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Early versus late intensification for patients with high‐risk Hodgkin lymphoma—3 Cycles of intensive chemotherapy plus low‐dose lymph node radiation therapy versus 4 cycles of combined doxorubicin, bleomycin, vinblastine, and dacarbazine plus myeloablative chemotherapy with autologous stem cell transplantation
Author(s) -
Arakelyan Nina,
Berthou Christian,
Desablens Bernard,
de Guibert Sophie,
Delwail Vincent,
Moles MariePierre,
Quittet Philippe,
Jais JeanPhilippe,
Colonna Pierre,
Andrieu JeanMarie
Publication year - 2008
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.23979
Subject(s) - medicine , abvd , dacarbazine , vinblastine , etoposide , carmustine , vindesine , chemotherapy , gastroenterology , melphalan , surgery , urology , vincristine , cyclophosphamide
BACKGROUND. The 5‐year freedom from treatment failure (FFTF) rate, with treatment failure defined as the lack of post‐treatment complete remission (CR), recurrence, or death, ranges from 60% to 70% after 6 to 8 cycles of combined doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), which is the reference treatment for patients with advanced Hodgkin lymphoma (HL). In this randomized, phase 2 study, the authors tested 2 intensive chemotherapy regimens in 158 patients with clinical stage (CS) IIB through IV HL accompanied by high‐risk factors who were recruited between May 1997 and December 2004. METHODS. High‐risk CS IIB, III, and IV were defined by the presence of ≥5 involved lymphoid areas, and/or a mediastinal mass ratio ≥0.45, and/or ≥2 extra lymph node sites affected by the disease (for CS IV). In Arm V, 82 patients received 3 courses of combined vindesine (5 mg/m 2 ), doxorubicin (99 mg/m 2 ), carmustine (140 mg/m 2 ), etoposide (600 mg/m 2 ), and methylprednisolone (600 mg/m 2 ) (VABEM) followed by low‐dose lymph node irradiation. In Arm A, 76 patients received 4 cycles of ABVD followed by myeloablative combined carmustine (300 mg/m 2 ), etoposide (800 mg/m 2 ), cytarabine (1600 mg/m 2 ), and melphalan (140 mg/m 2 ) and underwent autologous stem cell transplantation. RESULTS. After 3 cycles of VABEM, the CR rate was 89% versus 60% after 4 cycles of ABVD. However, after the completion of treatment, the CR rates for Arms V and A were similar (89% and 88%, respectively). The 5‐year FFTF rates for Arms V and A also were similar (79% and 75%, respectively) along with the 5‐year overall survival rates (87% and 86%, respectively). CONCLUSIONS. Early intensification (Arm V) and late intensification (Arm A) were equally effective for treating patients with high‐risk/advanced HL. Cancer 2008. © 2008 American Cancer Society.