ABVD versus Stanford V chemotherapy for early-stage, bulky Hodgkin lymphoma

This trial compared the outcomes of ABVD and Stanford-V chemotherapy in patients with stage I or stage II bulky Hodgkin lymphoma. The authors concluded that both treatments were equally effective.

Hodgkin Lymphoma is a cancer of the lymph system. Patients with bulky disease have tumors larger than 10 cm. 20-25% of Hodgkin lymphoma patients have bulky disease in the chest area. The most common treatment for Stage I or Stage II bulky disease is ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine). This is followed by radiation therapy.

Stanford-V chemotherapy (mechlorethamine, doxorubicin, vincristine, bleomycin, vinblastine, etoposide, and prednisone) is another combination used with radiation therapy. Stanford-V treatment results in less overall exposure to anthracyclines (such as doxorubicin) and bleomycin than does ABVD chemotherapy. It is not clear whether this treatment is as effective as ABVD chemotherapy in early-stage patients with bulky disease.

This trial compared ABVD and Stanford-V chemotherapy in early-stage, bulky-disease patients.

264 patients with stage I or stage II bulky disease were included. All patients were previously untreated. 135 were treated with 6–8 cycles of ABVD chemotherapy (group A). 129 were treated with Stanford V chemotherapy once a week for twelve weeks (group S). Both groups were treated with radiation 2–3 weeks after the end of chemotherapy. Stanford-V patients also received further radiotherapy to their large (i.e. greater-than-5cm) tumors. Patients were followed for an average of 6.5 years. 

83% of group A patients and 88% of group S patients saw a response to treatment (such as tumor shrinkage). At five years, there were no significant differences in failure-free survival (time from treatment until disease progression, relapse or death), overall survival (time rom treatment until death from any cause) and risk of second cancers between groups. Less than 10% of patients relapsed overall.

Group S patients had higher rates of short-term side effects. 83% of group S had low levels of lymphocytes (a type of white blood cell), compared to 46% of group A. 7% of group S experienced nerve pain compared to 1% of group A.

This study concluded that both ABVD and Stanford-V chemotherapies were effective for early-stage, bulky-disease patients.