title: ABVD versus modified stanford V versus MOPPEBVCAD with optional and limited radiotherapy in intermediate- and advanced-stage Hodgkin's lymphoma: final results of a multicenter randomized trial by the Intergruppo Italiano Linfomi.
abstract: OBJECTIVE
  In this multicenter, prospective, randomized clinical trial on advanced Hodgkin's lymphoma (HL), the efficacy and toxicity of two chemotherapy regimens, doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone (Stanford V) and mechlorethamine, vincristine, procarbazine, prednisone, epidoxirubicin, bleomycin, vinblastine, lomustine, doxorubicin, and vindesine (MOPPEBVCAD), were compared with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) as standard therapy to select which regimen would best support a reduced radiotherapy program, which was limited to < or = two sites of either previous bulky or partially remitting disease (a modification of the original Stanford program).
  
  
  METHODS
  Three hundred fifty-five patients with stage IIB, III, or IV HL were randomly assigned. Three hundred thirty-four patients were assessable for the study and received six cycles of ABVD (n = 122), three cycles of Stanford V (n = 107), or six cycles of MOPPEBVCAD (n = 106); radiotherapy was administered to 76, 71, and 50 patients in these three arms, respectively.
  
  
  RESULTS
  The complete response rates for ABVD, Stanford V, and MOPPEBVCAD were 89%, 76% and 94%, respectively; 5-year failure-free survival (FFS) and progression-free survival rates were 78%, 54%, 81% and 85%, 73%, and 94%, respectively (P < .01 for comparison of Stanford V with the other two regimens). Corresponding 5-year overall survival rates were 90%, 82%, and 89% for ABVD, Stanford V, and MOPPEBVCAD, respectively. Stanford V was more myelotoxic than ABVD but less myelotoxic than MOPPEBVCAD, which had larger reductions in the prescribed drug doses.
  
  
  CONCLUSIONS
  When associated with conditioned and limited (not adjuvant) radiotherapy, ABVD and MOPPEBVCAD were superior to Stanford V chemotherapy in terms of response rate and FFS and progression-free survival. Patients were irradiated less often after MOPPEBVCAD, but this regimen was more toxic. ABVD is still the best choice when it is combined with optional, limited irradiation.
authors.affiliation: Medicina Interna e Oncologia Medica, Università di Pavia, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, Pavia, Italy. gobbipg@smatteo.pv.it
authors.forename: Paolo G
authors.initials: PG
authors.lastname: Gobbi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Levis
authors.forename: Teodoro
authors.initials: T
authors.lastname: Chisesi
authors.forename: Chiara
authors.initials: C
authors.lastname: Broglia
authors.forename: Umberto
authors.initials: U
authors.lastname: Vitolo
authors.forename: Caterina
authors.initials: C
authors.lastname: Stelitano
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pavone
authors.forename: Luigi
authors.initials: L
authors.lastname: Cavanna
authors.forename: Gino
authors.initials: G
authors.lastname: Santini
authors.forename: Francesco
authors.initials: F
authors.lastname: Merli
authors.forename: Marina
authors.initials: M
authors.lastname: Liberati
authors.forename: Luca
authors.initials: L
authors.lastname: Baldini
authors.forename: Giorgio Lambertenghi
authors.initials: GL
authors.lastname: Deliliers
authors.forename: Emanuele
authors.initials: E
authors.lastname: Angelucci
authors.forename: Roberto
authors.initials: R
authors.lastname: Bordonaro
authors.forename: Massimo
authors.initials: M
authors.lastname: Federico
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; D003606:Dacarbazine / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008130:Lomustine / Q000008:administration & dosage; D008297:Male; D008466:Mechlorethamine / Q000008:administration & dosage; D008558:Melphalan / 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; D014751:Vindesine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D011344:Procarbazine; D008466:Mechlorethamine; D014750:Vincristine; D014747:Vinblastine; D005047:Etoposide; D008130:Lomustine; D003606:Dacarbazine; D004317:Doxorubicin; D008558:Melphalan; D014751:Vindesine; D011241:Prednisone