Zinzani P L, Magagnoli M, Frezza G, Barbieri E, Gherlinzoni F, Galuppi A, Bendandi M, Merla E, Albertini P, Babini L, Tura S
Institute of Hematology and Oncology Seràgnoli, University of Bologna, Italy.
Leuk Lymphoma. 1999 Feb;32(5-6):553-9. doi: 10.3109/10428199909058413.
The purpose of this study was to evaluate the efficacy of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and radiotherapy in advanced Hodgkin's disease. In addition, to evaluate whether patients with slow responding tumors could profit from the early change of treatment regimen [MOPP (mechloretamine, vincristine, procarbazine, and prednisone)] followed by radiation therapy or autologous bone marrow transplantation (ABMT). Finally, to evaluate treatment options for patients with both early and late relapses. A total of 78 patients with previously untreated stages IIA bulky, IIB, III (A and B), and IV (A and B) Hodgkin's disease were treated with the ABVD regimen followed by radiotherapy. Patients with stages IIIB and IV (A and B) were re-staged after 4 ABVD courses of the treatment: slow responders (response less than 70%) underwent second-line treatment (MOPP) and eventually ABMT. Relapsed patients with a long initial complete response (> or = 12 months) were treated with second-line conventional treatment and those patients with a short initial complete response (< 12 months) underwent ABMT. The complete response (CR) rate was 91% after ABVD and radiation therapy. An additional 5 stage IIIB and IV patients whose therapy was switched after 4 cycles because of a slow response obtained a CR (3 after 2 MOPP courses plus radiotherapy and 2 after 2 MOPP courses followed by ABMT). Including these additional CRs, the overall CR rate was 97%. No episodes of clinical cardiopulmonary toxicity were observed. With a median follow-up time of 42 months, the 4-year relapse-free survival was 87%. The 4-year overall survival was 96%. Ten cases relapsed: all but one obtained a second CR with different approaches depending on the timing of relapse. The ABVD regimen appears to be effective and well tolerated confirming the validity of this four-drug regimen in the treatment of advanced Hodgkin's disease. In addition, therapeutic choices based on the timing of the relapse and the use of re-staging after 4 cycles in order to identify slow responders can play an important role in increasing the number of cured patients.
本研究的目的是评估多柔比星、博来霉素、长春碱和达卡巴嗪（ABVD）联合放疗在晚期霍奇金病中的疗效。此外，评估肿瘤反应缓慢的患者是否能从早期改变治疗方案[MOPP（氮芥、长春新碱、丙卡巴肼和泼尼松）]后接受放疗或自体骨髓移植（ABMT）中获益。最后，评估早期和晚期复发患者的治疗选择。共有78例先前未经治疗的IIA期大包块、IIB期、III（A和B）期以及IV（A和B）期霍奇金病患者接受ABVD方案治疗后再行放疗。IIIB期和IV（A和B）期患者在接受4个周期的ABVD治疗后重新分期：反应缓慢者（反应率低于70%）接受二线治疗（MOPP）并最终接受ABMT。初始完全缓解期长（≥12个月）的复发患者接受二线传统治疗，而初始完全缓解期短（<12个月）的患者接受ABMT。ABVD联合放疗后的完全缓解（CR）率为91%。另外5例IIIB期和IV期患者因反应缓慢在4个周期后更换治疗方案，其中3例在接受2个周期MOPP方案加放疗后获得CR，2例在接受2个周期MOPP方案后接受ABMT并获得CR。包括这些额外的CR病例，总体CR率为97%。未观察到临床心肺毒性事件。中位随访时间为42个月，4年无复发生存率为87%。4年总生存率为96%。10例患者复发：除1例患者外，其余患者均根据复发时间采用不同方法再次获得CR。ABVD方案似乎有效且耐受性良好，证实了这种四联方案在治疗晚期霍奇金病中的有效性。此外，根据复发时间进行治疗选择以及在4个周期后重新分期以识别反应缓慢者，对于增加治愈患者数量可发挥重要作用。
