Viviani S, Bonadonna G, Santoro A, Bonfante V, Zanini M, Devizzi L, Soncini F, Valagussa P
Division of Medical Oncology, Istituto Nazionale Tumori, Milan, Italy.
J Clin Oncol. 1996 May;14(5):1421-30. doi: 10.1200/JCO.1996.14.5.1421.
To compare, in a prospective randomized trial, the efficacy of two different sequences of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) and doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy in untreated advanced Hodgkin's disease.
From June 1982 to September 1990, 427 consecutive previously untreated patients with pathologic stage IB, IIA bulky, IIB, III (A and B), and IV (A and B) disease were prospectively randomized to receive two different sequences of MOPP and ABVD for a minimum of six cycles followed by radiotherapy (median dose, 30 Gy) to the nodal site(s) of pretreatment bulky disease. Of 415 assessable patients, 211 received one cycle of MOPP monthly, alternated with one cycle of ABVD (alternating regimen), and 204 patients received one-half cycle of MOPP alternated with one-half cycle of ABVD within a 1-month period (hybrid regimen).
The complete remission (CR) rate was 91% with the alternating regimen and 89% with the hybrid regimen. At 10 years, the freedom-from-progression (FFP) rate was 67% versus 69% and the overall survival (OS) rate was 74% versus 72%, respectively. After attainment of CR, 85 patients relapsed in nodal (n = 60) versus extranodal with or without nodal (n = 25) sites. In patients given consolidative radiation because of bulky lymphoma, the true recurrence rate was 13%. A total of 23 second malignancies (6%) were documented, including 11 cases of acute nonlymphocytic leukemia. No cases of congestive heart failure attributable to doxorubicin or pulmonary toxicity related to bleomycin were documented.
By delivering MOPP and ABVD, it is possible to cure approximately 70% of patients with advanced Hodgkin's disease. The two different drug sequences yielded superimposable results.
在一项前瞻性随机试验中，比较氮芥、长春新碱、丙卡巴肼和泼尼松（MOPP）与多柔比星、博来霉素、长春碱和达卡巴嗪（ABVD）两种不同化疗方案序贯治疗初治晚期霍奇金淋巴瘤的疗效。
1982年6月至1990年9月，427例先前未经治疗的病理分期为IB、IIA大包块型、IIB、III（A和B）及IV（A和B）期疾病的患者被前瞻性随机分组，接受两种不同序贯的MOPP和ABVD方案，至少进行6个周期，随后对预处理时存在大包块的淋巴结部位进行放疗（中位剂量30 Gy）。在415例可评估患者中，211例患者每月接受1个周期的MOPP，与1个周期的ABVD交替使用（交替方案），204例患者在1个月内接受半个周期的MOPP与半个周期的ABVD交替使用（混合方案）。
交替方案的完全缓解（CR）率为91%，混合方案为89%。10年时，无进展生存率（FFP）分别为67%和69%，总生存率（OS）分别为74%和72%。达到CR后，85例患者复发，其中淋巴结复发60例，结外复发（有或无淋巴结受累）25例。因淋巴瘤大包块接受巩固性放疗的患者，真正的复发率为13%。共记录到23例第二原发恶性肿瘤（6%），包括11例急性非淋巴细胞白血病。未记录到因多柔比星导致的充血性心力衰竭或与博来霉素相关的肺部毒性病例。
通过使用MOPP和ABVD方案，大约70%的晚期霍奇金淋巴瘤患者有可能被治愈。两种不同的药物序贯方案产生了相似的结果。
