Results of CAV regimen (CCNU, melphalan, and VP-16) as third-line salvage therapy for Hodgkin's disease.

Abstract

BACKGROUND:

A prospective study was conducted to assess the efficacy and toxicity of a salvage regimen consisting of CCNU, Melphalan, and VP-16 (CAV) given at 28-day intervals in patients with Hodgkin's disease (HD) relapsing after primary therapy or refractory to the alternating MOPP/ABVD regimen.

PATIENTS AND METHODS:

This study included 58 patients (median age: 34 years), with resistant or relapsing HD. Primary therapy had consisted of alternating MOPP/ABVD (81%) or MOPP alone (19%); 38% of patients were relapsing from prior complete remission (CR) while 62% had resistant disease. Extranodal disease was present in 55% and B-symptoms in 72% of patients; one-fifth had bulky disease and/or bone marrow involvement. The CAV was used as first salvage in half of the patients.

RESULTS:

Complete remission was obtained in 17 patients (29%); unfavorable factors for CR in univariate analysis were the presence of bulky disease and the failure to achieve CR with prior therapy. Nine patients (53% of remitters) have subsequently relapsed with a 10-month median duration of CR. The 3-year overall survival after CAV was 25% with an 18-month median survival; significant differences in survival were found according to the extent of disease, the presence of B-symptoms and the HD status (prior sensitive or resistant disease, first or subsequent relapse). Seven patients are long-term remitters (12%), and one of them has been given high-dose chemotherapy and autologous bone marrow transplantation at relapse after CAV. The CAV toxicity was mostly hematological; severe pancytopenia occurred in six cases with two cases of fatal infections and one of fatal hemorrhage.

CONCLUSION:

CAV therapy was moderately effective as third-line salvage in patients with HD resistant to alternating MOPP/ABVD or previously given two different regimens for relapse; the toxicity was mostly hematological and supportive therapy was needed in one-third of the patients.

• Authors: E Brusamolino, E Orlandi, A Canevari, E Morra, G Castelli, E P Alessandrino, G Pagnucco, P Bernasconi, C Astori, M Lazzarino
• Journal: Annals of oncology : official journal of the European Society for Medical Oncology (Ann Oncol) Vol. 5 Issue 5 Pg. 427-32 (May 1994) ISSN: 0923-7534 [Print] England
• PMID: 7521204 (Publication Type: Journal Article)

Chemical References

• Bleomycin
• Procarbazine
• Mechlorethamine
• Vincristine
• Vinblastine
• Etoposide
• Lomustine
• Dacarbazine
• Doxorubicin
• Melphalan
• Prednisone

Topics

• Adolescent
• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Bleomycin (administration & dosage)
• Dacarbazine (administration & dosage)
• Doxorubicin (administration & dosage)
• Drug Resistance
• Etoposide (administration & dosage)
• Female
• Hodgkin Disease (drug therapy, mortality)
• Humans
• Lomustine (administration & dosage)
• Male
• Mechlorethamine (administration & dosage)
• Melphalan (administration & dosage)
• Middle Aged
• Pancytopenia (chemically induced)
• Prednisone (administration & dosage)
• Procarbazine (administration & dosage)
• Prospective Studies
• Recurrence
• Remission Induction
• Salvage Therapy
• Survival Rate
• Vinblastine
• Vincristine (administration & dosage)