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Vinblastine, bleomycin, and methotrexate chemotherapy plus irradiation for patients with early-stage, favorable Hodgkin lymphoma
The experience of the Gruppo Italiano Studio Linfomi
Article first published online: 3 NOV 2003
Copyright © 2003 American Cancer Society
Volume 98, Issue 11, pages 2393–2401, 1 December 2003
How to Cite
Gobbi, P. G., Broglia, C., Merli, F., Dell'Olio, M., Stelitano, C., Iannitto, E., Federico, M., Bertè, R., Luisi, D., Molica, S., Cavalli, C., Dezza, L. and Ascari, E. (2003), Vinblastine, bleomycin, and methotrexate chemotherapy plus irradiation for patients with early-stage, favorable Hodgkin lymphoma. Cancer, 98: 2393–2401. doi: 10.1002/cncr.11807
- Issue published online: 17 NOV 2003
- Article first published online: 3 NOV 2003
- Manuscript Accepted: 22 AUG 2003
- Manuscript Revised: 18 AUG 2003
- Manuscript Received: 3 JUN 2003
- Ministero dell'Università (Rome, Italy)
- Adolfo Ferrata e Edoardo Storti Foundation (Pavia, Italy)
The acknowledged effectiveness of vinblastine, bleomycin, and methotrexate (VBM) chemotherapy in patients with early-stage Hodgkin lymphoma has been associated with conflicting toxicity reports.
One hundred forty-three patients were evaluated clinically and had favorable Stage IA or IIA Hodgkin lymphoma. Ninety-three patients were treated with the standard VBM schedule combined with extended-field radiotherapy (EF-RT), leaving the choice of the therapeutic sequence free. Fifty subsequent patients were treated with a slightly modified VBM schedule (VbMp) combined with RT limited to involved fields (IF-RT) and delivered only after the end of chemotherapy. In the VbMp schedule, intervals between cycles were 21 days instead of 28 days, bleomycin doses were reduced, small doses of prednisone were given orally, and the interval before RT was prolonged.
Clinical response was complete in 96% of patients who were treated with VBM plus EF-RT and in 94% of patients who were treated with VbMp plus IF-RT. Recurrence rates were nearly identical (12% and 11%, respectively) over necessarily different follow-up (91 months and 33 months, respectively). Hematologic toxicity was tolerable in both trials, and pulmonary side effects were moderate in the first trial and negligible in the second. On the whole, treatment was tolerated better when RT followed chemotherapy.
The VBM regimen was confirmed to be effective in patients with early-stage Hodgkin lymphoma. Administration of all cycles before RT improved tolerance; pulmonary toxicity probably is mitigated further by reduced bleomycin doses, mild prednisone therapy, and a more prolonged resting interval before RT. A slightly higher recurrence rate was expectable in the VBM plus IF-RT trial despite the actual intensification of vinblastine and methotrexate. Cancer 2003. © 2003 American Cancer Society.