OUTCOME OF PATIENTS WITH HODGKINS-DISEASE FAILING AFTER PRIMARY MOPP-ABVD

Purpose: This study analyzed long-term results in patients with Hodgki n's disease who were resistant to or relapsed after first-fine treatme nt with MOPP and ABVD. Response to salvage treatments and prognostic f actors were also evaluated. Patients and Methods: The study population included 115 refractory or relapsed patients among a total of 415 pat ients treated with alternating or hybrid MOPP-ABVD followed by radioth erapy (25 to 30 Gy) to initial bulky sites. The median follow-up durat ion of the present series was 91 months. Thirty-nine of 115 patients ( 34%) showed disease progression while on primary treatment (induction failures); 48 relapsed after complete remissions that lasted less than or equal to 12 months and 28 after complete remission that lasted mor e than 12 months from the end of all treatments. Results: At 8 years, the overall survival rate was 27%, being 54% and 28% in patients whose initial complete remission was longer or shorter than 12 months, resp ectively, and 8% in induction failures (P < .001), Response to first-l ine chemotherapy and disease extent at first progression significantly influenced long-term results, as well as the incidence and duration o f complete remission. Conclusion: The present data confirm previous ob servations that showed the main prognostic factors to influence outcom e after salvage treatment are response duration to first-line therapy and disease extent at relapse, The results indicate that patients who relapse after the alternating MOPP/ABVD regimen have a prognosis simil ar to that of patients who relapse after a four-drug regimen (MOPP or ABVD alone), Re-treatment with initial chemotherapy seems the treatmen t of choice for patients who relapse after an initial complete remissi on that lasts greater than 12 months, while the real impact of high-do se chemotherapy or new regimens should be assessed in resistant patien ts. (C) 1997 by American Society of Clinical Oncology.