Correspondence

Long-Term Follow-up of Hodgkin's Disease Trial

N Engl J Med 2002; 346:1417-1418May 2, 2002

Article

To the Editor:

In 1992, we reported the results of the prospective, randomized Cancer and Leukemia Group B trial in patients with newly diagnosed, advanced-stage Hodgkin's disease. The study compared three regimens: MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) for 6 to 8 months, the standard treatment at that time; ABVD, a nonalkylating-agent–containing regimen (doxorubicin, bleomycin, vinblastine, and dacarbazine) for 6 to 8 months; and MOPP alternating with ABVD for 12 months.1

Radiation therapy was not administered. ABVD therapy alone for 6 to 8 months resulted in a rate of failure-free survival similar to the rate with a 12-month regimen of MOPP alternating with ABVD, and better than the rate with MOPP alone. ABVD also was not associated with an increased risk of leukemia or a loss of fertility, recognized side effects of alkylating agents contained in the MOPP regimen. These findings led to the widespread use of ABVD as therapy for advanced Hodgkin's disease. The regimen has also been used in early-stage disease with or without radiation therapy.2

We report the results of long-term follow-up of patients enrolled in that study. At a median follow-up of 14.1 years, we tested for equality of the failure-free and overall survival distributions in the three treatment groups using the Cox proportional-hazards model. We found a significant difference in the failure-free survival distributions (score test, P=0.03) but not in the overall survival distributions (score test, P=0.35). Patients who were randomly assigned to ABVD have continued to have a higher rate of failure-free survival than those treated with MOPP alone and a similar rate of failure-free survival to those treated with MOPP alternating with ABVD (Figure 1AFigure 1Failure-free Survival (Panel A) and Overall Survival (Panel B) According to Initial Treatment.). Overall survival is not significantly different among the groups, reflecting the ability of salvage therapy to prolong survival or to cure the disease (Figure 1B).

George P. Canellos, M.D.
Dana–Farber Cancer Institute, Boston, MA 02115
george_canellos@dfci.harvard.edu

Donna Niedzwiecki, Ph.D.
Duke University Medical Center, Durham, NC 27710

2 References

1. 1

   Canellos GP, Anderson JR, Propert KJ, et al. Chemotherapy of advanced Hodgkin's disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med 1992;327:1478-1484
   Full Text | Web of Science | Medline

2. 2

   Rueda A, Alba E, Ribellas N, Sevilla I, Ruiz I, Miramon J. Six cycles of ABVD in the treatment of stage I and II Hodgkin's lymphoma: a pilot study. J Clin Oncol 1997;15:1118-1122
   Web of Science | Medline

Citing Articles (32)

Citing Articles

1. 1

   Bosko M. Andjelic, Biljana S. Mihaljevic, Ljubomir R. Jakovic. (2012) ABVD as the Treatment Option in Advanced Hodgkin’s Lymphoma Patients Older than 45 Years. Pathology & Oncology Research
   CrossRef

2. 2

   Dennis A. Eichenauer, Peter Borchmann, Andreas Engert. (2011) Adolescents with Hodgkin lymphoma – old children or young adults?. Leukemia & Lymphoma1-16
   CrossRef

3. 3

   Paolo G. Gobbi, Francesco Valentino, Emilio Bassi, Chiara Coriani, Francesco Merli, Valeria Bonfante, Alfonso Marchianò, Andrea Gallamini, Silvia Bolis, Caterina Stelitano, Alessandro Levis, Massimo Federico, Francesco Angrilli, Giuseppe Di Giulio, Gino R. Corazza. (2011) Chemoresistance As a Function of the Pretherapy Tumor Burden and the Chemotherapy Regimen Administered: Differences Observed With 2 Current Chemotherapy Regimens for Advanced Hodgkin Lymphoma. Clinical Lymphoma Myeloma and Leukemia 11:5, 396-402
   CrossRef

4. 4

   Yehuda E. Deutsch, Tamar Tadmor, Eckhard R. Podack, Joseph D. Rosenblatt. (2011) CD30: an important new target in hematologic malignancies. Leukemia & Lymphoma 52:9, 1641-1654
   CrossRef

5. 5

   A. Tempescul, J. C. Ianotto, J. R. Eveillard, G. Guillerm, C. Berthou. (2011) ESHAP chemotherapy regimen associated to lenalidomide induces complete isotopic remission in Hodgkin’s lymphoma relapsing after autologous stem cell transplantation. Annals of Hematology 90:8, 971-973
   CrossRef

