historical management of Hodgkin's disease
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Management
- treatment based on stage (older recommendations)
- Stage IA & IIA:
- Stage IIIA: radiation or chemotherapy
- Stage IIIB & IV: chemotherapy
- B symptoms: chemotherapy
- chemotherapy (historical)
- the first effective combination chemotherapy for Hodgkin's disease was introduced in 1960, MOPP (mechlorethamine (nitrogen mustard), vincristine (Oncovin), procarbazine, prednisone)
- MOPP has been associated with 84% complete remission & 48% 14 year survival
- toxicities of MOPP include
- MOPP therapy has been associated with a 2% risk of developing secondary leukemia within 10 years of therapy; the leukemia is acute non-lymphocytic leukemia
- none of the newer regimens has proven superior to the original MOPP
- ABVD (adriamycin, bleomycin, vinblastine, & dacarbazine)
- has been used to treat Hodgkin's disease refractory to MOPP
- toxicities of ABVD are similar to MOPP, but may be associated with fewer secondary malignancies, but increased incidence of myocardial & pulmonary damage
- preferred 1st line agent[1]
- 4 cycles of ABVD
- 2-3 cycles may be sufficient for early stage (stage I & II) Hodgkin's disease[1][2][4]
- sequential combinations of MOPP & ABVD may show more favorable outcomes
- brentuximab vedotin (Adcetris) FDA-approved for relapsed or refractory Hodgkin's lymphoma
- bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine & prednisone for patients with disease activity demonstrated on PET scan after 3 cycles of ABVD[1][3]
- ABVD (adriamycin, bleomycin, vinblastine, & dacarbazine)
- chemotherapy alone (without radiation) for stage 3 or 4
References
- ↑ 1.0 1.1 1.2 1.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015
- ↑ 2.0 2.1 Engert A et al. Reduced treatment intensity in patients with early-stage Hodgkin's lymphoma. N Engl J Med 2010 Aug 12; 363:640. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20818855
- ↑ 3.0 3.1 Kostakoglu L, Coleman M, Leonard JP et al PET predicts prognosis after 1 cycle of chemotherapy in aggressive lymphoma and Hodgkin's disease. J Nucl Med. 2002 Aug;43(8):1018-27. PMID: https://www.ncbi.nlm.nih.gov/pubmed/12163626
- ↑ 4.0 4.1 Ferme C, Eghbali H, Meerwaldt JH et al Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease. N Engl J Med. 2007 Nov 8;357(19):1916-27. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17989384