overall survival (OS) estimates were 90% for AB-VPP؋8, 78% for MOPP/ABV؋8, 82% for MOPP/ABV with RT, and 77% for AB-VPP؋6 with RT (P ‫؍‬ .03); and the 10-year disease-free survival (DFS) estimates were 70%, 76%, 79%, and 76%, respectively (P ‫؍‬ .09). The 10-year DFS estimates for patients treated with consolidation CT or RT were 73% and 78% (P ‫؍‬ .07), and OS estimates were 84% and 79%, respectively (P ‫؍‬ .29). These results showed that RT was not superior to consolidation CT after a doxorubicin-induced CR in patients with advanced HL. An analysis of competing risks identified age more than 45 years as a significant risk factor for death, relapse, and second cancers.

Molecular profiling of classical Hodgkin lymphoma tissues uncovers variations in the tumor microenvironment and correlations with EBV infection and outcome

“…Nonetheless, approximately 40% of patients are refractory to initial treatment and/or relapse after achieving complete remission. 1,2 Various prognostic systems are currently used to predict the outcome of cHL patients, including the International Prognostic Score (IPS), which is considered the "gold standard" for advancedstage patients. 3 However, the IPS has limited applicability for early-stage patients.…”

Relevance of Positron-Emission Therapy for Optimization of Treatment of Advanced Hodgkin’s Lymphoma Using Intensive ЕАСОРР-14 Program

“…Лучевая консолидация не улучшила результатов лечения больных в полной ремиссии ЛХ, получивших 6 или 8 циклов ABVD, но потенциально повысила эффективность его у пациентов с частичной ремиссией [7,8]. Эти данные подтверждает и рандо-мизированное контролируемое исследование UK Lymphoma Group LY09.…”

Classical Hodgkin's lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up

“…49,50 A randomized EORTC study 44 demonstrated that consolidation with IF-RT did not improve the outcome in patients in complete remission after 6-8 courses of alternating MOPP and ABV, and a randomized GELA trial 45 that consolidation with IF-RT was not superior to two additional cycles of chemotherapy. The EP concluded that in patients achieving complete remission with chemotherapy, additional radiotherapy does not improve the overall results.…”

“…To reach their conclusions, the experts have analyzed the results of randomized clinical trials, either as full papers [33][34][35][36][37][38][39][40][41][42][43][44][45] or abstracts, [46][47][48] and of meta-analyses of randomized clinical trials. 49,50 Evidence for the efficacy of chemotherapy to cure advanced Hodgkin's lymphoma has derived from studies initiated more than 35 years ago, with the introduction into the clinical practice of MOPP (mechlorethamine, vincristine, procarbazine, prednisone) chemotherapy.…”