Radiation therapy compared with chemotherapy for consolidation of chemotherapy-induced remission of advanced Hodgkin lymphoma: a study by the Eastern Co-operative Oncology Group (E1476) with >20 years follow-up.

MOPP-Bleo (nitrogen mustard, vincristine, procarbazine, prednisone and bleomycin) induction therapy was given to 253 evaluable patients with Hodgkin lymphoma, stages IIIB, IIIs, or IV. Complete response (CR) occurred in 145 patients (57%) and partial response (PR) in 93 (37%). Of those 238 responders, 178 were randomized to consolidation therapy, and 164 were eligible and analyzable, including 114 CRs [55 patients randomized to ABVD and 59 to radiation therapy (RT)] and 50 partial responders (PRs) (25 each randomized to ABVD and RT). Among the 50 patients with PR, 34 (68%) converted to CR (16 with ABVD and 18 with RT). Therefore, of 253 patients, 182(72%) achieved CR and 56 (22%), PR. Median follow-up for all patients is 22.3 years and the estimated overall survival (OS) rate at 20 years is 48%. Of the 148 eligible, analyzable patients with CR, the estimated proportion remaining in CR at 20 years is 62%. OS at 20 years was significantly greater for patients receiving ABVD consolidation (66%) when compared with those who received RT consolidation (43%) (p = 0.002). Treatment toxicity was acceptable. After MOPP-Bleo induction for advanced Hodgkin lymphoma, ABVD provides better consolidation than local RT.