Skip to main content
NCBI home page
British Journal of Cancer logoLink to British Journal of Cancer
. 2001 May;84(10):1293–1300. doi: 10.1054/bjoc.2001.1778

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

B W Hancock 1, W M Gregory 2, M H Cullen 3, G Vaughan Hudson 2, A Burton 4, P Selby 5, K A Maclennan 5, A Jack 6, E M Bessell 7, P Smith 2, D C Linch 2; on behalf of the British National Lymphoma Investigation and Central Lymphoma Group
PMCID: PMC2363648  PMID: 11355937

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 www.bjcancer.com

Keywords: alternating chemotherapy; ChlVPP/PABlOE, advanced Hodgkin's disease

Full Text

The Full Text of this article is available as a PDF (123.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bartlett N. L., Rosenberg S. A., Hoppe R. T., Hancock S. L., Horning S. J. Brief chemotherapy, Stanford V, and adjuvant radiotherapy for bulky or advanced-stage Hodgkin's disease: a preliminary report. J Clin Oncol. 1995 May;13(5):1080–1088. doi: 10.1200/JCO.1995.13.5.1080. [DOI] [PubMed] [Google Scholar]
  2. 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 Jun;104(6):739–746. doi: 10.7326/0003-4819-104-6-739. [DOI] [PubMed] [Google Scholar]
  3. Canellos G. P., Anderson J. R., Propert K. J., Nissen N., Cooper M. R., Henderson E. S., Green M. R., Gottlieb A., Peterson B. A. Chemotherapy of advanced Hodgkin's disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med. 1992 Nov 19;327(21):1478–1484. doi: 10.1056/NEJM199211193272102. [DOI] [PubMed] [Google Scholar]
  4. Canellos G. P. Is ABVD the standard regimen for Hodgkin's disease based on randomized CALGB comparison of MOPP, ABVD and MOPP alternating with ABVD? Leukemia. 1996 Jun;10 (Suppl 2):s68–s68. [PubMed] [Google Scholar]
  5. Carbone P. P., Kaplan H. S., Musshoff K., Smithers D. W., Tubiana M. Report of the Committee on Hodgkin's Disease Staging Classification. Cancer Res. 1971 Nov;31(11):1860–1861. [PubMed] [Google Scholar]
  6. Cullen M. H., Stuart N. S., Woodroffe C., Murphy A., Fletcher J., Blackledge G. R., Child J. A., Grieve R. J., Jones E. L. ChlVPP/PABlOE and radiotherapy in advanced Hodgkin's disease. The Central Lymphoma Group. J Clin Oncol. 1994 Apr;12(4):779–787. doi: 10.1200/JCO.1994.12.4.779. [DOI] [PubMed] [Google Scholar]
  7. Devita V. T., Jr, Serpick A. A., Carbone P. P. Combination chemotherapy in the treatment of advanced Hodgkin's disease. Ann Intern Med. 1970 Dec;73(6):881–895. doi: 10.7326/0003-4819-73-6-881. [DOI] [PubMed] [Google Scholar]
  8. Dhaliwal H. S., Rohatiner A. Z., Gregory W., Richards M. A., Johnson P. W., Whelan J. S., Gallagher C. J., Matthews J., Ganesan T. S., Barnett M. J. Combination chemotherapy for intermediate and high grade non-Hodgkin's lymphoma. Br J Cancer. 1993 Oct;68(4):767–774. doi: 10.1038/bjc.1993.425. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Diehl V., Sieber M., Rüffer U., Lathan B., Hasenclever D., Pfreundschuh M., Loeffler M., Lieberz D., Koch P., Adler M. BEACOPP: an intensified chemotherapy regimen in advanced Hodgkin's disease. The German Hodgkin's Lymphoma Study Group. Ann Oncol. 1997 Feb;8(2):143–148. doi: 10.1023/a:1008294312741. [DOI] [PubMed] [Google Scholar]
  10. Gams R. A., Durant J. R., Bartolucci A. A. Chemotherapy for advanced Hodgkin's disease: conclusions from the Southeastern Cancer Study Group. Cancer Treat Rep. 1982 Apr;66(4):899–905. [PubMed] [Google Scholar]
  11. Glick J. H., Young M. L., Harrington D., Schilsky R. L., Beck T., Neiman R., Fisher R. I., Peterson B. A., Oken M. M. 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. 1998 Jan;16(1):19–26. doi: 10.1200/JCO.1998.16.1.19. [DOI] [PubMed] [Google Scholar]
