Randomized Comparison of ABVD and MOPP/ABV Hybrid for the Treatment of Advanced Hodgkin’s Disease: Report of an Intergroup Trial

TLDR

ABVD and MOPP/ABV have been identified as effective treatments for Hodgkin’s disease in prior trials. This study compared ABVD and MOPP/ABV as initial chemotherapy in 856 adults with advanced Hodgkin’s disease through random assignment. The trial evaluated failure‑free and overall survival, life‑threatening acute toxicities, and serious long‑term toxicities such as cardiomyopathy, pulmonary toxicity, myelodysplastic syndromes, and secondary malignancies, reporting similar remission, failure‑free survival, and overall survival rates for both regimens. The randomized trial found no significant differences in remission, failure‑free survival, or overall survival between ABVD and MOPP/ABV, but MOPP/ABV was linked to higher rates of acute pulmonary and hematologic toxicity, more secondary malignancies, and a greater incidence of myelodysplastic syndrome or leukemia, leading the authors to recommend ABVD as the standard treatment for advanced Hodgkin’s disease.

Abstract

In a series of trials, doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (MOPP/ABV) have been identified as effective treatments for Hodgkin's disease. We compared these regimens as initial chemotherapy for Hodgkin's disease.Adult patients (N = 856) with advanced Hodgkin's disease were randomly assigned to treatment with ABVD or MOPP/ABV. The major end points were failure-free and overall survival, life-threatening acute toxicities, and serious long-term toxicities, including cardiomyopathy, pulmonary toxicity, myelodysplastic syndromes (MDS), and secondary malignancies.The rates of complete remission (76% v 80%, P =.16), failure-free survival at 5 years (63% v 66%, P =.42), and overall survival at 5 years (82% v 81%, P =.82) were similar for ABVD and MOPP/ABV, respectively. Clinically significant acute pulmonary and hematologic toxicity were more common with MOPP/ABV (P =.060 and.001, respectively). There was no difference in cardiac toxicity. There were 24 deaths attributed to initial treatment: nine with ABVD and 15 with MOPP/ABV (P =.057). There have been 18 second malignancies associated with ABVD and 28 associated with MOPP/ABV (P =.13). Thirteen patients have developed MDS or acute leukemia: 11 were initially treated with MOPP/ABV, and two were initially treated with ABVD but subsequently received MOPP-containing regimens and radiotherapy before developing leukemia (P =.011).ABVD and the MOPP/ABV hybrid are effective therapies for Hodgkin's disease. MOPP/ABV is associated with a greater incidence of acute toxicity, MDS, and leukemia. ABVD should be considered the standard regimen for treatment of advanced Hodgkin's disease.