This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Johnson, P. W.M. Articles by Hancock, B. W. Search for Related Content PubMed PubMed Citation Articles by Johnson, P. W.M. Articles by Hancock, B. W.

Comparison of Outcomes in Studies of Advanced Hodgkin's Lymphoma

Cancer Research UK Clinical Centre, Southampton General Hospital, Southampton, United Kingdom

John A. Radford

Cancer Research UK Department of Medical Oncology, Christie Hospital, Manchester, United Kingdom

Michael H. Cullen

Department of Medical Oncology, Queen Elizabeth Hospital, Birmingham, United Kingdom

Matthew R. Sydes, Sally P. Stenning

Medical Research Council Clinical Trials Unit, London, United Kingdom

Barry W. Hancock

Yorkshire Cancer Research Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, United Kingdom

To the Editor:

We were interested to read the editorial by Dr Carde¹, which referred to our article² that reported the results of the United Kingdom Lymphoma Group LY09 study in advanced Hodgkin's lymphoma. The editorial may have given the impression that our study was a randomized comparison of three regimens, which is not the case. A standard arm of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) was used, and investigators elected in advance whether to randomize against the alternating or hybrid regimen. Thus, it is not legitimate to make direct comparison of the two multidrug arms. It is also difficult to compare the overall results in this study to the Italian trial reported in the same issue by Gobbi et al³, which included a more favorable group of patients among whom only 11% of patients were in International Prognostic Score group 4 to 7, compared with 19% in the UK study. The measure of 65% progression-free survival at 5 years cited by Dr Carde refers only to patients in stages III/IV, whereas for the UK study as a whole the figure is 73%.

The interpretation of information regarding the use of radiotherapy in the two parallel randomizations is problematic. Dr Carde suggests that a comparison can be made between the two standard ABVD groups, with the more frequent use of eight cycles in the centers randomizing against alternating treatment apparently giving marginally better freedom from progression results than those seen in the hybrid randomization, where it was more common to use six cycles followed by radiotherapy. Such data must be interpreted with caution, especially because the patients in the hybrid randomization were more likely to have bulky mediastinal disease and systemic symptoms, suggesting a worse prognostic group. We contend that such an effect may be due to patient selection rather than the use of radiotherapy or fewer cycles of ABVD.

Finally, Dr Carde has made a provocative analysis of the data, correlating freedom from progression with intended, rather than actual doses delivered. This may be helpful in terms of generating hypotheses to be tested in future studies but does not necessarily explain observed outcomes in the LY09 trial.

Authors' Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

REFERENCES

1. Carde P: The chemotherapy/radiation balance in advanced Hodgkin's lymphoma: Overweight which side? J Clin Oncol 23:9058-9062, 2005[Free Full Text]

2. Johnson PWM, Radford JA, Cullen MH, et al: Comparison of ABVD and alternating or hybrid multidrug regimens for the treatment of advanced Hodgkin's lymphoma: Results of the United Kingdom Lymphoma Group LY09 trial. J Clin Oncol 23:9208-9218, 2005[Abstract/Free Full Text]

3. Gobbi PG, Levis A, Chisesi T, et al: 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. J Clin Oncol 23:9198-9207, 2005[Abstract/Free Full Text]

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Johnson, P. W.M. Articles by Hancock, B. W. Search for Related Content PubMed PubMed Citation Articles by Johnson, P. W.M. Articles by Hancock, B. W.