  12. Goldie J. H., Coldman A. J., Gudauskas G. A. Rationale for the use of alternating non-cross-resistant chemotherapy. Cancer Treat Rep. 1982 Mar;66(3):439–449. [PubMed] [Google Scholar]
  13. Hancock B. W., Vaughan Hudson G., Vaughan Hudson B., Bennett M. H., MacLennan K. A., Haybittle J. L., Anderson L., Linch D. C. 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. 1992 Aug;10(8):1252–1258. doi: 10.1200/JCO.1992.10.8.1252. [DOI] [PubMed] [Google Scholar]
  14. Hancock B. W., Vaughan Hudson G., Vaughan Hudson B., Haybittle J. L., Bennett M. H., MacLennan K. A., Jelliffe A. M. 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. 1991 Apr;63(4):579–582. doi: 10.1038/bjc.1991.134. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Loeffler M., Brosteanu O., Hasenclever D., Sextro M., Assouline D., Bartolucci A. A., Cassileth P. A., Crowther D., Diehl V., Fisher R. I. 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 Mar;16(3):818–829. doi: 10.1200/JCO.1998.16.3.818. [DOI] [PubMed] [Google Scholar]
  16. Longo D. L., Duffey P. L., DeVita V. T., Jr, Wiernik P. H., Hubbard S. M., Phares J. C., Bastian A. W., Jaffe E. S., Young R. C. Treatment of advanced-stage Hodgkin's disease: alternating noncrossresistant MOPP/CABS is not superior to MOPP. J Clin Oncol. 1991 Aug;9(8):1409–1420. doi: 10.1200/JCO.1991.9.8.1409. [DOI] [PubMed] [Google Scholar]
  17. Longo D. L., Young R. C., Wesley M., Hubbard S. M., Duffey P. L., Jaffe E. S., DeVita V. T., Jr Twenty years of MOPP therapy for Hodgkin's disease. J Clin Oncol. 1986 Sep;4(9):1295–1306. doi: 10.1200/JCO.1986.4.9.1295. [DOI] [PubMed] [Google Scholar]
  18. Nicholson W. M., Beard M. E., Crowther D., Stansfeld A. G., Vartan C. P., Malpas J. S., Fairley G. H., Scott R. B. Combination chemotherapy in generalized Hodgkin's disease. Br Med J. 1970 Jul 4;3(5713):7–10. doi: 10.1136/bmj.3.5713.7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Peto R., Pike M. C., Armitage P., Breslow N. E., Cox D. R., Howard S. V., Mantel N., McPherson K., Peto J., Smith P. G. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. Br J Cancer. 1977 Jan;35(1):1–39. doi: 10.1038/bjc.1977.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Radford J. A., Crowther D., Rohatiner A. Z., Ryder W. D., Gupta R. K., Oza A., Deakin D. P., Arnott S., Wilkinson P. M., James R. D. 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 Sep;13(9):2379–2385. doi: 10.1200/JCO.1995.13.9.2379. [DOI] [PubMed] [Google Scholar]
  21. Santoro A., Bonadonna G., Bonfante V., Valagussa P. Alternating drug combinations in the treatment of advanced Hodgkin's disease. N Engl J Med. 1982 Apr 1;306(13):770–775. doi: 10.1056/NEJM198204013061303. [DOI] [PubMed] [Google Scholar]
  22. Selby P., Patel P., Milan S., Meldrum M., Mansi J., Mbidde E., Brada M., Perren T., Forgeson G., Gore M. ChlVPP combination chemotherapy for Hodgkin's disease: long-term results. Br J Cancer. 1990 Aug;62(2):279–285. doi: 10.1038/bjc.1990.278. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Vinciguerra V., Propert K. J., Coleman M., Anderson J. R., Stutzman L., Pajak T. F., Nissen N. I., Frizzera G., Gottlieb A., Holland J. F. Alternating cycles of combination chemotherapy for patients with recurrent Hodgkin's disease following radiotherapy. A prospectively randomized study by the Cancer and Leukemia Group B. J Clin Oncol. 1986 Jun;4(6):838–846. doi: 10.1200/JCO.1986.4.6.838. [DOI] [PubMed] [Google Scholar]
  24. Wagstaff J., Gregory W. M., Swindell R., Crowther D., Lister T. A. Prognostic factors for survival in stage IIIB and IV Hodgkin's disease: a multivariate analysis comparing two specialist treatment centres. Br J Cancer. 1988 Oct;58(4):487–492. doi: 10.1038/bjc.1988.246. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES