Preti A, Hagemeister F B, McLaughlin P, Swan F, Rodriguez A, Besa P, Cox J D, Allen P K, Cabanillas F
Department of Hematology, University of Texas M. D. Anderson Cancer Center, Houston.
Ann Oncol. 1994;5 Suppl 2:97-100. doi: 10.1093/annonc/5.suppl_2.s97.
Management of Hodgkin's disease (HD) and large mediastinal adenopathy (LMA) usually includes intensive chemotherapy (CT) with or without radiation therapy (XT) regardless of stage.
One hundred and eighteen evaluable patients received one of four treatment regimens: (1) 6 cycles of MOPP or similar CT and XT; (2) 2 of MOPP followed by XT; (3) 6 of CVPP/ABDIC (cyclophosphamide, vincristine, procarbazine, prednisone/doxorubicin, bleomycin, decarbazine, prednisone, lomustine) followed by XT; or (4) 3 of NOVP (mitoxantrone, vincristine, vinblastine, procarbazine) and XT. XT doses included 30-40 Gy to areas of nodal involvement noted prior to therapy.
Complete remission (CR) rates for groups 1, 2, 3, and 4 were 100%, 85%, 87%, and 96%. Respective 3-year freedom from progression (FFP) results were 88%, 66%, 82%, and 88%, and 3-year freedom from tumor mortality (FTM) results were 100%, 84%, 84%, and 100%. The presence of B symptoms and stage IV disease was correlated with lower CR and 3-year FFP rates but similar 3-year survival.
Results of this study suggest that patients with stage I-III Hodgkin's disease and LMA greater than 10 cm treated with 3 NOVP and XT have results similar to those obtained for a similar group of patients treated with 2 to 6 MOPP or 6 CVPP/ABDIC and XT. NOVP has also been reported to produce limited toxicity in this trial and should be considered as an alternative to MOPP or doxorubicin-containing regimens in treatment of patients with early-staged disease and LMA greater than 10 cm.
无论处于何阶段，霍奇金淋巴瘤（HD）和大纵隔淋巴结肿大（LMA）的治疗通常包括强化化疗（CT），可联合或不联合放射治疗（XT）。
118例可评估患者接受了四种治疗方案之一：（1）6个周期的MOPP或类似的CT及XT；（2）2个周期的MOPP，随后进行XT；（3）6个周期的CVPP/ABDIC（环磷酰胺、长春新碱、丙卡巴肼、泼尼松/阿霉素、博来霉素、氮烯咪胺、泼尼松、洛莫司汀），随后进行XT；或（4）3个周期的NOVP（米托蒽醌、长春新碱、长春花碱、丙卡巴肼）及XT。XT剂量包括对治疗前记录的淋巴结受累区域给予30 - 40 Gy。
第1、2、3和4组的完全缓解（CR）率分别为100%、85%、87%和96%。各自的3年无进展生存期（FFP）结果分别为88%、66%、82%和88%，3年无肿瘤死亡率（FTM）结果分别为100%、84%、84%和100%。B症状和IV期疾病的存在与较低的CR率和3年FFP率相关，但3年生存率相似。
本研究结果表明，对于I - III期霍奇金淋巴瘤且LMA大于10 cm的患者，采用3个周期的NOVP及XT治疗的结果与采用2至6个周期的MOPP或6个周期的CVPP/ABDIC及XT治疗的类似患者群体的结果相似。在本试验中，NOVP还被报道产生的毒性有限，对于早期疾病且LMA大于10 cm的患者，应考虑将其作为MOPP或含阿霉素方案的替代治疗方案。
