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A correction has been published: N Engl J Med 2005;353(7):744.

Previous Volume 348:2386-2395 June 12, 2003 Number 24 Next

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ABSTRACT

Background Faced with unsatisfactory results of treatment for advanced Hodgkin's disease, we investigated three combinations of chemotherapy.

Methods From 1993 to 1998, 1201 eligible patients 15 to 65 years of age who had newly diagnosed Hodgkin's disease in unfavorable stage IIB or IIIA or stage IIIB or IV were randomly assigned to receive eight cycles of cyclophosphamide, vincristine, procarbazine, and prednisone alternating with doxorubicin, bleomycin, vinblastine, and dacarbazine (COPP-ABVD); bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP); or increased-dose BEACOPP, each followed by local radiotherapy when indicated. Enrollment in the COPP-ABVD group was stopped in 1996 owing to inferior results.

Results For the final analysis, 1195 of 1201 patients could be evaluated: 260 in the COPP-ABVD group, 469 in the BEACOPP group, and 466 in the increased-dose BEACOPP group; the median follow-up was 72, 54, and 51 months, respectively. The rate of freedom from treatment failure at five years was 69 percent in the COPP-ABVD group, 76 percent in the BEACOPP group, and 87 percent in the increased-dose BEACOPP group (P=0.04 for the comparison of the COPP-ABVD group with the BEACOPP group and P<0.001 for the comparison of the increased-dose BEACOPP group with the COPP-ABVD group and with the BEACOPP group), and the five-year rates of overall survival were 83 percent, 88 percent, and 91 percent, respectively (P=0.16 for the comparison of the COPP-ABVD group with the BEACOPP group, P=0.06 for the comparison of the BEACOPP group with the increased-dose BEACOPP group, and P=0.002 for the comparison of the COPP-ABVD group with the increased-dose BEACOPP group). Rates of early progression were significantly lower with increased-dose BEACOPP than with COPP-ABVD or standard BEACOPP.

Conclusions Increased-dose BEACOPP resulted in better tumor control and overall survival than did COPP-ABVD.

Source Information

From the First Department of Internal Medicine, University of Cologne, Cologne, Germany (V.D., J.F., M.P., B.L., U.P., H.T.); the Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany (D.H., M.L.); the Canton Hospital, Basel, Switzerland (R.H.); Charité Hospital, Berlin, Germany (B.D.); the Institute of Pathology, University of Würzburg, Würzburg, Germany (H.-K.M.-H.); and the Department of Radiotherapy, University of Munich, Munich, Germany (E.D.).

Address reprint requests to Dr. Diehl at the Klinik I für Innere Medizin, Universität Köln, Joseph-Stelzmann-Str. 9, 50924 Cologne, Germany, or at v.diehl{at}uni-koeln.de.

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