Treatment of advanced untreated Hodgkin's disease with SCAB—an alternative to MOPP

Appropriate management of Hodgkin's disease is based on both the stage of disease and the specific anatomic sites of involvement within each stage. As a result of the combination of sequential staging and effective treatment, histopathologic subclassification has become less important. Although not generally appreciated, this is also true for constitutional symptoms. During the past 15 years, differences in survival between early and advanced stages have diminished progressively with refinements both in management of newly diagnosed patients, and in management of relapsing disease. Currently, our five‐year survival figure for laparotomy‐Staged I and II patients is 95%. The corresponding result for Stages IIIA and IIIB patients is 85%; and 67% of our Stage IV patients, who were treated with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) are projected to be surviving at five years. With the anticipation of a high probability for cure, quality of life including the possibility for parenthood has become increasingly important. In the past, the trend has been to increase treatment for patients with poor prognostic factors. However, very little attention has been paid to the possibility of administering less treatment for very precisely staged patients with good prognostic factors. In this review, management is discussed by stage. Emphasis is placed on the indications for less treatment as well as for more intensive therapy in adult patients with Hodgkin's disease.

Diagnosis and management of Hodgkin's disease in the adult

Fuller

Hagemeister

1983

Sequential non-cross-resistant chemotherapy regimens (MOPP and CAVmP) in Hodgkin's disease stage IIIB and IV

Wagener

Burgers

Dekker

et al. 1983

Fifty consecutive patients with advanced Hodgkin's disease were treated in a multicentre study with 6 cycles of an alternating scheme of MOPP and CAVmP followed by irradiation to a dose of 20 Gy. The objective was to increase complete remission (CR) and cure rates by alternating two effective noncross‐resistant regimens with subsequent consolidation of the remission by irradiating bulky nodes. A total of 47 patients completed the treatment and are evaluable. In the first 13 patients the irradiation fields amounted to a total or subtotal nodal irradiation with inclusion of the spleen. In case of organ involvement the affected organ was also included in the irradiation field. The irradiation protocol was later changed to an irradiation of the initially involved sites because of severe leucopenia and thrombopenia. After completion of the chemotherapy 32 (68%) patients (for Stage IIIB and IV patients: 63% and 71%, respectively) achieved a CR, after ending the radiotherapy the percentage of CR increased to 87% (for stage IIIB and IV patients: 90% and 86%, respectively). Five of the patients relapsed in an irradiated and nonirradiated area, three patients in a nonirradiated field. The actuarial 3‐year survival rate for the entire group was 86% and for patients in CR 94%. The relapse‐free survival was 73%. It is concluded that this alternating chemotherapy scheme followed by irradiation is at least equally effective as MOPP treatment in achieving a CR, and is probably superior in terms of survival.

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

Pillai

Hagemeister

Velasquez

et al. 1985

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.