ANALYSIS OF LONG-TERM RESULTS AND PROGNOSTIC FACTORS AMONG 138 PATIENTS WITH ADVANCED HODGKINS-DISEASE TREATED WITH THE ALTERNATING MOPP ABVD CHEMOTHERAPY

Background. A prospective study was conducted to assess (a) the long-t erm results and toxicity of the alternating MOPP/ABVD regimen in advan ced Hodgkin's disease; (b) the prognostic value of pretreatment variab les and of drug dose intensity. Patients and methods: A total 138 cons ecutive patients with advanced Hodgkin's disease entered this study; p atient selection included stages IIB (33% of total), IIIB (26%), IV (2 5%), and stages IIA-IIIA (16%) with bulky disease and pulmonary hilum involvement. The MOPP/ABVD program was delivered in an 8-month program ; adjuvant radiotherapy on sites of bulky disease was delivered in 24 patients. Results: Complete remission was obtained in 106 (77%) patien ts; significant factors for CR in univariate analysis were stage, symp toms, histology, and bone marrow involvement. The five-year relapse-fr ee survival (RFS) was 83%; in a multivariate analysis, histology only correlated with RFS (p = 0.04). The five-year freedom from tumor morta lity and overall survival (OS) were 79% and 67%, respectively. An adve rse prognostic significance for OS was observed for B symptoms and bon e marrow involvement. The median percentage of relative dose intensity (RDI) was as follows: Adriamycin 86, mechlorethamine 85, vincristine 73, vinblastine 84, bleomycin 79, procarbazine 74, dacarbazine 81. No significant association was found between RDI and clinical outcome. No severe pancytopenia or life-threatening complications occurred during therapy. Conclusions: Alternating MOPP and ABVD cured more than 65% o f patients with advanced HD; acute and late toxicity were acceptable. Prognostic analysis defined subgroups with a lower chance of cure whic h may deserve a more intensive initial therapy.