Skip to main content

Treatment of Advanced Stage Hodgkin Lymphoma

  • Chapter
  • First Online:

Part of the book series: Hematologic Malignancies ((HEMATOLOGIC))

Abstract

Before the introduction of combination chemotherapy, more than 95% of patients with advanced HL succumbed to their disease within 5 years. Thus, remission rates in excess of 50% achieved with MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) were a major breakthrough in oncology (J Clin Oncol 4:1295–1306, 1986; Ann Intern Med 92:587–595, 1980). MOPP was successfully introduced almost 40 years ago and used for many years for advanced stage disease, resulting in long-term remission of nearly 50% (J Clin Oncol 4:1295–1306, 1986; Ann Intern Med 104:739–746, 1986). It was then replaced by ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine), after a series of large multicenter trials had investigated ABVD vs. alternating MOPP/ABVD or MOPP alone (Ann Intern Med 104:739–746, 1986; J Clin Oncol 21:607–614, 2003; J Clin Oncol 5:27–37, 1987).

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   199.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Longo DL, Young RC, Wesley M, Hubbard SM, Duffey PL, Jaffe ES, et al. Twenty years of MOPP therapy for Hodgkin’s disease. J Clin Oncol. 1986;4:1295–306.

    PubMed  CAS  Google Scholar 

  2. DeVita Jr VT, Simon RM, Hubbard SM, Young RC, Berard CW, Moxley JH, et al. Curability of advanced Hodgkin’s disease with chemotherapy. Long-term follow-up of MOPP-treated patients at the National Cancer Institute. Ann Intern Med. 1980;92:587–95.

    PubMed  Google Scholar 

  3. Bonadonna G, Valagussa P, Santoro A. Alternating non-cross-resistant combination chemotherapy or MOPP in stage IV Hodgkin’s disease. A report of 8-year results. Ann Intern Med. 1986;104:739–46.

    PubMed  CAS  Google Scholar 

  4. Duggan DB, Petroni GR, Johnson JL, Glick JH, Fisher RI, Connors JM, et al. Randomized comparison of ABVD and MOPP/ABV hybrid for the treatment of advanced Hodgkin’s disease: report of an intergroup trial. J Clin Oncol. 2003;21:607–14.

    Article  PubMed  CAS  Google Scholar 

  5. Santoro A, Bonadonna G, Valagussa P, Zucali R, Viviani S, Villani F, et al. Long-term results of combined chemotherapy-radiotherapy approach in Hodgkin’s disease: superiority of ABVD plus radiotherapy versus MOPP plus radiotherapy. J Clin Oncol. 1987;5:27–37.

    PubMed  CAS  Google Scholar 

  6. Canellos GP, Anderson JR, Propert KJ, Nissen N, Cooper MR, Henderson ES, et al. Chemotherapy of advanced Hodgkin’s disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med. 1992;327:1478–84.

    Article  PubMed  CAS  Google Scholar 

  7. Viviani S, Bonadonna G, Santoro A, Bonfante V, Zanini M, Devizzi L, et al. Alternating versus hybrid MOPP and ABVD combinations in advanced Hodgkin’s disease: ten-year results. J Clin Oncol. 1996;14:1421–30.

    PubMed  CAS  Google Scholar 

  8. Connors JM, Klimo P, Adams G, Burns BF, Cooper I, Meyer RM, et al. Treatment of advanced Hodgkin’s disease with chemotherapy--comparison of MOPP/ABV hybrid regimen with alternating courses of MOPP and ABVD: a report from the National Cancer Institute of Canada clinical trials group. J Clin Oncol. 1997;15:1638–45.

    PubMed  CAS  Google Scholar 

  9. Sieber M, Tesch H, Pfistner B, Rueffer U, Paulus U, Munker R, et al. Treatment of advanced Hodgkin’s disease with COPP/ABV/IMEP versus COPP/ABVD and consolidating radiotherapy: final results of the German Hodgkin’s Lymphoma Study Group HD6 trial. Ann Oncol. 2004;15:276–82.

