Prognostic factors for stage IV Hodgkin's disease treated with MOPP, with or without bleomycin

Abstract

Prognostic factors for 53 previously untreated patients with Stage IV Hodgkin's disease were analyzed for their effects upon complete remission rate, survival, and disease‐free survival following treatment with mechlorethamine, Oncovin (vincristine), procarbazine, and prednisone (MOPP) or MOPP plus bleomycin (MOPP‐Bleo). Although 75% of those patients with only one site of extranodal disease achieved complete remission, only 25% of those with more than one site of involvement entered complete remission. Seven of the eight patients with more than one extranodal site were dead of disease at 4 years, compared with a 5‐year survival of 75% for those with only one site of involvement. Disease‐free survival from complete remission was dependent upon the percentage of planned doses of nitrogen mustard actually administered. Patients who received higher doses of nitrogen mustard had significantly longer freedom from relapse and survival after attaining complete remission than those who received reduced doses. Age, symptoms, pathologic features, and presence or size of mediastinal disease did not affect the comple remission rate, survival, or disease‐free survival. Patients with Stage IV disease treated with MOPP alone should receive the highest tolerable dose of nitrogen mustard early in their treatment, since those receiving lower doses have a higher risk of relapse.

Radiation therapy compared with chemotherapy for consolidation of chemotherapy-induced remission of advanced Hodgkin lymphoma: a study by the Eastern Co-operative Oncology Group (E1476) with >20 years follow-up

“…The superior outcome with ABVD consolidation may be primarily for patients with pathology other than nodular sclerosis [5,6]. The overall 71% CR rate for patients in this study, 22% of whom had involvement at more than one extranodal site is compatible with the results of Pillai et al [7] in a similar group of patients treated with similar induction therapy, and with those of Sullivan et al [8] obtained in children with involved field RT followed by MOPP-Bleo. It is also similar to the CR rate with MOPP alternating with ABVD as induction therapy reported by Canellos et al [9].…”

A risk factor for relapse in Hodgkin's disease: Female gender?

“…This would allow effective but less morbid treatments to be given to low risk patients and more intensive therapy to be reserved for patients at higher risk. A number of factors which predict lower CR rates have been described and these include advanced stage (Longo et al, 1986), presence of systemic (B) symptoms (Longo et al, 1986), number of extranodal sites (Pillai et al, 1985), and drug dose intensity (Longo et al, 1986).…”

“…Factors which predict the length of CR include B symptoms (Cosset et al, 1984;Tubiana et al, 1985;Longo et al, 1986), stage (Haybittle et al, 1985;Sutcliffe et al, 1984;Horwich et al, 1986), histology (Haybittle et al, 1985;Sutcliffe et al, 1984;Specht et al, 1987), number of disease sites (Cosset et al, 1984;Tubiana et al, 1985;Horwich et al, 1986), age (Sutcliffe et al, 1984;Tubiana et al, 1985;Longo et al, 1986), male sex (Tubiana et al, 1985;Specht et al, 1987), erythrocyte sedimentation rate (ESR) (Haybittle et al, 1985;Tubiana et al, 1985), tumour burden (Specht et al, 1987), number of extranodal sites (Longo et al, 1986), the presence of bulky mediastinal disease (Hoppe et al, 1982), time to achieve CR (Longo et al, 1986) and drug dose intensity (Pillai et al, 1985).…”

“…Factors predicting for overall survival in patients with Hodgkin's disease include age (Haybittle et al, 1985;Sutcliffe et al, 1984;Tubiana et al, 1985;Horwich et al, 1986), stage (Sutcliffe et al, 1984), histology (Haybittle et al, 1985;Sutcliffe et al, 1984;Tubiana et al, 1985), mediastinal disease (Haybittle et al, 1985), ESR (Haybittle et al, 1985), male sex (Haybittle et al, 1985;Tubiana et al, 1985), number of extranodal sites and drug dose intensity (Pillai et al, 1985). In Christchurch there has been a clinical impression that females with nodular sclerosis Hodgkin's disease involving the mediastinum relapsed more frequently than expected according to the published risk factors.…”

Prognostic factors for survival in stage IIIB and IV Hodgkin's disease: a multivariate analysis comparing two specialist treatment centres

“…n = 104 analysis included response as a factor. The two centres (DeVita et al, 1980;Carde et al, 1983) who examined pleural involvement found it significant, as did the two centres (Peterson, 1982;Pillai et al, 1985) examining the number of sites of extra-nodal disease. Only DeVita et al (1980) found histological subtype to be important, patients E. = 47 with nodular sclerosing pathology having a significantly shorter survival than the rest.…”