Abstract
The purpose of this randomized trial was to compare the efficacy of 6 cycles of prednisolone, Adriamycin (doxorubicin), bleomycin, vincristine (Oncovin) and etoposide (PABlOE) with 3 cycles of PABIOE that alternate with 3 cycles of chlorambucil, vinblastine, procarbazine and prednisone (ChlVPP) in patients with advanced Hodgkin's disease. Between October 1992 and April 1996, 679 patients were entered onto the study. 41 of these did not match the protocol requirements on review and were excluded from further analysis, most of these being reclassified as NHL on histological review. Of the remaining 638 patients, 319 were allocated to receive PABIOE and 319 were allocated to receive ChlVPP/PABlOE. The complete remission (CR) rates were 78% and 64%, for ChlVPP/PABlOE and PABIOE respectively after initial chemotherapy (P< 0.0001). 124 patients were re-evaluated subsequently following radiotherapy to residual masses. The CR rates changed from 78% to 88% for ChlVPP/PABlOE and from 64% to 77% for PABlOE when re-evaluated in this manner (treatment difference still significant P = 0.0002). The treatment associated mortality in the PABlOE arm was 2.2% (7 deaths), while there were no such deaths in the ChlVPP/PABlOE arm (P = 0.015). The failure-free survival was significantly greater in the ChlVPP/PABlOE arm (P< 0.0001) as was the overall survival (P = 0.01). The failure-free and overall survival rates at 3 years were 77% and 91% in the ChlVPP/PABlOE arm, compared with 58% and 85% in the PABIOE arm, respectively. These results indicate that ChlVPP alternating with PABIOE is superior to PABIOE alone as initial treatment for advanced Hodgkin's disease. © 2001 Cancer Research Campaign
Similar content being viewed by others
Article PDF
Change history
16 November 2011
This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication
References
Altman DG (1991) Analysis of survival times in “Practical Statistics for Medical Research’ by. Altman DG Chapman & Hall: London. pp. 383–384
Bartlett NL, Rosenberg SA, Hoppe RT, Hancock SL and Horning SJ (1995) Brief chemotherapy, Stanford V, and adjuvant radiotherapy for bulky or advanced-stage Hodgkin's disease: A preliminary report. J Clin Oncol 13: 1080–1088
Bennett MH, MacLennan KA and Vaughan Hudson B (1989) The clinical and prognostic relevance of histopathological classification in Hodgkin's Disease. in Fenoglio-Preiser CM, Wolff M, Rilke F (ed): Progress in Surgical Pathology, New York: Field and Wood. pp. 127–151
Bonadonna G, Valagussa P and Santoro A (1986) Alternating non-cross resistant combination chemotherapy or MOPP in stage IV Hodgkin's disease: A report of 8-year results. Annal Intern Med 104: 739–46
Canellos GP (1996) Is ABVD the standard regimen for Hodgkin's disease based on randomised CALGB comparison of MOPP, ABVD and MOPP alternating with ABVD. Leukaemia 10 (suppl.2): S68
Canellos GP, Anderson JR, Propert KJ, Nissen N, Cooper MR, Henderson ES, Green MR, Gottlieb A and Peterson BA (1992) Chemotherapy of advanced Hodgkin's disease with MOPP, ABVD, or MOPP alternating with ABVD. New Engl J Med 327: 1478–1484
Carbone PP, Kaplan HS, Musshoff N, Smithers DW and Tubiana M (1971) Report of the Committee on Hodgkin's Disease staging classifications. Cancer Res 31: 1860–1861
Cox DR (1972) Regression models and life tables. J Roy Statist Soc (B) 34: 187–220
Cullen MH, Stuart NSA, Woodroffe C, Murphy A, Fletcher J, Blackledge GRP, Child JA, Grieve RJ and Jones EL (1994) ChlVPP/PABIOE and radiotherapy in advanced Hodgkin's disease. J Clini Oncol 12: 779–787
De Vita VT, Serpick AA and Carbone PP (1970) Combination chemotherapy in the treatment of advanced Hodgkin's disease. Annal Intern Med 73: 881–895
Dhaliwal HS, Rohatiner AZS, Gregory W, Richards MA, Johnson PWM, Whelan JS, Gallagher CJ, Matthews J, Ganesan TS, Barnett MJ, Waxman JH, Stansfeld AG, Wrigley PFM, Slevin ML, Malpas JS and Lister TA (1993) Combination chemotherapy for intermediate and high grade non-Hodgkin's lymphoma. Br J Cancer 68: 767–774
Diehl V, Sieber M, Ruffer U, Cathan B, Hasenclever D, Pfreundschuh M, Leoffler M, Lieberz D, Koch P, Adler M and Tesch H (1997) An intensified chemotherapy regimen in advanced Hodgkin's disease. Annal Oncol 8: 143–148
Duggan D, Petroni G, Johnson J, Hanson K, Glick J, Connors JM, Cherny R, Barcos M and Peterson BA (1997) MOPP/ABV versus ABVD for advanced Hodgkin's disease – a preliminary report of CALGB 8952 (with SWOG, ECOG, NCIC). Proceedings of American Society of Clinical Oncology 16: 12a (abstract 43)
Gams RA, Durant JR and Bartolucci AA (1982) Chemotherapy for advanced Hodgkin's disease: Conclusions from the Southeastern Cancer Study Group. Cancer Treatment Reports 66: 899–905
