Early Versus Late Intensification for Patients With High-Risk Hodgkin Lymphoma-3 Cycles of Intensive Chemotherapy Plus Low-Dose Lymph Node Radiation Therapy Versus 4 Cycles of Combined Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine Plus Myeloablative Chemotherapy With Autologous Stem Cell Transplantation Five-Year Results of a Randomized Trial on Behalf of the GOELAMS Group

摘要

BACKGROUND. The 5-year freedom from treatment failure (FFTF) rate, with treatment failure defined as the lack of post-treatment complete remission (CR), recurrence, or death, ranges from 60% to 70% after 6 to 8 cycles of combined doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), which is the reference treatment for patients with advanced Hodgkin lymphoma (HL). In this randomized, phase 2 study, the authors tested 2 intensive chemotherapy regimens in 158 patients with clinical stage (CS) IIB through IV HL accompanied by high-risk factors who were recruited between May 1997 and December 2004. METHODS. High-risk CS IIB, III, and IV were defined by the presence of >5 involved lymphoid areas, and/or a rnediastinal mass ratio >0.45, and/or >2 extra lymph node sites affected by the disease (for CS TV). In Arm V, 82 patients received 3 courses of combined vindesine (5 mg/m2), doxorubicin (99 mg/m2), carmustine (140 mg/m2), etoposide (600 mg/m2), and methylprednisolone (600 mg/m2) (VABEM) followed by low-dose lymph node irradiation.