HYBRID MOPP ABVD AND RADIOTHERAPY IN ADVANCED HODGKINS-DISEASE

Background: In patients with advanced Hodgkin's disease (HD), the alte rnation of MOPP with ABVD or hybrid MOPP/ABVD are associated with a hi gh CR rate and a high probability of 5-year survival. However, even af ter effective chemotherapy the risk of nodal relapse is not negligible , and not only in initial bulky site(s) of disease. For this reason, i n an attempt to prevent relapses after combination chemotherapy alone, we performed a prospective study to evaluate the efficacy and toxic e ffects of 6 courses of hybrid MOPP/ABVD followed by radiotherapy (RT) in stages IT A bulky, II B, III and also in stage TV with bulky diseas e or residual after chemotherapy. Patients and methods: From January 1 985 to August 1993, 133 patients with HD (128 newly diagnosed, stage I I A bulky-IV 5 in first relapse after RT) were treated according to th e following program: 6 courses of the hybrid MOPP/ABVD regimen followe d by RT (STNI + spleen in stages II A, If B, III without pelvic lymph node involvement, TNI + spleen in stage III with pelvic lymph node inv olvement, involved field in stage IV with bulky disease or residual af ter chemotherapy). The total dose of RT was 4000 cGy to the sites of b ulky or residual disease and 2000 cGy to the other sites. Results: Aft er hybrid MOPP/ABVD, 107 of 130 (82.3%) fully evaluable patients were classified as in CR or CR(U). After completion of RT, 108 patients wer e in CR and 3 were in PR, for an overall response rate of 85%. With a median follow-up duration of 45 months, the actuarial 5-year survival is 76% and the progression-free survival 68.6%. So far, only 14, patie nts have relapsed (6 within the irradiation field) and the 5-year rela pse-free survival is 82.5%. Conclusion: Six courses of hybrid MOPP/ABV D followed by RT in stages II A bulky, II B, III and in stage IV with bulky disease or residual after chemotherapy produced a high CR rate w ith low risk of relapse. However, a longer follow-up is necessary to e valuate the late effects of combined therapy.