Last update:
16-Dec-2013

During the past 50 years the treatment of Hodgkin lymphoma (HL) has pioneered the field of chemotherapy in oncology. Today more than 90% of patients with early stage HL and 80−85% of those with advanced disease can be ultimately cured with either first-line or salvage therapy. In 1964 de Vita and colleagues introduced the MOPP regimen that resulted in a long-term overall survival rate of 50%. In 1975 Βοnadonna and colleagues established the ABVD regimen, which is considered nowadays to be the standard of care with which other regimes should be compared. ABVD, alternating MOPP/ABVD, and MOPP/ABV hybrid were shown to be associated with a long-term survival rate of 70%, with a significant proportion of patients experiencing primary refractory or relapsing disease. In the 1990s, the German Hodgkin Study Group (GHSG) developed the BEACOPP-escalated regimen, which proved to be superior to COPP/ABVD in terms of freedom from treatment failure and overall survival in the HD9 trial. This outcome, however, was accomplished at the expense of significant hematological toxicity, toxic deaths and secondary neoplasms. The subsequent studies conducted by GHSG, HD12 and HD15 have established BEACOPP-escalated as a highly effective therapeutic option for patients aged up to 60 years, showing that 6 cycles were adequately therapeutic and less toxic than the originally administered 8 cycles. Two recently published Italian studies and the #20012 EORTC trial suggest, however, that BEACOPP-escalated may be no superior to ABVD in terms of overall survival. In conclusion, intensification of chemotherapy does not appear to be a panacea in the treatment of advanced HL; recognition of the subset of patients that would benefit from such an approach remains crucial to effective treatment.

Key words: ABVD, Advanced stages, Escalated BEACOPP, Hodgkin lymphoma, Stanford V.