Prognostic value of response after three MOPP cycles in hodgkin's disease ? stage III and IV

Abstract

Sixty-eight patients with Hodgkin's disease stage III and IV were evaluated after three out of six MOPP cycles. At that time, 46 (68%) were classified as early responders and 22 as slow responders. The criteria of response were: disappearance of B symptoms, decrease in the size of the largest lymph nodes (by more than 50%) and significant reduction (more than 20%) of mediastinal enlargement. Out of 43 early responders, 38 were in complete remission after six MOPP cycles and only five out of 22 slow responders. Such an early response is only related to the absence of B symptoms at the time of diagnosis (p less than 0.05). The survival curves of early responders and slow responders were significantly different (p less than 0.02). A rapid erythrocyte sedimentation rate (ESR) (greater than 50 mm) was the most frequently abnormal sign found in the group not responding after three MOPP cycles (p less than 0.0001). Such a significant prognostic value of early response is observed for stage III but not for stage IV patients. We conclude that early clinical response after three MOPP cycles is a good prognostic factor which must be kept in mind in the formulation of the therapeutic regimen for Hodgkin's disease stage III and IV.

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

“…Although the percent of complete remission after chemotherapy is low (32 %), all but three patients who were in nodal partial remission with an apparent complete control of the visceral localizations achieved complete remission after radiation therapy, which resulted in an overall complete remission rate of 80%. In contrast to others [30,31], we did not observe that postchemotherapy partial remission had any negative prognostic value.…”

“…Some groups have used low-dose irradiation (20-25 Gy) either on bulky initial sites or in extended field [7]. Other groups have used higher doses of radiation (for CS IIIB) similar to those administered in localized stages: [30][31][32][33][34][35] Gy for the Milan group, in sandwich after three cycles of MOPP (78 cases) or ABVD (94 cases) and before three other similar chemotherapy cycles, with a complete remission rate of 78/94 % , a 7- P, lung). Histology: abbreviations as in Table I.…”

Front-line high-dose therapy with autologous stem cell transplantation for high risk Hodgkin's disease: comparison with combined-modality therapy

“…The third unfavorable factor considered in our study is an incomplete response after the first-line chemotherapy. Three studies published in 1983 23 and 1987 24,25 showed that the response to initial chemotherapy could provide a prognostic factor that might serve to delineate a high risk group of patients. More recently, Levis et al 26 showed that the early response to chemotherapy evaluated after three cycles might be useful for identifying a high risk group of patients that can benefit from ASCT as the first-line therapy.…”