ALTERNATING VERSUS HYBRID MOPP AND ABVD COMBINATIONS IN ADVANCED HODGKINS-DISEASE - 10-YEAR RESULTS

Purpose: To compare, in a prospective randomized trial, the efficacy o f two different sequences of mechlorethamine, vincristine, procarbazin e, and prednisone (MOPP) and doxorubicin, bleomycin, vinblostine, and dacarbazine (ABVD) chemotherapy in untreated advanced Hodgkin's diseas e. Patients and Methods: From June 1982 to September 1990, 427 consecu tive previously untreated patients with pathologic stage IB, IIA bulky , IIB, III (A and B), and IV (A and B) disease were prospectively rand omized to receive two different sequences of MOPP and ABVD for a minim um of six cycles followed by radiotherapy (median dose, 30 Gy) to the nodal site(s) of pretreatment bulky disease, Of 415 assessable patient s, 211 received one cycle of MOPP monthly, alternated with one cycle o f ABVD (alternating regimen), and 204 patients received one-half cycle of MOPP alternated with one-half cycle of ABVD within a 1-month perio d (hybrid regimen). Results. The complete remission (CR) rate was 91% with the alternating regimen and 89% with the hybrid regimen. At 10 ye ars, the freedom-from-progression (FFP) rate was 67% versus 69% and th e overall survival (OS) rate was 74% versus 72%, respectively. After a ttainment of CR, 85 patients relapsed in nodal (n = 60) versus extrano dal with or without nodal (n = 25) sites, In patients given consolidat ive radiation because of bulky lymphoma, the true recurrence rate was 13%. A total of 23 second malignancies (6%) were documented, including 11 Eases of acute nonlymphocytic leukemia. No cases of congestive hea rt failure attributable to doxorubicin or pulmonary toxicity related t o bleomycin were documented. Conclusion: By delivering MOPP and ABVD, it is possible to cure approximately 70% of patients with advanced Hod gkin's disease. The two different drug sequences yielded superimposabl e results. (C) 1996 by American Society of Clinical Oncology.