Treatment of advanced stage Hodgkin's disease

Hodgkin's disease remains one of the few malignant diseases which can be cu red by modern chemotherapy in most cases even in advanced stages. Adriamyci n-containing chemotherapy regimens are considered as the standard therapy w hich induce long-term remission in about 60-70 % of patients. The ABVD sche me, developed by Bonadonna and colleagues in Milan, has a favorable toxicit y profile and causes less myelotoxicity, acute leukemia or sterility relati ve to many previous treatment programs containing alkylating agents. Howeve r, 20-30 % of patients eventually relapse and are then frequently treated w ith high-dose prog rams including stem cell transplantation. There are two major goals in advanced Hodgkin's disease: (1) to improve the cure rate and (2) to reduce acute and long-term toxicities. The recent definition of pro gnostic factors identified patients who a re at a high risk of treatment fa ilure as well as those in whom less toxic approaches can be applied. The op timal approach or program has not yet been defined, although new chemothera py regimens such as BEACOPP and Stanford V with increased tumor response ra tes have been identified. These new drug combinations are currently analyze d and compared with ABVD in several international trials. While the additio n of radiotherapy improved disease control in some trials a survival benefi t was not identified and the role of radiotherapy remains controversial. Hi gh dose programs remain experimental in advanced stage Hodgkin's disease an d should be restricted to prospective clinical trials. Copyright (C) 2001 S . Karger AG, Basel.