Vinblastine, bleomycin, and methotrexate chemotherapy plus irradiation for patients with early‐stage, favorable Hodgkin lymphoma

Abstract

BACKGROUNDThe acknowledged effectiveness of vinblastine, bleomycin, and methotrexate (VBM) chemotherapy in patients with early‐stage Hodgkin lymphoma has been associated with conflicting toxicity reports.METHODSOne hundred forty‐three patients were evaluated clinically and had favorable Stage IA or IIA Hodgkin lymphoma. Ninety‐three patients were treated with the standard VBM schedule combined with extended‐field radiotherapy (EF‐RT), leaving the choice of the therapeutic sequence free. Fifty subsequent patients were treated with a slightly modified VBM schedule (VbMp) combined with RT limited to involved fields (IF‐RT) and delivered only after the end of chemotherapy. In the VbMp schedule, intervals between cycles were 21 days instead of 28 days, bleomycin doses were reduced, small doses of prednisone were given orally, and the interval before RT was prolonged.RESULTSClinical response was complete in 96% of patients who were treated with VBM plus EF‐RT and in 94% of patients who were treated with VbMp plus IF‐RT. Recurrence rates were nearly identical (12% and 11%, respectively) over necessarily different follow‐up (91 months and 33 months, respectively). Hematologic toxicity was tolerable in both trials, and pulmonary side effects were moderate in the first trial and negligible in the second. On the whole, treatment was tolerated better when RT followed chemotherapy.CONCLUSIONSThe VBM regimen was confirmed to be effective in patients with early‐stage Hodgkin lymphoma. Administration of all cycles before RT improved tolerance; pulmonary toxicity probably is mitigated further by reduced bleomycin doses, mild prednisone therapy, and a more prolonged resting interval before RT. A slightly higher recurrence rate was expectable in the VBM plus IF‐RT trial despite the actual intensification of vinblastine and methotrexate. Cancer 2003. © 2003 American Cancer Society.

Resection alone in 58 children with limited stage, lymphocyte‐predominant Hodgkin lymphoma–experience from the European network group on pediatric Hodgkin lymphoma

“…The global prognosis for patients with LPHL is excellent, as demonstrated in previous studies, with an OS rate of ≈95% and a PFS rate between 85% and 94% 15–18. Our study confirmed these results, with a 100% OS rate at a median follow‐up of 4 years.…”

“…The prognosis is favorable with an indolent course of disease, and the rare patient deaths are related to secondary (treatment‐related) malignancies or transformation to aggressive B‐cell lymphoma9–14 or classic Hodgkin lymphoma (HL). In the past, patients with LPHL often have been treated with chemotherapy and radiotherapy according to standard, classic HL protocols 15–17. Patients with early‐stage disease who were treated with radiotherapy alone usually received extended‐field radiation,18–20 chemotherapy alone,21 or, more recently in adults, monoclonal antibody therapy with rituximab 21–23.…”

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

“…To reach their conclusions, the experts extensively analyzed large randomized clinical trials conducted in the last 15 years, whose results have been published as full papers [13][14][15][16][17][18][19][20][21] or as abstracts. [22][23][24][25] A number of cohort studies, 3,26,27 and the results of Cochrane analysis on chemotherapy, RT and combined modality for HL 28 have also been considered. For decades, RT has been the standard of care for patients with early stage HL.…”

The role of high-dose therapy and autologous stem cell transplantation in patients with primary refractory Hodgkin's lymphoma: a report from the Gruppo Italiano per lo Studio dei Linfomi (GISL)

“…Patients with a low-risk were treated with a VBM (vinblastine, bleomycin, methotrexate)-based CC plus involved-field radiotherapy (IF-RT). 9 Patients with an intermediate-risk were treated with four courses of an adriamycin-including regimen, that is, ABVD 10 Patients with HL who did not respond to an induction CC, whether they had progressive, stable or only minimally responsive disease were considered to have primary refractory HL. Out of the 1078 HL patients, 82 cases failed (7.6%).…”