XVII. Treatment of advanced-stage Hodgkin lymphoma.

Advanced-stage Hodgkin lymphoma (HL) usually includes all patients diagnosed in Ann Arbor stages III and IV. Many groups also include patients with stage IIB and additional risk factors such as large mediastinal mass and/or extranodal disease. Historically, less than 5% of these patients survived when left untreated or received singleagent chemotherapy. With the development of multi-agent chemotherapy such as MOPP (mechlorethamine, vincristine, procarbazine and prednisone) or ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine), the disease became curable, and a multicenter trial demonstrated that ABVD was better than MOPP in terms of freedom from progression (80.8% vs 62.8%; p<0.002) and overall survival (77.4% vs 76.9%; p=0.03) [1]. These findings were confirmed in different trials with longer follow-up. The next generation of clinical trials included hybrid regimens such as MOPP/ABVD, cyclophosphamide, oncovin, procarbazine and prednisone (COPP)/ABVD or MOPP/ABV or regimens containing even more drugs in rapidly alternating sequence (Table 1). Examples were MOPP/epidoxirubicin, bleomycin, and vinblastine (EBV)/ cyclophosphamide, adriamycin, dexamethason (CAD) or hybrid regimens such as chlorambucil, procarbazine, prednisolone, vinblastine, doxorubicin, vincristine, bleomycin, and etoposide (ChlVPP/PABlOE) or chlorambucil, vinblastine, procarbazine, and prednisolone/etoposide, vincristine, and doxorubicin (ChlVPP/EVA) [2]. An alternative shorter US regimen, Stanford V, gave challenging results in a phase II trial. With 142 patients treated at a single centre, the 5-year tumour control was 89% and OS 96%. Importantly, 91% of patients in this trial received additional radiotherapy. A small prospectively randomised multicenter trial compared ABVD with Stanford V and MOPP-EBV-CAD demonstrating that Stanford V was associated with poorer failure free survival (FFS) (67% vs 83% or 85%) when compared with ABVD or MOPP-EBV-CAD [3]. In addition, a larger intergroup trial compared also Stanford V with ABVD [4]. In this trial, the complete remission rates were rather similar (73% for ABVD and 69% for Stanford V), and there was no difference in FFS at 5 years (74% for