Combination chemotherapy including bleomycin in the treatment of advanced Hodgkin's disease

Fifty-six patients with advanced Hodgkin's disease were treated with a combination of nitrogen mustard, a vinca alkaloid (vincristine or vinblastine), procarbazine, prednisone and bleomycin, given in repeated cycles. Complete remission was achieved in 33 out of 53 evaluable patients (62,5%). The complete remission rate in patients who had received prior radiation therapy alone (65%) was similar to that in previously untreated patients (73%). Patients who had previously received combination chemotherapy, either alone or together with radiation therapy, responded less well to this regimen of therapy, with a complete remission rate of less than 40%. The complete remission rate was not influenced by the histological subtype of the Hodgkin's disease. Twenty-three of the 33 responders (70%) remain in continuous complete remission. The median for this group has not been reached but will be in excess of 24 months. Major bleomycin toxicity was not encountered in this study. Lung function was monitored throughout but no consistent changes were encountered. The degree of haematological toxicity caused by treatment was no greater than would have been expected without bloemycin. Although the results obtained with the 5-drug combination were satisfactory, the follow-up to date does not suggest that the addition of bleomycin to the convention 4-drug regimen has significantly affected the outcome.