title: Rapidly alternating COPP/ABV/IMEP is not superior to conventional alternating COPP/ABVD in combination with extended-field radiotherapy in intermediate-stage Hodgkin's lymphoma: final results of the German Hodgkin's Lymphoma Study Group Trial HD5.
abstract: OBJECTIVE
  To investigate whether treatment results in intermediate-stage Hodgkin's lymphoma can be improved by rapid application of non-cross-resistant drugs, the 10-drug regimen cyclophosphamide, vincristine, procarbazine, and prednisone (COPP), doxorubicin, bleomycin, and vinblastine (ABV), and ifosfamide, methotrexate, etoposide, and prednisone (IMEP), repeated every 6 weeks, was compared with conventional alternating COPP/doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) administered every 8 weeks.
  
  
  METHODS
  From January 1988 to January 1993, 996 patients in stage I or II Hodgkin's lymphoma with at least one risk factor (massive mediastinal tumor, massive spleen involvement, extranodal disease, elevated ESR, or more than two lymph node areas involved) and all patients in stage IIIA Hodgkin's lymphoma were randomized to receive two cycles of COPP/ABVD or COPP/ABV/IMEP followed by extended-field radiotherapy.
  
  
  RESULTS
  Both regimens produced similar rates for treatment responses (complete remission, 93% v 94%), freedom from treatment failure (80% v 79%), and overall survival (88% for both regimens) at a median follow-up time of 7 years. Most serious toxicities during chemotherapy were similar in both regimens. However, World Health Organization grade 3 and 4 leukocytopenia occurred significantly more frequently in the COPP/ABV/IMEP arm (53% v 44% of patients; P =.010). There were no differences in the number of serious infections and toxic deaths during therapy. The number of second malignancies was also the same in both arms (22 each).
  
  
  CONCLUSIONS
  Alternating COPP/ABVD and rapid alternating COPP/ABV/IMEP in combination with extended-field radiotherapy are equally effective in intermediate-stage Hodgkin's lymphoma and produce excellent long-term treatment results.
authors.affiliation: German Hodgkin's Lymphoma Study Group, Cologne, Germany. markus.sieber@medizin.uni-koeln.de
authors.forename: Markus
authors.initials: M
authors.lastname: Sieber
authors.forename: Hans
authors.initials: H
authors.lastname: Tesch
authors.forename: Beate
authors.initials: B
authors.lastname: Pfistner
authors.forename: Ulrich
authors.initials: U
authors.lastname: Rueffer
authors.forename: Bernd
authors.initials: B
authors.lastname: Lathan
authors.forename: Oana
authors.initials: O
authors.lastname: Brosteanu
authors.forename: Ursula
authors.initials: U
authors.lastname: Paulus
authors.forename: Tina
authors.initials: T
authors.lastname: Koch
authors.forename: Michael
authors.initials: M
authors.lastname: Pfreundschuh
authors.forename: Markus
authors.initials: M
authors.lastname: Loeffler
authors.forename: Andreas
authors.initials: A
authors.lastname: Engert
authors.forename: Andreas
authors.initials: A
authors.lastname: Josting
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wolf
authors.forename: Dirk
authors.initials: D
authors.lastname: Hasenclever
authors.forename: Jeremy
authors.initials: J
authors.lastname: Franklin
authors.forename: Eckhart
authors.initials: E
authors.lastname: Duehmke
authors.forename: Axel
authors.initials: A
authors.lastname: Georgii
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Schalk
authors.forename: Hartmut
authors.initials: H
authors.lastname: Kirchner
authors.forename: Gottfried
authors.initials: G
authors.lastname: Doelken
authors.forename: Reinhold
authors.initials: R
authors.lastname: Munker
authors.forename: Peter
authors.initials: P
authors.lastname: Koch
authors.forename: Richard
authors.initials: R
authors.lastname: Herrmann
authors.forename: Richard
authors.initials: R
authors.lastname: Greil
authors.forename: Anna Paola
authors.initials: AP
authors.lastname: Anselmo
authors.forename: Volker
authors.initials: V
authors.lastname: Diehl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003606:Dacarbazine / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D011344:Procarbazine; D014750:Vincristine; D014747:Vinblastine; D005047:Etoposide; D003606:Dacarbazine; D004317:Doxorubicin; D003520:Cyclophosphamide; D007069:Ifosfamide; D011241:Prednisone; D008727:Methotrexate