805 Vincristine, etoposide, mitoxantrone and prednisone (VEMP) as first-line chemotherapy for Hodgkin's disease (HD)

Abstract

Etoposide and mitoxantrone were combined with vinca alkaloid and steroid in order to evaluate the activity of a new combination, VEMP, whilst avoiding the long term complications related to MOPP and ABVD. 30 consecutive patients (pts) with de novo HD were treated between Jan. 1992 and Dec. 1994. 21 were males, median age was 34 years (range 18–67). 3 patients were HIV+. 18 had nodular sclerosis, 8 mixed cellularity, 3 lymphocytic predominance, 1 lymphocyte depletion. 2 pts were IA, 6 IIA, 3 IIB, 5 IIIA, 3 IIIB, 2 IVA, 9 IVB. 4 pts had lung involvement, 2 bone marrow, 1 liver, 1 bone, 3 both liver and bone marrow. VEMP was given on a 21-day (D) cycle basis for a median of 6 courses as follows: vincristine 1.4 mg/m 2 iv D1 and 8, etoposide 100 mg/m 2 iv D1 to 4, mitoxantrone 10 mg/m 2 D1 and prednisone 100 mg po D1 to 5. Toxicity data are available for 25 pts. 6 pts had grade (G) 4 WHO leucopenia, 18 G2, 2 G1. I pt had G4 infection, 2 G2, 1 GI. 1 pt had G4 thrombocytopenia, 7 G1. Peripheral neuropathy G1 occurred in 10 pts, G2 in 6. I pt had cutaneous erythema, 1 toxic hepatitis, 1 myocardial infarction, 1 fatigue. Response rate was 100% with 42% complete remission (CR), 20% CR unconfirmed (CRu) and 38% partial remission (PR). 12 pts received additional radiation therapy and 3 pts high dose chemotherapy with peripheral stem cell rescue in first complete remission. I HIV+ pt relapsed at 6 months and died. 4 pts (2 HIV+) progressed at 3, 4, 6 and 9 months and died. Probability of survival in remission is 88% (95% CI 56–97%) at 18 months: (excluding the 3 HIV patients). VEMP is well tolerated and is highly active in most HD. VEMP can be combined with radiation therapy. VEMP can also be used as an induction regimen in selected cases proceeding immediately to high dose chemotherapy. VEMP is devoid of pulmonary toxicity. Despite a short follow-up, VEMP should not be as leukemogenic as the alkylating agent containing regimen and should neither sterilize men nor advance menopause in women.