Goldie J, Coldman A and Gudauskas G (1982) Rationale for the use of alternating non-cross-resistant chemotherapy. Cancer Treatment Reports 66: 439–449
Glick JH, Young ML, Harrington D, Schilsky RL, Beck T, Neiman R, Fisher RI, Peterson B and Olsen MM (1998) MOPP/ABV Hybrid chemotherapy for advanced Hodgkin's Disease significantly improves failure-free and overall survival: The 8-year results of the Intergroup trial. J Clin Oncol 16: 19–26
Hancock BW, Vaughan Hudson G, Vaughan Hudson B, Haybittle JL, Bennett MH, Maclennan KA and Jelliffe AM (1991) British National Lymphoma Investigation randomised study of MOPP (mustine, Oncovin, procarbazine, prednisolone) against LOPP (Leukeran substituted for mustine) in advanced Hodgkin's disease – long term results. Br J Cancer 63: 579–582
Hancock BW, Vaughan Hudson B, Vaughan Hudson G, Bennett MH, Maclennan KA, Haybittle JL, Anderson L and Linch DC (1992) LOPP alternating with EVAP is superior to LOPP alone in the initial treatment of advanced Hodgkin's disease: results of a British National Lymphoma Investigation trial. J Clin Oncol 10: 1252–1258
Kaplan EL and Meier P (1958) Nonparametric estimation from incomplete observations. American Statistical Association Journal 53: 457–481
Linch DC and Vaughan Hudson B (1988) Management of the malignant lymphomas. In: Hoffbrand AV (ed) Recent Advances in Haematology, London: Longman Group. pp. 211–242
Longo DL, Young RC, Wesley M, Hubbard SM, Duffey PL, Jaffe ES and De Vita VT Jr (1986) 20 years of MOPP therapy for Hodgkin's disease. J Clin Oncol 4: 1295–1306
Longo DL, Duffey PL, De Vita VT, Wiernik PH, Hubbard SM, Phares JC, Bastian AW, Jaffe ES and Young RC (1991) Treatment of advanced-stage Hodgkin's disease: alternating non-cross resistant MOPP/CABS is not superior to MOPP. J Clin Oncol 8: 1409–1420
Loeffler M, Brosteanu O, Hasenclever D, Sextro M, Assouline D, Bartolucci AA, Cassileth PA, Crowther D, Diehl V, Fisher RI, Hoppe RT, Jacobs P, Pater JL, Pavlovsky S, Thompson E and Wiernik P (1998) Meta-analysis of chemotherapy versus combined modality treatment trials in Hodgkin's disease. J Clini Oncol 16: 818–829
Nicholson WM, Beard MEJ, Crowther D, Stansfeld AG, Vartan CP, Malpas JS, Hamilton Fairley G and Bodley Scott R (1970) Combination chemotherapy in generalised Hodgkin's disease. BMJ 3: 7–10
Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, Mantel N, McPherson K, Peto J and Smith PG (1977) Design and analysis of randomised clinical trials requiring prolonged observation of each patient. II. analysis and examples. Br J Cancer 35: 1–39
Radford JA, Crowther D, Rohatiner AZS, Ryder WDJ, Gupta RK, Oza A, Deakin DP, Arnott S, Wilkinson PM, James RD, Johnson RJ and Lister TA (1995) Results of a randomised trial comparing MVPP chemotherapy with a hybrid regimen, ChlVPP/EVA, in the initial treatment of Hodgkin's disease. J Clin Oncol 13: 2379–2385
Santoro A, Bonadonna G, Bonfante V and Valagussa P (1982) Alternating drug combinations in the treatment of advanced Hodgkin's disease. New Engl J Med 306: 770–775
Selby P, Patel P, Milan S, Meldrum M, Mansi J, Mbidde E, Brada M, Perren T, Forgeson G, Gore M, Smith I and McElwain T (1990) ChlVPP combination chemotherapy for Hodgkin's disease; long-term results. Br J Cancer 62: 279–285
Vinciguerra V, Propert KJ, Coleman M, Anderson JR, Stutzman L, Pajak TF, Nissen NI, Frizzera G, Gottleib A and Holland JF (1986) Alternating cycles of combination chemotherapy for patients with recurrent Hodgkin's disease following radiotherapy. A prospectively randomised study by the Cancer And Leukaemia Group B. J Clin Oncol 4: 838–846
Wagstaff J, Gregory WM, Swindell R, Crowther D and Lister TA (1988) Prognostic factors for survival in stage IIIB and IV Hodgkins disease: A multivariate analysis comparing two specialist treatment centres. Br J Cancer 58: 487–492
Author information
Authors and Affiliations
Consortia
Rights and permissions
From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/
About this article
Cite this article
Hancock, B., Gregory, W., Cullen, M. et al. ChlVPP alternating with PABlOE is superior to PABlOE alone in the initial treatment of advanced Hodgkin's disease: results of a British National Lymphoma Investigation/Central Lymphoma Group randomized controlled trial. Br J Cancer 84, 1293–1300 (2001). https://doi.org/10.1054/bjoc.2001.1778
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1054/bjoc.2001.1778
Keywords
This article is cited by
-
Long-term survival after treatment for Hodgkin’s disease (1973–2002): improved survival with successive 10-year cohorts
British Journal of Cancer (2012)
-
Guadagno di sopravvivenza dei nuovi farmaci
PharmacoEconomics Italian Research Articles (2004)