ABVD and MOPP/ABV yielded similar 5-year failure-free survival (63% vs 66%, P=0.42) in advanced Hodgkin's disease, but MOPP/ABV was associated with greater acute toxicity, MDS, and leukemia.
RCT (n=856)
Yes
Does ABVD compared to MOPP/ABV improve survival or reduce toxicity in adult patients with advanced Hodgkin's disease?
ABVD provides similar survival to MOPP/ABV in advanced Hodgkin's disease but with significantly less acute toxicity and secondary leukemia, establishing it as the standard regimen.
Absolute Event Rate: 63% vs 66%
p-value: p=.42
PURPOSE: 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. PATIENTS AND METHODS: 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. RESULTS: 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). CONCLUSION: 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.
Duggan et al. (Thu,) conducted a rct in Advanced Hodgkin's disease (n=856). ABVD vs. MOPP/ABV was evaluated on Failure-free survival at 5 years (p=.42). ABVD and MOPP/ABV yielded similar 5-year failure-free survival (63% vs 66%, P=0.42) in advanced Hodgkin's disease, but MOPP/ABV was associated with greater acute toxicity, MDS, and leukemia.