    Article  PubMed  CAS  Google Scholar 

  10. Stefan DC, Stones D: How much does it cost to treat children with Hodgkin lymphoma in Africa? Leuk Lymphoma. 2009;50:196–9.

    Article  PubMed  Google Scholar 

  11. Canellos GP, Niedzwiecki D: Long-term follow-up of Hodgkin’s disease trial. N Engl J Med. 2002;346:1417–8.

    Article  PubMed  Google Scholar 

  12. Gobbi PG, Levis A, Chisesi T, Broglia C, Vitolo U, Stelitano C, et al. 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. J Clin Oncol. 2005;23:9198–207.

    Article  PubMed  CAS  Google Scholar 

  13. Johnson PW, Radford JA, Cullen MH, Sydes MR, Walewski J, Jack AS, et al. Comparison of ABVD and alternating or hybrid multidrug regimens for the treatment of advanced Hodgkin’s lymphoma: results of the United Kingdom Lymphoma Group LY09 Trial (ISRCTN97144519). J Clin Oncol. 2005;23:9208–18.

    Article  PubMed  CAS  Google Scholar 

  14. Radford JA, Crowther D, Rohatiner AZ, Ryder WD, Gupta RK, Oza A, et al. Results of a randomized trial comparing MVPP chemotherapy with a hybrid regimen, ChlVPP/EVA, in the initial treatment of Hodgkin’s disease. J Clin Oncol. 1995;13:2379–85.

    PubMed  CAS  Google Scholar 

  15. Radford JA, Rohatiner AZ, Ryder WD, Deakin DP, Barbui T, Lucie NP, et al. ChlVPP/EVA hybrid versus the weekly VAPEC-B regimen for previously untreated Hodgkin’s disease. J Clin Oncol. 2002;20:2988–94.

    Article  PubMed  CAS  Google Scholar 

  16. Horning SJ, Hoppe RT, Breslin S, Bartlett NL, Brown BW, Rosenberg SA. Stanford V and radiotherapy for locally extensive and advanced Hodgkin’s disease: mature results of a prospective clinical trial. J Clin Oncol. 2002;20:630–7.

    Article  PubMed  Google Scholar 

  17. Hoskin PJ, Lowry L, Horwich A, Jack A, Mead B, Hancock BW, et al. Randomized comparison of the stanford V regimen and ABVD in the treatment of advanced Hodgkin’s Lymphoma: United Kingdom National Cancer Research Institute Lymphoma Group Study ISRCTN 64141244. J Clin Oncol. 2009;27:5390–6.

    Article  PubMed  Google Scholar 

  18. Diehl V. Dose-escalation study for the treatment of Hodgkin’s disease. The German Hodgkin Study Group (GHSG). Ann Hematol. 1993;66:139–40.

    Article  PubMed  CAS  Google Scholar 

  19. Diehl V, Franklin J, Pfreundschuh M, Lathan B, Paulus U, Hasenclever D, et al. Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin’s disease. N Engl J Med. 2003;348:2386–95.

    Article  PubMed  CAS  Google Scholar 

  20. Engert A, Diehl V, Franklin J, Lohri A, Dorken B, Ludwig WD, et al. Escalated-dose BEACOPP in the treatment of patients with advanced-stage Hodgkin’s lymphoma: 10 years of follow-up of the GHSG HD9 study. J Clin Oncol. 2009;27:4548–54.

    Article  PubMed  Google Scholar 

  21. Diehl V, H. H, Mueller RP, Eich HT, Mueller-Hermelink H, Cerny T, et al. Eight Cycles of BEACOPP Escalated Compared with 4 Cycles of BEACOPP Escalated Followed by 4 Cycles of BEACOPP Baseline with Or without Radiotherapy in Patients in Advanced Stage Hodgkin Lymphoma (HL): Final Analysis of the Randomised HD12 Trial of the German Hodgkin Study Group (GHSG). Blood (ASH Annual Meeting Abstracts). 2008; Abstract 1558.

