ABVD and radiation therapy as first-line treatment in advanced Hodgkin's disease

The purpose of this study was to evaluate the efficacy of doxorubicin, bleo mycin, vinblastine, and dacarbazine (ABVD) and radiotherapy in advanced Hod gkin's disease. In addition, to evaluate whether patients with slow respond ing tumors could profit from the early change of treatment regimen [MOPP (m echloretamine, vincristine, procarbazine, and prednisone)] followed by radi ation therapy or autologous bone marrow transplantation (ABMT). Finally, to evaluate treatment options for patients with both early and late relapses. A total of 78 patients with previously untreated stages IIA bulky, IIB, II I (A and B), and IV(A and B) Hod,akin's disease were treated with the ABVD regimen followed by radiotherapy. Patients with stages IIIB and IV (A and B ) were re-staged after 4 ABVD courses of the treatment: slow responders (re sponse less than 70%) underwent second-line treatment (MOPP) and eventually ABMT, Relapsed patients with a long initial complete response (greater tha n or equal to 12 months) were treated with second-line conventional treatme nt and those patients with a short initial complete response (< 12 months) underwent ABMT. The complete response (CR) rate was 91% after ABVD and radi ation therapy. An additional 5 stage IIIB and IV patients whose therapy was switched after 4 cycles because of a slow response obtained a CR (3 after 2 MOPP courses plus radiotherapy and 2 after 2 MOPP courses followed by ABM T). Including these additional CRs, the overall CR rate was 97%. No episode s of clinical cardiopulmonary toxicity were observed. With a median follow- up time of 42 months, the 4-year relapse-free survival was 87%. The 4-year overall survival was 96%. Ten cases relapsed: all but one obtained a second CR with different approaches depending on the timing of relapse, The ABVD regimen appears to be effective and well tolerated confirming the validity of this four-drug regimen in the treatment of advanced Hodgkin's disease. I n addition, therapeutic choices based on the timing of the relapse and the use of re-staging after 4 cycles in order to identify slow responders can p lay an important role in increasing the number of cured patients.