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Long-Term Results From MOPPEBVCAD Chemotherapy With Optional Limited
Radiotherapy in Advanced Hodgkin's Disease
Paolo G. Gobbi,
Carla Pieresca,
Maria L. Ghirardelli,
Nicola DiRenzo,
Massimo Federico,
Francesco Merli,
Emilio Iannitto,
Vincenzo Pitini,
Giovanni Grignani,
Amedea Donelli,
Mario Carotenuto,
Vittorio Silingardi, and
Edoardo Ascari for the Gruppo Italiano per lo
Studio dei Linfomi
From Medicina Interna e Oncologia Medica, IRCCS
Policlinico S. Matteo, Università di Pavia, Pavia, Italy; the
Divisione di Ematologia, Ospedale "Casa Sollievo della
Sofferenza," S. Giovanni Rotondo, Foggia, Italy; the Cattedra e
Divisione di Oncologia, Università di Modena, Modena, Italy; the
Divisione di Ematologia, Ospedale S. Maria Nuova, Reggio Emilia, Italy;
the Divisione di Ematologia con Trapianto di Midollo,
Università di Palermo, Palermo, Italy; the Istituto di Clinica
Oncologica, Università di Messina, Messina, Italy; and the
Divisione di Ematologia, Università di Modena, Modena, Italy.
The purpose was to verify the 5-year results of the
MOPPEBVCAD chemotherapy regimen with limited radiotherapy in
relation to the promising preliminary data. Mechlorethamine,
vincristine, procarbazine, prednisone, epidoxorubicin, bleomycin,
vinblastine, lomustine, melphalan, and vindesine were delivered
according to a schedule derived through hybridization, intensification,
and shortening of the corresponding alternating CAD/MOPP/ABV regimen. Radiotherapy was restricted to sites of bulky involvement or to areas
that responded incompletely to chemotherapy. This multicenter, controlled, nonrandomized trial involved 145 eligible patients. Radiotherapy was administered to 47 patients, 46 of whom were in
complete remission after chemotherapy. Remissions were complete in 137 patients (94%), partial in 4 (3%), and null in the remaining 4. Tumor-specific, overall, relapse-free, and failure-free survival at 5 years were 0.89, 0.86, 0.82, and 0.78, respectively. Hematologic toxicity was considerable, whereas nonhematologic side effects were
fully acceptable. Most of the unfavorable prognostic factors lost their
clinical weight. Only age and lymphocyte depletion histologic type were
statistically correlated with major follow-up endpoints; performance
status and bone marrow involvement were subordinate to age. Seven
patients developed a second cancer (including 3 myelodysplasias).
MOPPEBVCAD with selected radiotherapy is a highly effective regimen in
advanced Hodgkin's disease. Early and late toxicity are no more severe
than what would be expected with other alternating or hybrid regimens.
A comparison with ABVD, which is currently considered the standard
regimen for advanced Hodgkin's disease, is needed.
Blood, Vol. 91 No. 8 (April 15), 1998:
pp. 2704-2712
© 1998 by The American Society of Hematology.
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