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Journal of Clinical Oncology, Vol 21, Issue 4 (February), 2003: 607-614
© 2003 American Society for Clinical Oncology

Randomized Comparison of ABVD and MOPP/ABV Hybrid for the Treatment of Advanced Hodgkin’s Disease: Report of an Intergroup Trial

David B. Duggan, Gina R. Petroni, Jeffrey L. Johnson, John H. Glick, Richard I. Fisher, Joseph M. Connors, George P. Canellos, Bruce A. Peterson

From the Department of Medicine, State University of New York Upstate Medical University, Syracuse, and James P. Wilmot Cancer Center, University of Rochester School of Medicine, Rochester, NY; Cancer and Leukemia Group B Statistical Center, Duke University, Durham, NC; Division of Oncology, University of Minnesota School of Medicine, Minneapolis, MN; University of Pennsylvania Cancer Center and Abramson Family Cancer Research Institute, Philadelphia, PA; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; and British Columbia Cancer Agency-Vancouver Cancer Center, Vancouver, British Columbia, Canada.

Address reprint requests to David Duggan, MD, Department of Medicine, State University of New York Upstate Medical University, 750 East Adams St, Syracuse, NY 13210; email: duggand{at}upstate.edu.

Purpose: In a series of trials, doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (MOPP/ABV) have been identified as effective treatments for Hodgkin’s disease. We compared these regimens as initial chemotherapy for Hodgkin’s disease.

Patients and Methods: Adult patients (N = 856) with advanced Hodgkin’s disease were randomly assigned to treatment with ABVD or MOPP/ABV. The major end points were failure-free and overall survival, life-threatening acute toxicities, and serious long-term toxicities, including cardiomyopathy, pulmonary toxicity, myelodysplastic syndromes (MDS), and secondary malignancies.

Results: The rates of complete remission (76% v 80%, P = .16), failure-free survival at 5 years (63% v 66%, P = .42), and overall survival at 5 years (82% v 81%, P = .82) were similar for ABVD and MOPP/ABV, respectively. Clinically significant acute pulmonary and hematologic toxicity were more common with MOPP/ABV (P = .060 and .001, respectively). There was no difference in cardiac toxicity. There were 24 deaths attributed to initial treatment: nine with ABVD and 15 with MOPP/ABV (P = .057). There have been 18 second malignancies associated with ABVD and 28 associated with MOPP/ABV (P = .13). Thirteen patients have developed MDS or acute leukemia: 11 were initially treated with MOPP/ABV, and two were initially treated with ABVD but subsequently received MOPP-containing regimens and radiotherapy before developing leukemia (P = .011).

Conclusion: ABVD and the MOPP/ABV hybrid are effective therapies for Hodgkin’s disease. MOPP/ABV is associated with a greater incidence of acute toxicity, MDS, and leukemia. ABVD should be considered the standard regimen for treatment of advanced Hodgkin’s disease.

Research for CALGB 8952 was supported in part by grants from the National Cancer Institute, Bethesda, MD (CA31946), to the Cancer and Leukemia Group B (Richard L. Schilsky, MD, Chair). Additional grants to participating institutions are listed in the Appendix (available online at www.jco.org).

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.




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