Comparison of adriamycin‐containing chemotherapy (MOP‐BAP) with MOPP‐bleomycin in the management of advanced Hodgkin‐s disease a southwest oncology group study

Between 1974 and 1978, 315 eligible patients with advanced Hodgkin‐s disease (HD) without prior chemotherapy were randomized to MOPP plus low‐dose bleomycin or the same agents plus Adriamycin (in 1 of 2 schedules). The results of the two Adriamycin‐containing schedules were similar and were, therefore, combined as „MOP‐BAP and compared to MOPP‐Bleo. All patients completed remission induction therapy with a median time on study of 47 months. Of 291 evaluable patients, the complete remission rate was 77% for 166 patients treated with MOP‐BAP compared to 67% for 125 patients receiving MOPP‐Bleo (P = 0.05, one‐sided test). Among patients with more favorable pretreatment prognostic factors, MOP‐BAP produced a higher CR rate than MOPP‐Bleo (patients with hemoglobin ≥ 12 g/dl, 85 versus 67%, P = 0.01; those with a performance status of 70‐100%, 81 versus 70%, P = 0.03; those without bone marrow involvement, 81 versus 68%, P = 0.03, those older than age of 40 years, 79 versus 62%, P = 0.03; those who were asymptomatic [A], 94 versus 77%, P = 0.04; and those without any prior therapy, 75 versus 63%, P = 0.04). CR duration and overall survival were similar for the two treatments. However, survival was better for patients with favorable pretreatment prognostic factors treated with MOP‐BAP compared to MOPP‐Bleo (those who were asymptomatic [P = 0.08], without bone marrow involvement [P = 0.04], and with nearly normal initial hemoglobin levels [P = 0.02]). MOP‐BAP was associated with less nausea and vomiting and significantly less thrombocytopenia than MOPP‐Bleo (P = 0.01). For patients with prognostically more favorable types of HD, the use of an initial Adriamycin‐containing MOPP regimen (MOP‐BAP) offers a higher complete remission rate, less acute toxicity and improved survival compared to MOPP‐Bleo.