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Blood, 15 June 2006, Vol. 107, No. 12, pp. 4636-4642.
Prepublished online as a Blood First Edition Paper on February 14, 2006; DOI 10.1182/blood-2005-11-4429.
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Submitted November 10, 2005
Accepted February 3, 2006
Long-term results and competing risk analysis of the H89 trial in patients with advanced-stage Hodgkin lymphoma: A study by the Groupe d'Etude des Lymphomes de l'Adulte (GELA)
Christophe Ferme*, Nicolas Mounier, Olivier Casasnovas, Pauline Brice, Marine Divine, Anne Sonet, Fahdela Bouafia, Aspasia Bastard-Stamatoullas, Dominique Bordessoule, Laurent Voillat, Oumedaly Reman, Michel Blanc, and Christian Gisselbrecht
Department of Medicine, Institut Gustave Roussy, Villejuif, France
Hematology, Hopital Saint-Louis, Paris, France
Hematology, CHU de Dijon, Dijon, France
Hematology, CHU Henri Mondor, Creteil, France
Hematology, Universite Catholique de Louvain, Yvoir, Belgium
Hematology, Hospices Civils de Lyon, Pierre-Benite, France
Hematology, Centre Becquerel, Rouen, France
Hematology, CHU de Limoges, Limoges, France
Hematology, CHU de Besancon, Besancon, France
Hematology, CHU de Caen, Caen, France
Hematology, Hospitalier de Chambery, Chambery, France
* Corresponding author; email: ferme{at}igr.fr.
From 1989 to 1996, 533 eligible patients with stage IIIB/IV Hodgkin lymphoma (HL) were randomly assigned to receive 6 cycles of hybrid MOPP/ABV (n = 266) or ABVPP (doxorubicin, bleomycin, vinblastine, procarbazine, prednisone) (n = 267). Patients in complete remission (CR) or partial response of at least 75% after 6 cycles received 2 cycles of consolidation chemotherapy (CT) (n = 208) or sub-total nodal irradiation (RT) (n = 210). A better survival probability was observed after ABVPP alone: the 10-year overall survival (OS) estimates were 90% for ABVPPx8, 78% for MOPP/ABVx8, 82% for MOPP/ABV+RT, and 77% for ABVPPx6+RT (P = .03); and the 10-year disease-free survival (DFS) estimates were 70%, 76%, 79% and 76% respectively (p =.09). The 10-year DFS estimates for patients treated with consolidation CT or RT were 73% and 78% (P = .07), and OS estimates were 84% and 79%, respectively (P = .29). These results showed that RT was not superior to consolidation CT after a doxorubicin-induced CR in patients with advanced HL. An analysis of competing risks identified age above 45 years as a significant risk factor for death, relapse and second cancers. Prospective evaluation of late adverse events may improve the management of patients with HL.
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