Salvage treatment for patients with multiply relapsed Hodgkin’s disease

Abstract

The use of combination chemotherapy for patients with Hodgkin’s disease has dramatically improved survival rates for this malignancy. The MOPP chemotherapy regimen (nitrogen mustard, Oncovin, prednisone, and procarbazine) introduced by De Vita et al. [1] can cure patients with both advanced Hodgkin’s disease and Hodgkin’s disease that has relapsed after the initial use of radiotherapy alone. However, it has been estimated that nearly 50% of patients in these two categories will have recurrent Hodgkin’s disease during or after their MOPP chemotherapy treatments [2]. The optimal management of Hodgkin’s disease patients who develop progressive disease after primary chemotherapy remains to be clearly established. An attempt at retreatment of MOPP failures was described by Fisher et al. [3]. This group reutilized the MOPP combination in patients who relapsed after completing an earlier prescribed course of the MOPP program. They reported a 59% second complete remission rate with this retreatment approach. A second avenue for treatment of MOPP failures was the introduction of multiagent chemotherapy combinations that were felt to be non-cross-resistant to the MOPP program. The first of these was the ABVD combination (Adriamycin, bleomycin, vinblastine, and dacarbazine) introduced by Santoro et al. [4], who initially reported a 50% complete response rate in patients who were previous MOPP failures.