Hybrid chemotherapy consisting of cyclophosphamide, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (C‐MOPP/ABV) as first‐line treatment for patients with advanced hodgkin disease

BACKGROUND.Combination chemotherapy, including hybrid regimens, is the standard treatment for patients with advanced Hodgkin disease (HD).Although a prolonged complete response (CR) is achieved in up to 70 -80% of patients, long term complications, such as secondary leukemia, are of concern.Cyclophosphamide, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (C-MOPP/ABV) is a hybrid chemotherapy in which cyclophosphamide is substituted for mechlorethamine, an agent that has been implicated as the cause of secondary malignancies. METHODS.Seventy-three patients (37 males and 36 females; median age, 35 years) diagnosed with Stage III or IV HD or Stage II with bulky disease, B-symptoms, elevated erythrocyte sedimentation rate, or hilar adenopathy were treated with 8 courses of C-MOPP/ABV at a single institution during a 6-year period.Radiotherapy (RT) was administered when bulky disease or residual masses were present.Endpoints of the study were response to therapy, failure free survival (FFS), overall survival (OS), and toxicity. RESULTS.Sixty-five patients (90%) received the 8 planned courses, with 49 of them (70%) receiving the full prescribed doses.After chemotherapy, 57 patients (78%) reached CR.Seven additional patients who achieved partial response (PR) reached CR after complementary radiotherapy, with an overall CR rate of 88%.The median follow-up was 31 months.Twelve patients relapsed; the 4-year FFS was 66% (95% CI, 54 -78%).Two patients died during treatment because of sepsis and four due to disease progression.The 4-year OS was 92% (95% CI, 86 -98%).Age Ͼ 60 years and bone marrow involvement were related to severe infectious complications.No late toxicity was reported.CONCLUSIONS.C-MOPP/ABV induces CR with acceptable toxicity in a high proportion of advanced HD patients.