FIRED VERSUS RESPONSE-ADAPTED MOPP ABVD CHEMOTHERAPY IN HODGKINS-DISEASE - A PROSPECTIVE RANDOMIZED TRIAL/

Background: The optimal number of chemotherapy courses in responding p atients with advanced-stage Hodgkin's disease (HD) is unknown. Patient s and methods: With minimizing chemotherapy and thereby reducing late complications as the objective, patients with advanced HD were randomi zed to receive either 4 full MOPP/ABVD courses or treatment up to comp lete remission (CR). Forty-seven patients were given the fixed (FT) an d 41 patients the individual treatment (IT). The two groups were balan ced according to age, histopathology and sex, although stage IVB domin ated in the IT group (20 vs. 8). Results: Sixty-six of 88 patients (75 %) achieved CR. No difference between the two treatment groups in the proportion of stage IVB patients was seen when those achieving CR, i.e ., the efficacy population were compared. The mean number of single ch emotherapy courses given was 3.7 of MOPP and 3.5 of ABVD in the FT gro up, compared to 2.6 of MOPP and 2.5 of ABVD in the IT group (p < 0.001 ). The predicted progression-free survival at 10 years-was 81% in the FT and 68% in the IT arm, respectively (p < 0.05). No statistically si gnificant difference in cause-specific 10-year survival was observed ( 82% and 83%, respectively; p = 0.18). Long-standing CRs were achieved following minimal chemotherapy. Conclusions. Since there are no availa ble methods to identify long-term disease-free survivors among CR pati ents following a limited induction treatment, we suggest that the poli cy of giving 3-4 full MOPP/ABVD courses should continue. The price for such an approach is the overtreatment of a subset of already cured pa tients.