Originally published as JCO Early Release 10.1200/JCO.2005.02.907 on September 19 2005

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ABVD Versus Modified Stanford V Versus MOPPEBVCAD With Optional and Limited Radiotherapy in Intermediate- and Advanced-Stage Hodgkin's Lymphoma: Final Results of a Multicenter Randomized Trial by the Intergruppo Italiano Linfomi

From the Medicina Interna, Oncologia e Gastroenterologia, Università di Pavia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico S. Matteo, Pavia; Divisione di Ematologia, Ospedale "S.S. Antonio e Biagio," Alessandria; Unità Operativa di Ematologia, Ospedale Civile SS. Giovanni e Paolo, Venezia; Divisione di Ematologia, Ospedale "S.G. Battista," Torino; Divisione di Ematologia, Ospedali Riuniti, Reggio Calabria; Cattedra di Ematologia, Università di Bari, Policlinico, Bari; Divisione di Medicina I, Ospedale Civile, Piacenza; Divisione di Ematologia I, Ospedale S. Martino, Genova; Divisione di Ematologia, Ospedale "S.M. Nuova," Reggio Emilia; Medicina Interna e Scienze Oncologiche, Policlinico Monteluce, Perugia, Unità Malattie Linfoproliferative, Ematologia I, Centro "G. Marcora," IRCCS Ospedale Maggiore, Milano; Centro Oncologico "A. Businco," Cagliari; Oncologia Medica, Ospedale "S. Luigi," Catania; and Oncologia Medica, Università di Modena e Reggio Emilia, Modena, Italy

Address reprint requests to Paolo G. Gobbi, MD, Medicina Interna e Oncologia Medica, Università di Pavia, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, P le Golgi no. 2, 27100 Pavia, Italy; e-mail: gobbipg{at}smatteo.pv.it

PURPOSE: In this multicenter, prospective, randomized clinical trial on advanced Hodgkin's lymphoma (HL), the efficacy and toxicity of two chemotherapy regimens, doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone (Stanford V) and mechlorethamine, vincristine, procarbazine, prednisone, epidoxirubicin, bleomycin, vinblastine, lomustine, doxorubicin, and vindesine (MOPPEBVCAD), were compared with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) as standard therapy to select which regimen would best support a reduced radiotherapy program, which was limited to two sites of either previous bulky or partially remitting disease (a modification of the original Stanford program).

PATIENTS AND METHODS: Three hundred fifty-five patients with stage IIB, III, or IV HL were randomly assigned. Three hundred thirty-four patients were assessable for the study and received six cycles of ABVD (n = 122), three cycles of Stanford V (n = 107), or six cycles of MOPPEBVCAD (n = 106); radiotherapy was administered to 76, 71, and 50 patients in these three arms, respectively.

RESULTS: The complete response rates for ABVD, Stanford V, and MOPPEBVCAD were 89%, 76% and 94%, respectively; 5-year failure-free survival (FFS) and progression-free survival rates were 78%, 54%, 81% and 85%, 73%, and 94%, respectively (P < .01 for comparison of Stanford V with the other two regimens). Corresponding 5-year overall survival rates were 90%, 82%, and 89% for ABVD, Stanford V, and MOPPEBVCAD, respectively. Stanford V was more myelotoxic than ABVD but less myelotoxic than MOPPEBVCAD, which had larger reductions in the prescribed drug doses.

CONCLUSION: When associated with conditioned and limited (not adjuvant) radiotherapy, ABVD and MOPPEBVCAD were superior to Stanford V chemotherapy in terms of response rate and FFS and progression-free survival. Patients were irradiated less often after MOPPEBVCAD, but this regimen was more toxic. ABVD is still the best choice when it is combined with optional, limited irradiation.

Supported by grants from the Ministero dell'Università e della Ricerca Scientifica e Tecnologica, Roma; the Associazione "A. Serra," Modena; the Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo; and the Ferrata-Storti Foundation, Pavia, Italy.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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