MOPP OR RADIATION IN ADDITION TO ABVD IN THE TREATMENT OF PATHOLOGICALLY STAGED ADVANCED HODGKINS-DISEASE IN CHILDREN - RESULTS OF THE CHILDRENS CANCER GROUP PHASE-III TRIAL

purpose: A randomized trial designed to compare mechlorethamine, vincr istine, procarbazine, and prednisone (MOPP)/doxorubicin, bleomycin, vi nblastine, and daccarbazine (ABVD) (regimen A) with ABVD plus low-dose regional (extended-field) radiation therapy (EF RT) (regimen B) for t he treatment of children and adolescents with stages III and IV Hodgki n's disease was conducted by the Children's Cancer Group (CCG-521) fro m 1986 until 1990. Patients and Methods: One hundred eleven eligible p atients were randomized, 57 to regimen A and 54 to regimen B. All pati ents had pathologically verified stage III or stage IV Hodgkin's disea se. Results: Overall survival (S) is 87% at 4 years and event-free sur vival (EFS) is 82%, patients randomized to ABVD plus EF RT have a Q-ye ar EFS of 87% compared with 77% for patients randomized to MOPP/ABVD ( P = .09, two-sided), Patients randomized to ABVD plus EF RT have a 4-y ear S of 90% compared with 84% for patients randomized to MOPP/ABVD (P = .45, two-sided). Significant prognostic factors in multivariate ana lysis for EFS are stage of disease, erythrocyte sedimentation rate (ES R) at diagnosis, liver size at diagnosis, and, among stage III patient s, the size of the mediastinal mass at diagnosis. The acute toxicities of treatment are largely hematopoietic in nature, whereas acute pulmo nary and cardiac toxicities are modest and not limiting. Conclusion: T he results of this study show that, in advanced-stage Hodgkin's diseas e in children, equivalent results can be obtained by the addition of e ither MOPP or low-dose EF RT to the ABVD regimen; whether the addition of either contributes to outcome was not addressed in this study and will require additional testing. It is clear, however, that MOPP chemo therapy can safely be eliminated from front-line combination chemother apy regimens for advanced Hodgkin's disease in pediatric patients. (C) 1998 by American Society of Clinical Oncology.