Chemotherapy of advanced Hodgkin's disease

Charles A. Coltman

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


The benchmark studies of DeVita and associates29 29 DeVita VT, Serpick AA, Carbone PP: Combination chemotherapy in the treatment of advanced Hodgkin's disease, Ann Intern Med 73:881-895 197035 35 DeVita VTCanellos GPMoxley JH: A decade of combination chemotherapy of advanced Hodgkin's disease. Cancer 30:1495-1504 197260 60 DeVita VTLewis BVRozencweig Met al: The chemotherapy of Hodgkin's disease: Past experience and future directions. Cancer 42:979-990 1978 have made a major impact on the survival of patients with advanced Hodgkin's disease. Those data have been confirmed by a number of investigators.31 31 Bernard JBoiron MGoguel Aet al: Traitement de la maladie de Hodgkin par une polychimiotherapie associant moutarde a l'azotevincristinemethylhydrazine et prednisone. La Presse Med 52:2647-2649 196734 34 Mbidde EK, Nkwocha J, et al: Chemotherapy of Hodgkin's disease. Lancet 2:1397 19743537 37 Frei ELuce JKGamble JFet al: Combination chemotherapy in advanced Hodgkin's disease. Induction and maintenance of remission. Ann Intern Med 79:376-382 1973.38 38 Coltman CA JrFrei E IIIDelaney FC: Effectiveness of actinomycin (A)methotrexate (MTX) and vinblastine (V) in prolonging the duration of combination chemotherapy (MOPP) induced remission in advanced Hodgkin's disease (HD). Proc ASCO9:78 1973.40 40 Focan CBricteux NLemaire Met al: Combination chemotherapy in Hodgkin's disease at advanced stages. Acta Clin Belg 4:298-309 1975. Furthermore, MOPP has been compared with the single agent nitrogen mustard44 44 Huguley CM JrDurant JRMoores RRet al: A comparison of nitrogen mustardvincristineprocarbazine, and prednisone (MOPP) vs. nitrogen mustard in advanced Hodgkin's disease. Cancer 36:1227-1240 1975. and shown to be significantly betterwith respect to complete response ratedurationand survival. No other regimen has been proven to be superior to MOPP in head-to-head comparison.42 42 Nissen NIStutzman LHolland JFet al: Chemotherapy of Hodgkin's disease in studies by Acute Leukemia Group B. Arch Intern Med 13:396-401 1973.43 43 Bonadonna GZucali RMonfardino Set al: Combination chemotherapy of Hodgkin's disease with adriamycin, bleomycinvinblastineand imidazole carboxamide versus MOPP. Cancer 36:252-259 1975.45 45 British National Lymphoma Investigation: Value of prednisone in combination chemotherapy of stage IV Hodgkin's disease. Br J Med 3:413-414 1975.46 46 Cooper MRSpurg CLGlidengild Oet al: The superiority of a nitrosourea (CCNU) containing four drug combination over MOPP in the treatment of stage III and IV Hodgkin's disease. Proc Am Soc Hematol 18:60 1975.47 47 Bennett JMBakemeier RFCarbone PPet al: Clinical trials with BCNU (NSC-409962) in malignant lymphomas by the Eastern Cooperative Oncology Group. Cancer Treat Rev 60:737-745 1976.48 48 Jacobs CPortlock CSRosenberg SA: Prednisone in MOPP chemotherapy for Hodgkin's disease. Br Med J 2:1469-1471 1976.50 50 Nissen NIPajak TFGlidewell Oet al: A comparative study of a BCNU containing 4-drug program versus MOPP versus 3-drug combinations in advanced Hodgkin's disease. A cooperative study by the Cancer and Leukemia Group B. Cancer 43:31-40 1979. A variety of alternatives to MOPP as primary treatment have been developed51 51 Nicholson WMBeard MEVCrowther Det al: Combination chemotherapy in generalized Hodgkin's disease. Br J Med 3:7-10 1970.52 52 Eckhardt SDobrentey EBodrogi I: Results obtained with combination therapy of VM-26natulan and prednisolone in generalized Hodgkin's disease. Chemotherapy 21:248-254 1975.53 53 Bloomfield CDWeiss RBFortuny Iet al: Combined chemotherapy with cyclophosphamidevinblastineprocarbazine, and prednisone (CVPP) for patients with advanced Hodgkin's disease. An alternative program to MOPP. Cancer 38:42-48 1976.54 54 Diggs CHWiernik PHLevi JAet al: Cyclophosphamide, vinblastineprocarbazine and prednisone with CCNU and vinblastine maintenance for advanced Hodgkin's disease. Cancer 39:1949-1954 1977.55 55 Harrison DTNeiman PE: Primary treatment of disseminated Hodgkin's disease with BCNU alone and in combination with vincristineprocarbazineand prednisone. Cancer Treat Rep 61:789-795 1977.56 56 McElwain TJToy JSmith Eet al: A combination of chlorambucilvinblastineprocarbazine and prednisolone for treatment of Hodgkin's disease. Br J Cancer 36:276-280 1977.57 57 Sutcliffe SBWrigley PFMPeto Jet al: MVPP chemotherapy regimen for advanced Hodgkin's disease Br Med J 1:679-683 1978.58 58 Durant JRGams RAVelez-Garcia Eet al: BCNU, velbancyclophosphamideprocarbazineand prednisone (BVCPP) in advanced Hodgkin's disease. Cancer 42:2101-2110 1978.59 59 