Two different schedules for integrating filgrastim as adjuvant therapy in the treatment of patients with advanced stage Hodgkin's lymphoma receiving MOPP/ABV hybrid chemotherapy

Purpose: Management of advanced-stage Hodgkin's disease with a MOPP/ABV hyb rid regimen (mechlorethamine, vincristine, procarbazine, prednisone, Adriam ycin, bleomycin and vinblastine) has yielded a high complete response rate (75-85%). However, myelosuppression can limit delivery of treatment. Filgra stim has been shown to reduce chemotherapy-related neutropenia and allow fo r on-time administration of planned doses of chemotherapeutic agents. The o bjective of this study was to find the best way to integrate filgrastim wit h the MOPP/ABV hybrid regimen. Methods: Enrolled in this study were 24 pati ents (aged 18-52 years) with newly diagnosed, histologically documented Hod gkin's disease. In schedule I, patients received filgrastim (5 mu g/kg s.c. daily) beginning on day 9, 24 h after administration of ABV. In schedule I I, patients received filgrastim concomitantly with procarbazine on days 2-7 (starting 24 h after day-1 MOPP administration and stopping 24 h before AB V administration) as well as after ABV beginning on day 9. Filgrastim after ABV administration was administered until two consecutive ANC readings of 10 x 10(9)/1 were achieved. Results: All patients were able to complete all six cycles of therapy. There was a trend to fewer dose reductions in sched ule II (0.76%) as compared to schedule I (4.2%) with a P-value of 0.077 (ch i-squared test). Specifically, 11.6% of MOPP courses and 5.5% of ABV course s were dose-reduced in schedule I versus 1.7% and 1.4%, respectively, in sc hedule II. Conclusion: In conclusion, filgrastim was effective in supportin g the delivery of the MOPP/ABV chemotherapy. Concomitant administration of filgrastim with procarbazine (days 2-7) appears to be safe and allows the m aximum dose intensity of this therapy.