Correspondence

Long-Term Follow-up of Survival in Hodgkin's Lymphoma

N Engl J Med 2009; 361:2390-2391December 10, 2009

Article

To the Editor:

In 1992, the Cancer and Leukemia Group B (CALGB) reported the results of a prospective three-group randomized trial involving 359 patients with Hodgkin's lymphoma. This trial compared the following regimens: doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) for 6 to 8 months, mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) for 6 to 8 months, and MOPP alternating with ABVD for 12 months.1 The trial was limited to patients with advanced disease (clinical stages III and IV). No radiotherapy was administered. The results, published in the Journal in 1992, indicated an event-free survival advantage of ABVD over MOPP but no differences in overall survival between the ABVD and MOPP groups. These findings were reemphasized in a follow-up study of the data published in 2002.2 We report further follow-up data from a median follow-up period of 18.1 years (Figure 1Figure 1Event-free Survival and Overall Survival in Patients with Hodgkin's Lymphoma, According to Treatment Regimen.).

We analyzed the results from a follow-up period of at least 20 years. The fact that overall survival was still equivalent among the three groups despite a higher failure rate associated with MOPP is a testimony to the effective salvage treatments for Hodgkin's lymphoma. A review of the 12 consecutive series of prospective, randomized therapeutic trials involving a total of 6200 patients with advanced Hodgkin's lymphoma that have been published since 2003 revealed only one trial in which a small statistically significant difference in overall survival was noted.3 Relatively small but statistically significant differences in event-free survival, if seen, were corrected in terms of overall survival by effective salvage therapy.

Long-term results with the use of ABVD alone in the above-mentioned CALGB trial are often used to compare newer regimens. This comparison is not valid, since the trial began in 1982. The 5- and 10-year rates of both event-free and overall survival have increased from 73.5% and 62.0%, respectively, between 1980 and 1984 and, more recently, from 85.0% and 80.0%, respectively, in the 2000–2004 interval as shown in the Surveillance, Epidemiology, and End Results program.4

More intensive and toxic chemotherapy may confer a statistical event-free survival advantage but, unless overall survival is improved, the greater toxicity could compromise quality of life without a survival benefit. However, the identification of high-risk patients on the basis of persistently positive findings on positron-emission tomography during therapy may warrant an alternative, more intensive, approach.

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

Donna Niedzwiecki, Ph.D.
Jeffrey L. Johnson, M.S.
Cancer and Leukemia Group B Statistical Center, Durham, NC

4 References

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   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

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   Canellos GP, Niedzwiecki D. Long-term follow-up of Hodgkin's disease trial. N Engl J Med 2002;346:1417-1418
   Full Text | Web of Science | Medline

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   Diehl V, Franklin J, Pfeundschuh M, et al. Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin's disease. N Engl J Med 2003;348:2386-2395[Erratum, N Engl J Med 2005;353:744.]
   Full Text | Web of Science | Medline

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   Brenner H, Gondos A, Pulte D. Ongoing improvement in long-term survival of patients with Hodgkin disease at all ages and recent catch-up of older patients. Blood 2008;111:2977-2983
   CrossRef | Web of Science | Medline

Citing Articles (6)

Citing Articles

1. 1

   Jieun Uhm, John Kuruvilla. (2012) Treatment of newly diagnosed advanced stage Hodgkin lymphoma. Blood Reviews
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2. 2

   Andrea K. Ng, Lawrence Weiss, Ann S. LaCasce. 2012. Hodgkin's Lymphoma. , 1527-1543.
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3. 3

   Dennis A. Eichenauer, Peter Borchmann, Andreas Engert. (2011) Adolescents with Hodgkin lymphoma – old children or young adults?. Leukemia & Lymphoma1-16
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4. 4

   D. A. Eichenauer, A. Engert, M. Dreyling, . (2011) Hodgkin's lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology 22:Supplement 6, vi55-vi58
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5. 5

   Stephen D. Smith, Craig H. Moskowitz, Robert Dean, Brad Pohlman, Ronald Sobecks, Edward Copelan, Steven Andresen, Brian Bolwell, Jocelyn C. Maragulia, Jill M. Vanak, John Sweetenham, Alison J. Moskowitz. (2011) Autologous stem cell transplant for early relapsed/refractory Hodgkin lymphoma: results from two transplant centres. British Journal of Haematology 153:3, 358-363
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6. 6

   D. A. Eichenauer, A. Engert. (2011) One size for all in Hodgkin lymphoma?. Blood 117:9, 2557-2558
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