Chemotherapy of BOVAPEC in the primary treatment of Hodgkin´s lymphoma intermediate stages

Czech version

Authors: L. Raida ¹; T. Papajík ¹; K. Indrák ¹; M. Heřman ²; B. Pauček ²; J. Zapletalová ³
Authors‘ workplace: Hemato-onkologická klinika Lékařské fakulty UP a FN Olomouc, přednosta prof. MUDr. Karel Indrák, DrSc. ¹; Radiologická klinika Lékařské fakulty UP a FN Olomouc, přednosta doc. MUDr. Miroslav Heřman, Ph. D. ²; Ústav lékařské biofyziky Lékařské fakulty UP Olomouc, přednosta prof. Ing. Jan Hálek, CSc. ³
Published in: Vnitř Lék 2007; 53(1): 31-37
Category: Original Contributions

Overview

Design:
Chemotherapy of BOVAPEC is the modification of temporary intensified Stanford V protocol, an effective primary treatment of advanced Hodgkin´s lymphoma (HL) in spite of limited toxicity. Nitrogen mustard was substituted by less myelotoxic cyclophosphamide and the protocol has been used in the treatment of patients with an intermediate stage of HL.

Methods:
The primary treatment with BOVAPEC was started in 62 patients. Complete chemotherapy schedule was administered to 60 patients (97 %) and the median of its overall duration was 13 (12 - 18) weeks. 31 patients (50 %) underwent adjuvant “involved field” radiotherapy (RT). The median of posttherapeutic follow-up was 37 (range 8 - 85) months.

Results:
During the treatment, a neutropenia of grade 3 and 4 was observed in 14 patients (23 %) but without the development of any serious infectious complications. The manifestation of early non-hematological toxicity did not overcome grade 2. 58 patients (94 %) achieved the complete remission of HL. A relapse was observed in 11 cases (19 %) and estimated five years disease-free survival (DFS) is 72 %. The combination of BOVAPEC and RT in primary treatment was associated with higher probability of five years DFS but actually without statistical significance (88 % vs 58 %; p = 0.08).

Conclusion:
The BOVAPEC regimen with its acceptable toxicity may represent effective primary therapeutic approach to the patients with the intermediate stage of HL. Adjuvant RT is essential in all patients diagnosed with nodal bulk and/or residual lymphadenomegaly.

Key words:
Hodgkin´s lymphoma - intermediate stage - chemotherapy - Stanford V - radiotherapy - toxicity

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