Rapidly alternating COPP/ABV/IMEP is not superior to conventional alternating COPP/ABVD in combination with extended-field radiotherapy in intermediate-stage Hodgkin's lymphoma: final results of the German Hodgkin's Lymphoma Study Group Trial HD5.

Abstract

PURPOSE:

To investigate whether treatment results in intermediate-stage Hodgkin's lymphoma can be improved by rapid application of non-cross-resistant drugs, the 10-drug regimen cyclophosphamide, vincristine, procarbazine, and prednisone (COPP), doxorubicin, bleomycin, and vinblastine (ABV), and ifosfamide, methotrexate, etoposide, and prednisone (IMEP), repeated every 6 weeks, was compared with conventional alternating COPP/doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) administered every 8 weeks.

PATIENTS AND METHODS:

From January 1988 to January 1993, 996 patients in stage I or II Hodgkin's lymphoma with at least one risk factor (massive mediastinal tumor, massive spleen involvement, extranodal disease, elevated ESR, or more than two lymph node areas involved) and all patients in stage IIIA Hodgkin's lymphoma were randomized to receive two cycles of COPP/ABVD or COPP/ABV/IMEP followed by extended-field radiotherapy.

RESULTS:

Both regimens produced similar rates for treatment responses (complete remission, 93% v 94%), freedom from treatment failure (80% v 79%), and overall survival (88% for both regimens) at a median follow-up time of 7 years. Most serious toxicities during chemotherapy were similar in both regimens. However, World Health Organization grade 3 and 4 leukocytopenia occurred significantly more frequently in the COPP/ABV/IMEP arm (53% v 44% of patients; P =.010). There were no differences in the number of serious infections and toxic deaths during therapy. The number of second malignancies was also the same in both arms (22 each).

CONCLUSION:

Alternating COPP/ABVD and rapid alternating COPP/ABV/IMEP in combination with extended-field radiotherapy are equally effective in intermediate-stage Hodgkin's lymphoma and produce excellent long-term treatment results.

• Authors: Markus Sieber, Hans Tesch, Beate Pfistner, Ulrich Rueffer, Bernd Lathan, Oana Brosteanu, Ursula Paulus, Tina Koch, Michael Pfreundschuh, Markus Loeffler, Andreas Engert, Andreas Josting, Jürgen Wolf, Dirk Hasenclever, Jeremy Franklin, Eckhart Duehmke, Axel Georgii, Klaus-Peter Schalk, Hartmut Kirchner, Gottfried Doelken, Reinhold Munker, Peter Koch, Richard Herrmann, Richard Greil, Anna Paola Anselmo, Volker Diehl
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 20 Issue 2 Pg. 476-84 (Jan 15 2002) ISSN: 0732-183X [Print] United States
• PMID: 11786577 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Bleomycin
• Procarbazine
• Vincristine
• Vinblastine
• Etoposide
• Dacarbazine
• Doxorubicin
• Cyclophosphamide
• Ifosfamide
• Prednisone
• Methotrexate

Topics

• Adolescent
• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, therapeutic use)
• Bleomycin (administration & dosage)
• Combined Modality Therapy
• Cyclophosphamide (administration & dosage)
• Dacarbazine (administration & dosage)
• Disease-Free Survival
• Doxorubicin (administration & dosage)
• Etoposide (administration & dosage)
• Female
• Hodgkin Disease (drug therapy, pathology, radiotherapy)
• Humans
• Ifosfamide (administration & dosage)
• Male
• Methotrexate (administration & dosage)
• Middle Aged
• Prednisone (administration & dosage)
• Procarbazine (administration & dosage)
• Treatment Outcome
• Vinblastine (administration & dosage)
• Vincristine (administration & dosage)