CCNU, VINBLASTINE, PROCARBAZINE AND PREDNISONE (CVPP) WITH EXTENDED-FIELD RADIOTHERAPY IN THE TREATMENT OF EARLY UNFAVORABLE HODGKINS-DISEASE - A PROSPECTIVE-STUDY ON BEHALF OF THE GRUPPO-ITALIANO-PER-LO-STUDIO-DEI-LINFOMI (GISL)

Purpose. To test the adequacy of the CVPP four-drug regimen as ancilla ry chemotherapy associated with extended-field radiotherapy in the tre atment of early, unfavorable, clinically staged Hodgkin's disease. Pat ients and Methods. The population of this prospective, multicenter stu dy consisted of 49 patients with stage I-II disease, associated with b ulky involvement or unfavorable histology (lymphocyte-depleted nodular sclerosis or lymphocyte depletion), systemic symptoms or extranodal i nvolvement, or presenting with stage III A favorable-histology disease , with or without extranodal involvement. Results. Complete remission was achieved in 39 patients, partial remission in 2, while 8 patients did not respond. Four patients have relapsed so far (median follow-up: 43 months), all of whom were subsequently rescued with different salv age treatments. Dose intensity (mean+/-SD: 0.83+/-0.12) and hematologi cal toxicity (including 2 deaths from infection) were higher when RT f ollowed CT than when it was interposed in the middle of the 6 cycles. No growth factors were used. Nonhematological toxicity was very low an d fully tolerable. Conclusions. Results confirmed the mild neurologica l and gastroenteric side effects of CVPP that make it an interesting M OPP-variant regimen. This combination seems most indicated when a regi men devoid of cardiac and pulmonary toxicity is required for associati on with full-dosage mediastinal radiotherapy, as is often the case in early, unfavorable Hodgkin's disease. The optimal sequence consists of radiotherapy administered after completion of the chemotherapy progra m. The use of growth factors for correction (or prevention) of marked leukopenia seems appropriate.