Combination chemotherapy of advanced previously treated Hodgkin's disease with streptozotocin, CCNU, adriamycin and bleomycin

Seventeen patients with advanced, previously treated Hodgkin's disease received therapy with a combination of streptozotocin 500 mg/m2/day i.v. days 1--5, CCNU 100 mg/m2 orally day 1, adriamycin 45 mg/m2 i.v. day 1, and bleomycin 15 mg/m2 i.m. days 1 and 8 at 28-day intervals (SCAB). The overall response rate was 59% with six patients (35%) achieving complete remission and four patients (24%) entering partial remissions. No maintenance therapy was given and the median duration of complete remission was 8+ months (range 2+-18+ months), while the median duration of partial remission was only 2 months (range 2-3 months). The median duration of survival from the start of therapy for the complete responders was 16+ months (range 5+-25+ months) while the median survival for the partial and nonresponders was only 5 months (range 2-13 and 3-11+ months, respectively). Toxicity was a major problem with this drug combination. Myelosuppression occurred regularly and was severe after 25% of courses. There were two deaths directly related to drug-induced myelosuppression. Other serious toxicities included bleomycin-induced pulmonary toxicity in three patients, with one death; renal tubular dysfunction secondary to streptozotocin in three patients; hepatic dysfunction in three patients and severe weight loss in three. SCAB has proven to be an active although toxic combination which is not cross-resistant to MOPP-type regimens. Alterations in drug dosages and scheduling are being evaluated in an effect to ameliorate toxicity and preserve efficacy.