CHEMOTHERAPY OF ADVANCED HODGKINS-DISEASE WITH MOPP, ABVD, OR MOPP ALTERNATING WITH ABVD
CHEMOTHERAPY OF ADVANCED HODGKINS-DISEASE WITH MOPP, ABVD, OR MOPP ALTERNATING WITH ABVD
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DOI：
10.1056/nejm199211193272102
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发表时间：
1992-11-19
影响因子：
158.5
通讯作者：
PETERSON, BA
中科院分区：
文献类型：
--
作者：
CANELLOS, GP;ANDERSON, JR;PETERSON, BA
背景和方法。MOPP（氮芥、长春新碱、甲基苄肼和泼尼松）已成为霍奇金病的标准治疗近20年。 在一项随机、多中心试验中，我们比较了新诊断的晚期霍奇金病IIIA 2、IIIB和IVA或IVB的三种主要全身治疗方案：（1）MOPP单独给药6至8个周期，（2）MOPP与ABVD（多柔比星、博莱霉素、长春碱和达卡巴嗪）交替给药12个周期，（3）ABVD单独给药6至8个周期。放射治疗后首次复发的患者符合条件。未给予额外放射治疗。单用MOPP或单用ABVD治疗没有完全缓解或复发的患者换用相反的治疗方案。在361例合格患者中，123例接受MOPP治疗，123例接受MOPP与ABVD交替治疗，115例接受ABVD单药治疗。根据年龄、分期、既往放疗、组织学特征和体能状态对患者进行分层。总体缓解率为93%，完全缓解率为77%：MOPP组为67%，ABVD组为82%，MOPP-ABVD组为83%（MOPP与其他两种方案的比较P = 0.006，这两种方案都含有阿霉素）。MOPP的5年无失败生存率为50%，ABVD为61%，MOPP-ABVD为65%。年龄、分期（III期与IV期）和治疗方案显著影响无失败生存期。MOPP组5年总生存率为66%，ABVD组为73%，MOPP-ABVD组为75%（MOPP与多柔比星方案比较P = 0.28）。MOPP对骨髓的毒性作用比ABVD更严重，并且与处方剂量的更大减少相关。 在本试验中，ABVD治疗6至8个月与MOPP交替ABVD治疗12个月同样有效，且在治疗晚期霍奇金病方面均上级MOPP单药治疗。ABVD的骨髓毒性低于MOPP或ABVD与MOPP交替使用。
Background and Methods. MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) has been the standard treatment for Hodgkin's disease for almost 20 years. In a randomized, multicenter trial, we compared three regimens of primary systemic therapy for newly diagnosed advanced Hodgkin's disease in Stages IIIA2, IIIB, and IVA or IVB: (1) MOPP alone given for 6 to 8 cycles, (2) MOPP alternating with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) for 12 cycles, and (3) ABVD alone for 6 to 8 cycles. Patients in a first relapse after radiation therapy were eligible. No additional radiation therapy was given. Patients who did not have a complete response or who had a relapse with either MOPP alone or ABVD alone were switched to the opposite regimen.Results. Of 361 eligible patients, 123 received MOPP, 123 received MOPP alternating with ABVD, and 115 received ABVD alone. The patients were stratified according to age, stage, previous radiation, histologic features, and performance status. The overall response rate was 93 percent, with complete responses in 77 percent: 67 percent in the MOPP group, 82 percent in the ABVD group, and 83 percent in the MOPP-ABVD group (P = 0.006 for the comparison of MOPP with the other two regimens, both of which contained doxorubicin). The rates of failure-free survival at five years were 50 percent for MOPP, 61 percent for ABVD, and 65 percent for MOPP-ABVD. Age, stage (III vs. IV), and regimen influenced failure-free survival significantly. Overall survival at five years was 66 percent for MOPP, 73 percent for ABVD, and 75 percent for MOPP-ABVD (P = 0.28 for the comparison of MOPP with the doxorubicin regimens). MOPP had more severe toxic effects on bone marrow than ABVD and was associated with greater reductions in the prescribed dose.Conclusions. In this trial, ABVD therapy for 6 to 8 months was as effective as 12 months of MOPP alternating with ABVD, and both were superior to MOPP alone in the treatment of advanced Hodgkin's disease. ABVD was less myelotoxic than MOPP or ABVD alternating with MOPP.