MOPPEBVCAD CHEMOTHERAPY WITH LIMITED RADIOTHERAPYIN ADVANCED HODGKIN’S LYMPHOMA: 10-YEARRESULTS

Background: In 1987 the MOPPEBVCAD chemotherapy regimen wasone of the first attempts at reducing late toxicity and second tumor incidencewhile carrying out some basic concepts of the Goldie and Coldmantheory on cell growth to increase effectiveness. The new treatment programintensified and hybridized all the drugs of three previously alternatingregimens (CAD, MOPP and ABV), lowered the cumulative dose ofmechlorethamine and made irradiation optional, reducing it to no morethan 2 sites which responded uncertainly or partially to chemotherapy.Methods: The patients treated so far with MOPPEBVCAD were includedin one open and controlled GISL study and in two randomized trials(GISL and IIL) in which it represented one of the compared treatmentarms. Staging and treatment criteria were identical in the 3 trials. Drugdosages (mg/sm) were as follows: HN2 6 i.v. d 1 (cycles 1, 3 and 5),CCNU 100 p.o. d 1 (cycles 2, 4 and 6), VDZ 3 i.v. d 1, MPH 6 p.o.d 1–3, Pred p.o. 40 d 1–14, EPI 40 i.v. d 8, VCR i.v. d 8, PCZ 100 p.o.d 8–14, VBL 6 i.v. d 15 and Bleo i.v. 10 d 15 (q 28 day for 6 cycles).Radiotherapy doses ranged from 25 to 40 Gy.Results: A total of 307 treated patients were reviewed. With a median follow-up of 110 months, 10-year overall-, disease- and failure-free survivalwere 78%, 81%, 79%, respectively. Two hundred and ninety patients (94%) achieved complete remission, 12 (4%) obtained partial responsewhile 5 (2%) did not respond. Forty-two patients relapsed and 60 died.The causes of death were Hodgkin’s lymphoma in 36 patients, secondneoplasms in 12, cardiorespiratory diseases in 4, pulmonary diseases in 2,and unknown in 6. Sixteen second tumors were diagnosed, 9 myelodisplasiasand/or acute leukemias, 3 secondary non-Hodgkin’s and 4 solidtumors. Among these patients deaths due to second neoplasms were 8, 2and 2, respectively.Conclusions: Clinical response and long-term results are excellent, atleast as good as that from the best and most recent therapeutic combinations,and better than those attainable with MOPP or MOPP-like regimens.The second tumor incidence, however, is still too similar as thatrecorded with MOPP and MOPP variants and stimulates further effortstowards selected modifications of the schedule which can maintain effectivenesswhile reducing oncogeneity.