ChlVPP therapy for Hodgkin's disease: experience of 960 patients. The International ChlVPP Treatment Group

Abstract

Background: Combination chemotherapy or combined chemo-radiotherapy is the treatment of choice for patients with advanced stage Hodgkin's disease and for patients failing curative radiotherapy. Increasingly, particularly in Europe, patients with early stage disease with poor prognostic features are also primarily treated with chemotherapy or combined chemo-radiotherapy. We analyzed the experience of 4 research groups which used ChlVPP, with or without radiotherapy, as standard chemotherapy for Hodgkin's disease.

Patients and methods: Patients with Hodgkin's disease were treated with ChlVPP chemotherapy: days 1-14: chlorambucil: 6 mg/m2/day, procarbazine: 100 mg/m2/day, prednisone or prednisolone: 40 mg/day; Days 1, 8: vinblastine: 6 mg/m2/day. The use of radiotherapy varied across research groups, with many, but not all, patients receiving radiotherapy.

Results: A total of 960 patients were treated. 60% were male, 25% were aged 50+, 59% had nodular sclerosis histology. Failure-free survival (time to first occurrence of progression, relapse after response or death from any cause) at 5 years by stage was: Stage I/IIA (231 patients), 75%; I/IIB (152 patients), 62%; IIIA (180 patients), 67%; IIIB/IV (397 patients), 51%. Adverse prognostic factors for all patients included age 50+ and 'B' symptoms. Patients aged 50+ of all stages did especially poorly on ChlVPP therapy. The 34 stage IIIB/IV patients with lymphocyte depleted histology also did poorly.

Conclusions: These results compare favorably with other reported series. ChlVPP is an appropriate alternative to other chemotherapy regimens for some Hodgkin's disease patients, often with a reduced toxicity profile. Other chemotherapy may be preferred in patients greater than 50 years of age.