标准剂量和增加剂量的BEACOPP化疗与COPP-ABVD化疗治疗晚期霍奇金淋巴瘤的比较

Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin's disease.

作者信息

Diehl Volker, Franklin Jeremy, Pfreundschuh Michael, Lathan Bernd, Paulus Ursula, Hasenclever Dirk, Tesch Hans, Herrmann Richard, Dörken Bernd, Müller-Hermelink Hans-Konrad, Dühmke Eckhardt, Loeffler Markus

机构信息

First Department of Internal Medicine, University of Cologne, Cologne, Germany.

出版信息

N Engl J Med. 2003 Jun 12;348(24):2386-95. doi: 10.1056/NEJMoa022473.

DOI:10.1056/NEJMoa022473

PMID:12802024

Abstract

BACKGROUND

Faced with unsatisfactory results of treatment for advanced Hodgkin's disease, we investigated three combinations of chemotherapy.

METHODS

From 1993 to 1998, 1201 eligible patients 15 to 65 years of age who had newly diagnosed Hodgkin's disease in unfavorable stage IIB or IIIA or stage IIIB or IV were randomly assigned to receive eight cycles of cyclophosphamide, vincristine, procarbazine, and prednisone alternating with doxorubicin, bleomycin, vinblastine, and dacarbazine (COPP-ABVD); bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP); or increased-dose BEACOPP, each followed by local radiotherapy when indicated. Enrollment in the COPP-ABVD group was stopped in 1996 owing to inferior results.

RESULTS

For the final analysis, 1195 of 1201 patients could be evaluated: 260 in the COPP-ABVD group, 469 in the BEACOPP group, and 466 in the increased-dose BEACOPP group; the median follow-up was 72, 54, and 51 months, respectively. The rate of freedom from treatment failure at five years was 69 percent in the COPP-ABVD group, 76 percent in the BEACOPP group, and 87 percent in the increased-dose BEACOPP group (P=0.04 for the comparison of the COPP-ABVD group with the BEACOPP group and P<0.001 for the comparison of the increased-dose BEACOPP group with the COPP-ABVD group and with the BEACOPP group), and the five-year rates of overall survival were 83 percent, 88 percent, and 91 percent, respectively (P=0.16 for the comparison of the COPP-ABVD group with the BEACOPP group, P=0.06 for the comparison of the BEACOPP group with the increased-dose BEACOPP group, and P=0.002 for the comparison of the COPP-ABVD group with the increased-dose BEACOPP group). Rates of early progression were significantly lower with increased-dose BEACOPP than with COPP-ABVD or standard BEACOPP.

CONCLUSIONS

Increased-dose BEACOPP resulted in better tumor control and overall survival than did COPP-ABVD.

摘要

背景

面对晚期霍奇金病治疗效果不尽人意的情况，我们研究了三种化疗方案组合。

方法

1993年至1998年，1201例年龄在15至65岁之间、新诊断为处于不良IIB期或IIIA期、IIIB期或IV期霍奇金病的符合条件患者被随机分配接受八个周期的环磷酰胺、长春新碱、丙卡巴肼和泼尼松与多柔比星、博来霉素、长春碱和达卡巴嗪交替使用（COPP-ABVD）；博来霉素、依托泊苷、多柔比星、环磷酰胺、长春新碱、丙卡巴肼和泼尼松（BEACOPP）；或增加剂量的BEACOPP，每种方案在有指征时随后进行局部放疗。由于结果较差，COPP-ABVD组的入组在1996年停止。

结果

进行最终分析时，1201例患者中的1195例可进行评估：COPP-ABVD组260例，BEACOPP组469例，增加剂量的BEACOPP组466例；中位随访时间分别为72个月、54个月和51个月。五年无治疗失败率在COPP-ABVD组为69%，BEACOPP组为76%，增加剂量的BEACOPP组为87%（COPP-ABVD组与BEACOPP组比较，P = 0.04；增加剂量的BEACOPP组与COPP-ABVD组及BEACOPP组比较，P < 0.001），五年总生存率分别为83%、88%和91%（COPP-ABVD组与BEACOPP组比较，P = 0.16；BEACOPP组与增加剂量的BEACOPP组比较，P = 0.06；COPP-ABVD组与增加剂量的BEACOPP组比较，P = 0.002）。增加剂量的BEACOPP组的早期进展率显著低于COPP-ABVD组或标准BEACOPP组。