6. 6

   Young-Woong Won, Jung Hye Kwon, Soon Il Lee, Sung Yong Oh, Won Seog Kim, Seok Jin Kim, Jong-Ho Won, Kyoung Ha Kim, Seong Kyu Park, Jin Seok Kim, Cheolwon Suh, Dok Hyun Yoon, Joon Seong Park, Min Kyoung Kim, Hawk Kim, Hye Jin Kang, Yeung-Chul Mun, Jae-Yong Kwak, Hyo Jung Kim, Hyeon-Seok Eom. (2011) Clinical features and outcomes of Hodgkin’s lymphoma in Korea: Consortium for Improving Survival of Lymphoma (CISL). Annals of Hematology
   CrossRef

7. 7

   Robert Chen, Joycelynne M. Palmer, Leslie Popplewell, Jessica Shen, Eileen Smith, Maria Delioukina, Neil Kogut, Joseph Rosenthal, Stephen Forman, Auayporn Nademanee. (2011) Reduced intensity allogeneic hematopoietic cell transplantation can induce durable remission in heavily pretreated relapsed Hodgkin lymphoma. Annals of Hematology 90:7, 803-808
   CrossRef

8. 8

   Andrea Gallamini, Caterina Patti, Simonetta Viviani, Andrea Rossi, Francesca Fiore, Francesco Di Raimondo, Maria Cantonetti, Caterina Stelitano, Tatyana Feldman, Paolo Gavarotti, Roberto Sorasio, Antonino Mulè, Monica Leone, Alessandro Rambaldi, Alberto Biggi, Sally Barrington, Federico Fallanca, Umberto Ficola, Stéphane Chauvie, Alessandro Massimo Gianni, . (2011) Early chemotherapy intensification with BEACOPP in advanced-stage Hodgkin lymphoma patients with a interim-PET positive after two ABVD courses. British Journal of Haematology 152:5, 551-560
   CrossRef

9. 9

   P. Borchmann, A. Engert. (2010) The Past: What We Have Learned in the Last Decade. Hematology 2010:1, 101-107
   CrossRef

10. 10

    David W. Dougherty, Jonathan W. Friedberg. (2010) Gemcitabine and Other New Cytotoxic Drugs: Will Any Find Their Way Into Primary Therapy?. Current Hematologic Malignancy Reports 5:3, 148-156
    CrossRef

11. 11

    A. Avigdor, S. Bulvik, I. Levi, E. J. Dann, N. Shemtov, G. Perez-Avraham, A. Shimoni, A. Nagler, I. Ben-Bassat, A. Polliack. (2010) Two cycles of escalated BEACOPP followed by four cycles of ABVD utilizing early-interim PET/CT scan is an effective regimen for advanced high-risk Hodgkin's lymphoma. Annals of Oncology 21:1, 126-132
    CrossRef

12. 12

    Canellos, George P., , Niedzwiecki, Donna, Johnson, Jeffrey L., . (2009) Long-Term Follow-up of Survival in Hodgkin's Lymphoma. New England Journal of Medicine 361:24, 2390-2391
    Full Text

13. 13

    A. Engert, D. A. Eichenauer, M. Dreyling, . (2009) Hodgkin's lymphoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Annals of Oncology 20:Supplement 4, iv108-iv109
    CrossRef

14. 14

    Beate Klimm, Andreas Engert. (2009) Combined Modality Treatment of Hodgkin’s Lymphoma. The Cancer Journal 15:2, 143-149
    CrossRef

15. 15

    J. Kuruvilla. (2009) Standard therapy of advanced Hodgkin lymphoma. Hematology 2009:1, 497-506
    CrossRef

16. 16

    Olivera Tarabar, Ljiljana Tukic, Dragana Stamatovic, Bela Balint, Marija Elez, Gordana Ostojic, Zeljka Tatomirovic, Slobodan Marjanovic. (2009) Autologous stem cell transplantation in the treatment of Hodgkin's disease. Vojnosanitetski pregled 66:7, 571-576
    CrossRef

17. 17

    Dennis A Eichenauer, Michael Fuchs, Peter Borchmann, Andreas Engert. (2008) Hodgkin’s lymphoma: current treatment strategies and novel approaches. Expert Review of Hematology 1:1, 63-73
    CrossRef

18. 18

    Delphine Sénécal, Jean-Philippe Jais, Bernard Desablens, Christian Berthou, Philippe Casassus, Marie-Pierre Moles, Vincent Delwail, Thomas Gastinne, Pierre Colonna, Jean-Marie Andrieu. (2008) Twenty-year disease and treatment-associated mortality rates of patients with Hodgkin lymphoma of clinical stages IIIB and IV prospectively treated with 3-month anthracycline-based chemotherapy followed by extended high-dose radiation. Cancer 112:4, 846-855
    CrossRef