    Google Scholar 

  22. Linch DC, Winfield D, Goldstone AH, Moir D, Hancock B, McMillan A, et al. Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin’s disease: results of a BNLI randomised trial. Lancet. 1993;341:1051–4.

    Article  PubMed  CAS  Google Scholar 

  23. Schmitz N, Pfistner B, Sextro M, Sieber M, Carella AM, Haenel M, et al. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin’s disease: a randomised trial. Lancet. 2002;359:2065–71.

    Article  PubMed  CAS  Google Scholar 

  24. Josting A, Rudolph C, Mapara M, Glossmann JP, Sieniawski M, Sieber M, et al. Cologne high-dose sequential chemotherapy in relapsed and refractory Hodgkin lymphoma: results of a large multicenter study of the German Hodgkin Lymphoma Study Group (GHSG). Ann Oncol. 2005;16:116–23.

    Article  PubMed  CAS  Google Scholar 

  25. Federico M, Luminari S, Iannitto E, Polimeno G, Marcheselli L, Montanini A, et al. ABVD compared with BEACOPP compared with CEC for the initial treatment of patients with advanced Hodgkin’s lymphoma: results from the HD2000 Gruppo Italiano per lo Studio dei Linfomi Trial. J Clin Oncol. 2009;27:805–11.

    Article  PubMed  Google Scholar 

  26. Gianni AM, Rambaldi A, Zinzani PL, Levis A, Brusamolino E, Pulsoni A: Comparable 3-year outcome following ABVD or BEACOPP first-line chemotherapy, plus pre-planned high-dose salvage, in advanced Hodgkin lymphoma: a randomized trial of the Michelangelo, GITIL and IIL cooperative groups. J Clin Oncol. 2008;26:Abstract 8506.

    Google Scholar 

  27. Hasenclever D, Diehl V: A prognostic score for advanced Hodgkin’s disease. International Prognostic Factors Project on Advanced Hodgkin’s Disease. N Engl J Med. 1998;339:1506–14.

    Article  PubMed  CAS  Google Scholar 

  28. Carde P, Koscielny S, Franklin J, Axdorph U, Raemaekers J, Diehl V, et al. Early response to chemotherapy: a surrogate for final outcome of Hodgkin’s disease patients that should influence initial treatment length and intensity? Ann Oncol. 2002;13 Suppl 1:86–91.

    Article  PubMed  Google Scholar 

  29. Colonna P, Jais JP, Desablens B, Harousseau JL, Briere J, Boasson M, et al. Mediastinal tumor size and response to chemotherapy are the only prognostic factors in supradiaphragmatic Hodgkin’s disease treated by ABVD plus radiotherapy: ten-year results of the Paris-Ouest-France 81/12 trial, including 262 patients. J Clin Oncol. 1996; 14:1928–35.

    PubMed  CAS  Google Scholar 

  30. Kobe C, Dietlein M, Franklin J, Markova J, Lohri A, Amthauer H, et al. Positron emission tomography has a high negative predictive value for progression or early relapse for patients with residual disease after first-line chemotherapy in advanced-stage Hodgkin lymphoma. Blood. 2008;112:3989–94.

    Article  PubMed  CAS  Google Scholar 

  31. Gallamini A, Hutchings M, Rigacci L, Specht L, Merli F, Hansen M, et al. Early interim 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography is prognostically superior to international prognostic score in advanced-stage Hodgkin’s lymphoma: a report from a joint Italian-Danish study. J Clin Oncol. 2007;25:3746–52.

    Article  PubMed  CAS  Google Scholar 

  32. Hutchings M, Loft A, Hansen M, Pedersen LM, Buhl T, Jurlander J, et al. FDG-PET after two cycles of chemotherapy predicts treatment failure and progression-free survival in Hodgkin lymphoma. Blood. 2006;107:52–9.

