COMBINED CHEMOTHERAPY CYCLOPHOSPHAMIDE, VINBLASTINE, PROCARBAZINE AND PREDNISONE (CVPP) VS CVPP PLUS CCNU (CCVPP) IN HODGKINS-DISEASE

With the purpose of exploring new combinations less toxic and easier to manage, the Argentine Group for the Treatment of Acute Leukemia (GATLA) started a randomized controlled study to compare differences in efficacy of treatment in Hodgkin's disease using six courses of cyclophosphamide, vinblastine, procarbazine and prednisone (CVPP) versus the same drugs plus CCNU (CCVPP). A total of 298 patients entered this study; 157 with CVPP and 141 with CCVPP. No statistically significant difference was observed between both groups in each of the following features: prior therapy, sex, age, class, stage and histology. The doses in every monthly cycle are: cyclophosphamide 600 mg/m2 iv on day 1, vinblastine 6 mg/m2 iv on day 1, procarbazine 100 mg/m2/day 1 orally on day 1 to 14 and prednisone 40 mg/m2/day orally on day 1 to 14 in all the courses. The CCVPP group received also CCNU 75 mg/m2 day 1 orally on alternate cycles. Patients with stage I or II A received radiotherapy (4,000 rads) to involved areas as induction and were subsequently randomized to receive maintenance therapy. Patients in all other stages received only combination chemotherapy at random. Maintenance therapy consisted of one cycle every 2 months during the first year, every 4 months the second year and every 6 months the third year. Complete remission was obtained in 111 out of 157 patients (71%) of those receiving CVPP and in 110 out of 141 patients (78%) receiving CCVPP. There was no statistically significant difference between both regimens. The percentages of complete remission according to clinical stage and symptoms were: I‐IIA 88%. III‐IVA 84%, I‐IIB 76%, IIIB 76% and IVB 58%. After 42 months of remaining in complete remission 53% and 64% of those patients were treated with CVPP or CCVPP, respectively. The survival percent as a function of therapeutic response at 48 months for patients who achieved complete remission was 80%, 63% for partial remission, and 14% for those who failed to respond or died within the first six courses, with a median duration of survival of 6 months. Copyright © 1979 American Cancer Society