Randomized comparison of ABVD and MOPP/ABV hybrid for the treatment of advanced Hodgkin's disease: Report of an intergroup trial
Randomized comparison of ABVD and MOPP/ABV hybrid for the treatment of advanced Hodgkin's disease: Report of an intergroup trial
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DOI：
10.1200/jco.2003.12.086
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发表时间：
2003-02-15
影响因子：
45.3
通讯作者：
Peterson, BA
中科院分区：
文献类型：
--
作者：
Duggan, DB;Petroni, GR;Peterson, BA
目的：在一系列试验中，多柔比星、博来霉素、长春碱和达卡巴嗪（ABVD）和氮芥、长春新碱、甲基苄肼、泼尼松、多柔比星、博来霉素和长春碱（MOPP/ABV）已被确定为霍奇金病的有效治疗方法。我们比较了这些方案作为初始化疗Hodgkin's diseases.Patients和方法：成人患者（N = 856）与晚期霍奇金病随机分配到ABVD或MOPP/ABV治疗。主要终点是无失败和总生存期、危及生命的急性毒性和严重的长期毒性，包括心肌病、肺毒性、骨髓增生异常综合征（MDS）和继发性恶性肿瘤。完全缓解率ABVD组和MOPP/ABV组的生存率分别为76%和80%，P= 0.16，5年无失败生存率分别为63%和66%，P= 0.42，5年总生存率分别为82%和81%，P= 0.82。MOPP/ABV组临床显著的急性肺和血液学毒性更常见（分别为P= 0.060和0.001）。心脏毒性无差异。有24例死亡归因于初始治疗：9例ABVD和15例MOPP/ABV（P=.057）。有18例继发性恶性肿瘤与ABVD相关，28例与MOPP/ABV相关（P= 0.13）。13例患者发生MDS或急性白血病：11例最初接受MOPP/ABV治疗，2例最初接受ABVD治疗，但随后接受含MOPP的方案和放射治疗，然后发生白血病（P=.011）。结论：ABVD和MOPP/ABV混合物是治疗霍奇金病的有效方法。MOPP/ABV与急性毒性、MDS和白血病的发生率较高相关。ABVD应被视为治疗晚期霍奇金病的标准方案。
Purpose : In a series of trials, doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (MOPP/ABV) have been identified as effective treatments for Hodgkin's disease. We compared these regimens as initial chemotherapy for Hodgkin's disease.Patients and Methods: Adult patients (N = 856) with advanced Hodgkin's disease were randomly assigned to treatment with ABVD or MOPP/ABV. The major end points were failure-free and overall survival, life-threatening acute toxicities, and serious long-term toxicities, including cardiomyopathy, pulmonary toxicity, myelodysplastic syndromes (MDS), and secondary malignancies.Results: The rates of complete remission (76% v 80%, P=.16), failure-free survival at 5 years (63% v 66%, P=.42), and overall survival at 5 years (82% v 81%, P=.82) were similar for ABVD and MOPP/ABV, respectively. Clinically significant acute pulmonary and hematologic toxicity were more common with MOPP/ABV (P=.060 and .001, respectively). There was no difference in cardiac toxicity. There were 24 deaths attributed to initial treatment: nine with ABVD and 15 with MOPP/ABV (P=.057). There have been 18 second malignancies associated with ABVD and 28 associated with MOPP/ABV (P=.13). Thirteen patients have developed MDS or acute leukemia: 11 were initially treated with MOPP/ABV, and two were initially treated with ABVD but subsequently received MOPP-containing regimens and radiotherapy before developing leukemia (P=.011).Conclusion: ABVD and the MOPP/ABV hybrid are effective therapies for Hodgkin's disease. MOPP/ABV is associated with a greater incidence of acute toxicity, MDS, and leukemia. ABVD should be considered the standard regimen for treatment of advanced Hodgkin's disease.