19. 19

    Lena Specht, John Raemaekers. (2007) Do We Need an Early Unfavorable (Intermediate) Stage of Hodgkin's Lymphoma?. Hematology/Oncology Clinics of North America 21:5, 881-896
    CrossRef

20. 20

    George P. Canellos. (2007) Relapsed and Refractory Hodgkin's Lymphoma: New Avenues?. Hematology/Oncology Clinics of North America 21:5, 929-941
    CrossRef

21. 21

    S. J. Horning. (2007) Risk, Cure and Complications in Advanced Hodgkin Disease. Hematology 2007:1, 197-203
    CrossRef

22. 22

    Richard W. Tsang, David C. Hodgson, Michael Crump. (2006) Hodgkin’s Lymphoma. Current Problems in Cancer 30:3, 107-158
    CrossRef

23. 23

    Beate Klimm, Andreas Engert, Volker Diehl. (2006) First-line treatment of Hodgkin’s lymphoma. Current Hematologic Malignancy Reports 1:1, 51-59
    CrossRef

24. 24

    Beate Klimm, Volker Diehl, Beate Pfistner, Andreas Engert. (2005) Current treatment strategies of the German Hodgkin Study Group (GHSG). European Journal of Haematology 75, 125-134
    CrossRef

25. 25

    Volker Diehl, Beate Klimm, Daniel Re. (2005) Hodgkin lymphoma: a curable disease: what comes next?. European Journal of Haematology 75, 6-13
    CrossRef

26. 26

    M Ng, J Waters, D Cunningham, I Chau, A Horwich, M Hill, A R Norman, A Wotherspoon, D Catovsky. (2005) Gemcitabine, cisplatin and methylprednisolone (GEM-P) is an effective salvage regimen in patients with relapsed and refractory lymphoma. British Journal of Cancer 92:8, 1352-1357
    CrossRef

27. 27

    Nelson Spector, Cristiane Bedran Milito, Irene Biasoli, Ronir Raggio Luiz, Wolmar Pulcheri, José Carlos Morais. (2005) The prognostic value of the expression of Bcl-2, p53 and LMP-1 in patients with Hodgkin's lymphoma. Leukemia & Lymphoma 46:9, 1301-1306
    CrossRef

28. 28

    Volker Diehl, Roman K Thomas, Daniel Re. (2004) Part II: Hodgkin's lymphoma—diagnosis and treatment. The Lancet Oncology 5:1, 19-26
    CrossRef

29. 29

    Jonathan W. Friedberg, Donna Neuberg, Helen Kim, Sarah Miyata, Mary McCauley, David C. Fisher, Tak Takvorian, George P. Canellos. (2003) Gemcitabine added to doxorubicin, bleomycin, and vinblastine for the treatment of de novo Hodgkin disease. Cancer 98:5, 978-982
    CrossRef

30. 30

    Vincent T. DeVita. (2003) A selective history of the therapy of Hodgkin's disease. British Journal of Haematology 122:5, 718-727
    CrossRef

31. 31

    Leonidas G Koniaris, George Drugas, Philip J Katzman, Rabih Salloum. (2003) Management of gastrointestinal lymphoma. Journal of the American College of Surgeons 197:1, 127-141
    CrossRef

32. 32

    Aleman, Berthe M.P., Raemaekers, John M.M., Tirelli, Umberto, Bortolus, Roberto, van 't Veer, Mars B., Lybeert, Marnix L.M., Keuning, Jo J., Carde, Patrice, Girinsky, Théodore, van der Maazen, Richard W.M., Tomšič, Radka, Vovk, Marjeta, van Hoof, Achilles, Demeestere, Geertrui, Lugtenburg, Pieternella J., Thomas, José, Schroyens, Wilfried, De Boeck, Koenraad, Baars, Johanna W., Kluin-Nelemans, Johanna C., Carrie, Christian, Aoudjhane, Malek, Bron, Dominique, Eghbali, Houchingue, Smit, Wilma G.J.M., Meerwaldt, Jacobus H., Hagenbeek, Anton, Pinna, AntonellaHenry-Amar, Michel, . (2003) Involved-Field Radiotherapy for Advanced Hodgkin's Lymphoma. New England Journal of Medicine 348:24, 2396-2406
    Full Text