Morgenfeld MSomoza NMagnasco Jet al: Combined chemotherapy cyclophosphamidevinblastine, procarbazine and prednisone (CVPP) vs. CVPP plus CCNU (CCVPP) in Hodgkin's disease. Cancer 43:1579-1586 1979. and comparable results have been achievedbut few studies have sufficient follow-up for definitive statements concerning disease-free and overall survival compared with MOPP. The salvage treatment of MOPP failures, invoking non-cross-resistant combinationshas been reported by many investigators.62 62 Goldman JMDawson AA: Combination therapy for advanced resistant Hodgkin's disease. Lancet 2:1225-1227 1975.63 63 Osieka RBruntsch UGallmeier WMet al: Post-MOPP-chemotherapie des Morbus Hodgkin. Dtsch Med Wochenschr 32:1177-1182 1976.64 64 Lokich JJFrei EJaffe Net al: New multiple-agent chemotherapy (B-DOPA) for advanced Hodgkin's disease. Cancer 38:667-671 1976.65 65 Levi JAWiernik PHDiggs CH: Combination chemotherapy of advanced previously treated Hodgkin's disease with streptozotocinCCNUadriamycin and bleomycin. Med Ped Oncol 3:33-35 1977.66 66 Vinciguerra VColeman MJarowski CIet al: A new combination chemotherapy for resistant Hodgkin's disease. JAMA 237:33-35 1977.67 67 Case DC JrYoung CWLee BJ III: Combination chemotherapy of MOPP-resistant Hodgkin's disease with adriamycinbleomycindecarbazineand vinblastine (ABDV). Cancer 39:1382-1386 1977.68 68 Williams SDEinhorn LH: Combination chemotherapy with doxorubicin and lomustine. Treatment of refractory Hodgkin's disease. JAMA 238:1659-1661 1977.69 69 Peterson JAmare M: Hodgkin's disease. Combination chemotherapy in resistant Hodgkin's disease. J Kans Med Soc November 1977p 466.70 70 Clamon GHCorder MP: ABVP treatment of MOPP failures with Hodgkin's disease: A re-examination of goals or salvage therapy. Cancer Treat Rep 63:363-367 1978.71 71 Krikorian JGPortlock CSRossenberg SA: Treatment of advanced Hodgkin's disease with adriamycinbleomycin, vinblastine and imidazole carboxamide (ABVD) after failure of MOPP therapy. Cancer 41:2107-2111 1978.72 72 Rossof AHKerr ROBraine HGet al: A kinetically designed chemotherapeutic regimen for advanced refractory lymphoma patients. Med Ped Oncol 4:133-139 1978.73 73 Porzig KJPortlock CSRobertson Aet al: Treatment of advanced Hodgkin's disease with B-Cave following MOPP failure. Cancer 41:1670-1675 1978.74 74 Santoro ABonadonna G: Prolonged disease-free survival in MOPP-resistant Hodgkin's disease after treatment with adriamycinbleomycinvinblastine and dacarbazine (ABVD). Cancer Chemother Pharmacol 2:101-105 1979.75 75 Fisher RIDeVita VTHubbard SPet al: Prolonged disease-free survival in Hodgkin's disease with MOPP reinduction after first relapse. Ann Intern Med 90:761-763 1979. In generalthe complete response rates are low and the disease-free and median survival data are skimpy. The two best programs with respect to complete response duration are B-DOPA64 and ABVD,74 although in additional trialsthese data have been brought into question.697071 The most complete datahoweverare those of Santoro et al.74 in which 21 MOPP failures were treated with a complete response rate of 62% and a 70% disease-free and a 73% overall survival at 3 yr. It is clear from that there are important prognostic factors influencing complete responseresponse durationand survival in patients with advanced Hodgkin's disease. Because of the influence of these prognostic factorsand because most studies have not been stratified with respect to those factors that predict for responseresponse durationand survivalthe interpretation of many studies is done with considerable difficulty. The question of the value of additional therapy beyond induction has been clearly settledas long as patients have sufficient induction treatment to achieve a pathologically documented complete response. Finallymost recent studies with radiotherapy in addition to chemotherapy in advanced disease, particularly those in which low-dose radiotherapy is directed to areas of major bulk disease, have shown an ability to reduce the 34% recurrence at 5 yr60 to an 8% recurrence at 5 yr.83 83 Prosnitz LRFarber LRFischer JJet al: Long term remission with combined modality therapy for advanced Hodgkin's disease. Cancer 37:2826-2833 1976. Although we have not developed a chemotherapy regimen that has improved on the complete response rate of MOPPradiotherapyto prevent relapseis an extremely important lead for the future management of Hodgkin's disease.

Original languageEnglish (US)
Pages (from-to)155-173
Number of pages19
JournalSeminars in Oncology
Issue number2
StatePublished - Jun 1980
Externally publishedYes

ASJC Scopus subject areas

  • Hematology
  • Oncology


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