    Article  PubMed  CAS  Google Scholar 

  33. Sieber M, Bredenfeld H, Josting A, Reineke T, Rueffer U, Koch T, et al. 14-day variant of the bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone regimen in advanced-stage Hodgkin’s lymphoma: results of a pilot study of the German Hodgkin’s Lymphoma Study Group. J Clin Oncol. 2003;21:1734–9.

    Article  PubMed  CAS  Google Scholar 

  34. Dann EJ, Bar-Shalom R, Tamir A, Haim N, Ben-Shachar M, Avivi I, et al. Risk-adapted BEACOPP regimen can reduce the cumulative dose of chemotherapy for standard and high-risk Hodgkin lymphoma with no impairment of outcome. Blood. 2007;109:905–9.

    Article  PubMed  CAS  Google Scholar 

  35. Avigdor A, Bulvik S, Levi I, Dann EJ, Shemtov N, Perez-Avraham G, et al. Two cycles of escalated BEACOPP followed by four cycles of ABVD utilizing early-interim PET/CT scan is an effective regimen for advanced high-risk Hodgkin’s lymphoma. Ann Oncol. 2010;21:126–32.

    Article  PubMed  CAS  Google Scholar 

  36. Gallamini A, Rigacci L, Merli F, Nassi L, Bosi A, Capodanno I, et al. The predictive value of positron emission tomography scanning performed after two courses of standard therapy on treatment outcome in advanced stage Hodgkin’s disease. Haematologica. 91:475–81.

    Google Scholar 

  37. Gallamini A, Fiore F, Sorasio R, Rambaldi A, Patti C, Stelitano C, et al. Early chemotherapy intensification with BEACOPP in high-risk, interim-pet positive advanced stage Hodgkin lymphoma, improves the overall treatment outcome of ABVD: a GITIL multicenter clinical study. Annuanl EHA Meeting. 2009; Abstract Number 0502.

    Google Scholar 

  38. Federico M, Bellei M, Brice P, Brugiatelli M, Nagler A, Gisselbrecht C, et al. High-dose therapy and autologous stem-cell transplantation versus conventional therapy for patients with advanced Hodgkin’s lymphoma responding to front-line therapy. J Clin Oncol. 2003;21:2320–5.

    Article  PubMed  CAS  Google Scholar 

  39. Andrieu JM, Yilmaz U, Colonna P. MOPP versus ABVD and low-dose versus high-dose irradiation in Hodgkin’s disease at intermediate and advanced stages: analysis of a meta-analysis by clinicians. J Clin Oncol. 1999;17:730–4.

    PubMed  CAS  Google Scholar 

  40. Loeffler M, Brosteanu O, Hasenclever D, Sextro M, Assouline D, Bartolucci AA, et al. Meta-analysis of chemotherapy versus combined modality treatment trials in Hodgkin’s disease. International Database on Hodgkin’s Disease Overview Study Group. J Clin Oncol. 1998;16:818–29.

    PubMed  CAS  Google Scholar 

  41. Aleman BM, Raemaekers JM, Tirelli U, Bortolus R, van ‘t Veer MB, Lybeert ML, et al. Involved-field radiotherapy for advanced Hodgkin’s lymphoma. N Engl J Med. 2003;348:2396–406.

    Article  PubMed  Google Scholar 

  42. Ferme C, Mounier N, Casasnovas O, Brice P, Divine M, Sonet A, et al. Long-term results and competing risk analysis of the H89 trial in patients with advanced-stage Hodgkin lymphoma: a study by the Groupe d’Etude des Lymphomes de l’Adulte (GELA). Blood. 2006;107:4636–42.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Volker Diehl .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Borchmann, P., Diehl, V. (2011). Treatment of Advanced Stage Hodgkin Lymphoma. In: Engert, A., Horning, S. (eds) Hodgkin Lymphoma. Hematologic Malignancies. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-12780-9_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-12780-9_12

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-12779-3

  • Online ISBN: 978-3-642-12780-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics