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Blood, Vol. 95 No. 7 (April 1), 2000:
pp. 2246-2252
Comparison of chemotherapy to radiotherapy as consolidation of
complete or good partial response after six cycles of chemotherapy for
patients with advanced Hodgkin's disease: results of the Groupe
d'études des Lymphomes de l'Adulte H89 trial
Christophe Fermé,
Catherine Sebban,
Christophe Hennequin,
Marine Diviné,
Pierre Lederlin,
Jean Gabarre,
Augustin Ferrant,
Denis Caillot,
Dominique Bordessoule,
Pauline Brice,
Isabelle Moullet,
Françoise Berger, and
Eric Lepage
From the Groupe d'études des Lymphomes de l'Adulte,
Hôpital Saint-Louis, Paris, France; Department of Hematology,
Centre Léon Bérard, Lyon, France; Department of Hematology,
Hôpital Henri Mondor, Créteil, France; Department of
Medicine, Hôpitaux de Brabois, Vandoeuvre, France; Department of
Hematology, Hôpital de la Salpétrière, Paris, France;
Department of Hematology, Cliniques Universitaires St Luc, Brussels,
Belgium; Department of Hematology, Hôpital du Bocage, Dijon,
France; Department of Hematology, Hôpital Universitaire
Dupuytren, Limoges, France; Hematology Institute, Hôpital
Saint-Louis, Paris, France; Department of Hematology, Centre
Hospitalier Lyon-Sud, Pierre Bénite, France; Department of
Pathology, Hôpital Edouard-Herriot, Lyon, France; and Department
of Biostatistics and Medical Information Systems, Hôpital Henri
Mondor, Créteil, France.
The treatment of advanced Hodgkin's disease (HD) with chemotherapy
(CTx) alone or combined modality treatments has been controversial. In
1989, we designed a randomized study to compare 2 cycles of CTx to
(sub)total nodal irradiation (RTx) as consolidation treatments for
patients with stage IIIB/IV HD in complete remission (CR) or good
partial response after 6 cycles of CTx. A total of 559 patients were
randomized to receive 6 cycles of MOPP/ABV (mechlorethamine, vincristine, procarbazine, prednisone/Adriamycin [doxorubicin], bleomycin, vinblastine) hybrid (n = 266) or ABVPP (n = 267).
After induction treatment, 418 patients could be evaluated for the
consolidation phase. With a median follow-up of 48 months, the 5-year
disease-free survival estimates were 80% for 8 cycles of MOPP/ABV,
82% for 6 cycles of MOPP/ABV plus RTx, 68% for 8 cycles of ABVPP, and 75% for 6 cycles of ABVPP plus RTx (P = .01).
The 5-year disease-free survival estimates did not differ between CTx
and RTx, 74% and 79%, respectively (P = .07). After
MOPP/ABV, the 5-year overall survival estimates did not differ between
CTx and RTx, 85% and 88%, respectively (P = .2). After
ABVPP, the 5-year survival estimates were 94% for CTx and 78% for RTx
(P = .002). These results showed that RTx was not superior
to CTx consolidation after doxorubicin-induced CR for patients with
advanced HD. Because of the uncertainty of obtaining a prolonged second
remission for patients relapsing after CTx and RTx and the possible
long-term effects of RTx, we prefer 8 cycles of CTx as standard
treatment when a CR has been achieved after 6 cycles.
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