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Hodgkin’s lymphoma is a cancer of the lymph system, which is part of the immune (infection fighting) system that includes blood vessels, bone marrow, lymph nodes, and lymph vessels throughout the body. It also includes organs such as the spleen, thymus, and tonsils. This cancer is characterized by the presence of the uncontrollable growth and division of atypical white blood cells (immune cells) that crowd lymph tissue, suppressing the formation and function of other cells normally found in this tissue.

Stages IIB–IV Hodgkin’s lymphoma involve cancer that has spread from the site of origin to other sites in the body. Standard treatment for stages IIB-IV Hodgkin’s lymphoma is combination chemotherapy and/or radiation therapy. The standard chemotherapy regimen for these patients has been ABVD: doxorubicin (Adriamycin®), bleomycin (Blenoxane®), Velban® (vinblastine), and dacarbazine (DTIC-Dome®). Researchers have been comparing ABVD to other chemotherapy regimens to definitively determine which combination produces the highest cure rates with the fewest side effects.

Researchers from Italy recently reported the final results from a multi-center phase III clinical trial directly comparing three different chemotherapy regimens in the treatment of patients with stages IIB–IV Hodgkin’s lymphoma.

Patients were randomized to receive one of the three chemotherapy regimens:

  • ABVD
  • MOPP-EBV-CAD (nitrogen mustard, vincristine, procarbazine, prednisone, epirubicin, bleomycin, vinblastine, lomustine, melphalan, vindisine-also referred to as MEC)
  • Stanford V regimen (mustargen, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, prednisone).

Patients were treated with radiation therapy if they had residual cancer following chemotherapy or sites of previously “bulky” cancer.

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At 5 years, overall survival was similar between the three groups:

  • 90% for those treated with ABVD
  • 89% for those treated with MEC
  • 82% for those treated with Stanford SV

However, at 5 years the rate of patients who did not have cancer progression favored MEC: 89% for MEC, 79% for ABVD, and 55% for SV.

The rate of severe side effects including low levels of blood cells and infection were significantly higher in patients treated with MEC than ABVD or SV. Treatment with MEC (47%) resulted in a lower percentage of patients having to undergo radiation therapy than ABVD (62%) or SV (66%).

The researchers concluded that, for the time being, ABVD should remain the standard of care as initial treatment for patients with stages IIB-IV Hodgkin’s lymphoma. Although MEC resulted in the highest number of patients without disease progression at 5 years, overall survival at 5 years was similar between the three groups of regimens. MEC was associated with significantly higher rates of severe side effects. Patients diagnosed with advanced Hodgkin’s should speak with their physician regarding their individual risks and benefits of different treatment strategies.

Reference: Gobbi P, 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. *Journal of Clinical Oncology.*Early on-line publication. September 19, 2005. DOI: 10.1200/JCO.2005.02.907

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