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Outcome of treatment of first relapse of Hodgkin's disease after primary
chemotherapy: identification of risk factors from the British Columbia
experience 1970 to 1988
A Lohri, M Barnett, RN Fairey, SE O'Reilly, GL Phillips, D Reece, N Voss and JM Connors
Division of Medical Oncology, British Columbia Cancer Agency, Vancouver,
Canada.
The outcome of treatment for a first relapse of Hodgkin's disease after
primary chemotherapy was analyzed in 80 patients. They were divided into
four groups: group 1 (n = 24) had initially been treated with three cycles
of (mechlorethamine, vincristine, prednisone, and procarbazine [MOPP]) and
wide-field irradiation therapy; group 2 (n = 25) had six cycles of MOPP;
group 3 (n = 15) and group 4 (n = 16) both initially received MOPP/ABVD
(MOPP plus doxorubicin, bleomycin, vinblastine, and dacarbazine) or
MOPP/ABV hybrid, but group 3 received conventional salvage regimens whereas
group 4 was treated with high- dose chemotherapy and autologous bone marrow
transplantation as salvage therapy (n = 16). Freedom from second failure
(FF2F) was used as the major endpoint. Actuarial FF2F for all patients was
38% after a median follow-up of 75 months for patients who were alive. Risk
factor analysis was performed on the 71 patients who had been treated with
curative intent. The presence or absence of any one of three risk factors
had a strong negative impact on outcome: stage IV disease at primary
diagnosis, B symptoms at relapse, or a time from primary treatment to
relapse of less than 1 year. Actuarial FF2F at 5 years was 17% in the group
of patients with one or more of these three factors present (n = 49). If
none of these factors was present, FF2F was 82% (n = 22) (P less than
.001). Even high-dose chemotherapy and autologous bone marrow
transplantation were not able to overcome the negative impact of one or
more risk factors (FF2F = 19%, n = 12). The outcome of salvage treatments
depends most on the presence or absence of these three risk factors and
less on the type of salvage treatment. Patients with none of these risk
factors present have an excellent outcome if they are treated with
non-cross-resistant chemotherapy, or radiotherapy, or both. Novel
approaches are needed for patients with one or more of these factors
present. Reports on salvage treatments for Hodgkin's disease in first
relapse after primary chemotherapy should include data on the proportion of
patients having stage IV disease at diagnosis, B symptoms at relapse, and a
time from primary treatment to relapse of less than 1 year.
Volume 77,
Issue 10,
pp. 2292-2298,
05/15/1991
Copyright © 1991 by The American Society of Hematology
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