Comparison of adriamycin-containing chemotherapy (MOP-BAP) with MOPP-bleomycin in the management of advanced Hodgkin-s disease a southwest oncology group study

Between 1974 and 1978, 315 eligible patients with advanced Hodgkin-s disease (HD) without prior chemotherapy were randomized to MOPP plus low-dose bleomycin or the same agents plus Adriamycin (in 1 of 2 schedules). The results of the two Adriamycin-containing schedules were similar and were, therefore, combined as „MOP-BAP and compared to MOPP-Bleo. All patients completed remission induction therapy with a median time on study of 47 months. Of 291 evaluable patients, the complete remission rate was 77% for 166 patients treated with MOP-BAP compared to 67% for 125 patients receiving MOPP-Bleo (P = 0.05, one-sided test). Among patients with more favorable pretreatment prognostic factors, MOP-BAP produced a higher CR rate than MOPP-Bleo (patients with hemoglobin ≥ 12 g/dl, 85 versus 67%, P = 0.01; those with a performance status of 70-100%, 81 versus 70%, P = 0.03; those without bone marrow involvement, 81 versus 68%, P = 0.03, those older than age of 40 years, 79 versus 62%, P = 0.03; those who were asymptomatic [A], 94 versus 77%, P = 0.04; and those without any prior therapy, 75 versus 63%, P = 0.04). CR duration and overall survival were similar for the two treatments. However, survival was better for patients with favorable pretreatment prognostic factors treated with MOP-BAP compared to MOPP-Bleo (those who were asymptomatic [P = 0.08], without bone marrow involvement [P = 0.04], and with nearly normal initial hemoglobin levels [P = 0.02]). MOP-BAP was associated with less nausea and vomiting and significantly less thrombocytopenia than MOPP-Bleo (P = 0.01). For patients with prognostically more favorable types of HD, the use of an initial Adriamycin-containing MOPP regimen (MOP-BAP) offers a higher complete remission rate, less acute toxicity and improved survival compared to MOPP-Bleo.