Annals of Oncology Advance Access published online on January 6, 2008
Annals of Oncology, doi:10.1093/annonc/mdm575
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ABVD plus radiotherapy versus EVE plus radiotherapy in unfavorable stage IA and IIA Hodgkin's lymphoma: results from an Intergruppo Italiano Linfomi randomized study
1 Division of Haematology, Ospedale G. Panico, Tricase
2 Division of Radiotherapy, University of Torino, Torino
3 Division of Oncology, University of Modena, Modena
4 Division of Internal Medicine, University of Pavia, Pavia
5 Department of Haematology, Ospedale Maggiore, Milano
6 Division of Haematology, Ospedale Policlinico, Palermo
7 Division of Oncology, Ospedale ‘A. Manzoni’, Lecco
8 Division of Haematology, Ospedale S. G. Battista, Torino
9 Division of Haematology, Ospedale Businco, Cagliari
10 Department of Internal Medicine, University of Perugia, Perugia
11 Department of Haematology, University of Torino, Torino
12 Division of Haematology, Ospedale SS. Antonio e Biagio, Alessandria, Italy
* Correspondence to: Dr V. Pavone, Ematologia Osp. ‘Card. G. Panico’, via San Pio X, 4 73039 Tricase, Lecce, Italy. Tel: +39-0833-772113; Fax: +39-0833-543561; E-mail: salentoematologia{at}piafondazionepanico.it
Background: In 1997, the Intergruppo Italiano Linfomi started a randomized trial to evaluate, in unfavorable stage IA and IIA Hodgkin's lymphoma (HL) patients, the efficacy and toxicity of the low toxic epirubicin, vinblastine and etoposide (EVE) regimen followed by involved field radiotherapy in comparison to the gold standard doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) regimen followed by the same radiotherapy program.
Patients and methods: Patients should be younger than 65 years with unfavorable stage IA and IIA HL (i.e. stage IA or IIA with bulky disease and/or subdiaphragmatic disease, erythrocyte sedimentation rate higher than 40, extranodal (E) involvement, hilar involvement and more than three involved lymph node areas).
Results: Ninety-two patients were allocated to the ABVD arm and 89 to the EVE arm. Complete remission (CR) rates at the end of treatment program [chemotherapy (CT) + RT] were 93% and 92% for ABVD and EVE arms, respectively (P = NS). The 5-year relapse-free survival (RFS) rate was 95% for ABVD and 78% for EVE (P < 0.05). As a consequence of the different relapse rate, the 5-year failure-free survival (FFS) rate was significantly better for ABVD (90%) than for EVE (73%) arm (P < 0.05). No differences in terms of overall survival (OS) were observed for the two study arms.
Conclusions: In unfavorable stage IA and IIA HL patients, no differences were observed between ABVD and EVE arms in terms of CR rate and OS. EVE CT, however, was significantly worse than ABVD in terms of RFS and FFS and cannot be recommended as intial treatment for HL.
ABVD-EVE, early stage unfavorable Hodgkin lymphoma, radiotherapy
Received for publication October 26, 2006. Revision received October 17, 2007. Accepted for publication October 26, 2007.