Abstract
A total of 164 consecutive adults with newly confirmed stage IIIB, IVA or IVB Hodgkin's disease (HD) commenced cyclical combination chemotherapy comprising mustine, vinblastine, prednisolone and procarbazine (MVPP) every 6 weeks (145 patients) or minor variants (19) at St Bartholomew's Hospital between 1968 and 1984. The median follow-up period is 14 years. Complete remission (CR) was achieved in 97/164 (59%) and partial remission (PR) in 23/164 (14%) with lesser responses or death being documented in 44. Achievement of CR correlated with stage, serum albumin and serum beta2 microglobulin level at presentation on univariate and multivariate analysis; 55/97 (58%) remain in continuous CR, the median duration of remission not having been reached. Twelve patients died in first remission; there have been 30 recurrences, one occurring after 13 years. Second remission was achieved in 17/30; 6/17 remain in continuous second remission and two have died in second remission. There have been nine second recurrences, third remission being achieved in 6/9. Two continue in third remission, two patients have died in third remission: 82/164 patients are alive with a minimum follow-up of 6 years. Eighty-two patients have died; 66 with evidence of HD, six with second malignancy, one each of haemorrhage and infection, eight of unrelated causes, the cause of death was unknown in one. The overall median survival from presentation is 14 years, being the same for patients in CR and PR with minimal residual abnormality (good partial remission, GPR), and being better for those for whom remission was achieved than those for whom it was not. The median survival following first recurrence is 4 years, being significantly longer for younger patients (less than 50 years). These results emphasise the importance of long-term follow-up to determine the clinical course of HD and are vital for planning experimental chemotherapy at the time of early treatment failure or recurrence.
Highlights
A total of 164 consecutive previously untreated adults with advanced
Twenty-four of these proceeded to further therapy [mustine. vinblastine. prednisolone and procarbazine (MVPP) MOPP, alternative chemotherapy (16) or combined modality therapy], Complete remission (CR) being subsequently achieved in only one; a second patient was left with minimal residual disease (GPR) (Table III)
Response at first recurrence correlated with duration of first remission - remission (CR and Good partial remission (GPR)) was induced in 54% of patients whose first remission was less than 1 year. 63% when remission was between 1 and 2 years and 88% when remission greater than 2 years (Table VI)
Summary
A total of 164 consecutive previously untreated adults with advanced Twenty-four of these proceeded to further therapy [MVPP MOPP (seven), alternative chemotherapy (16) or combined modality therapy (one)], CR being subsequently achieved in only one; a second patient was left with minimal residual disease (GPR) (Table III). Salvage therapy with non-cross-resistant regimens was more effective than MVPP type regimes at inducing second remission (Table VI)).
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