Chemotherapy of Hodgkin's disease

During the past 10 to 15 years, there have been dramatic improvements in the prognosis of patients with advanced Hodgkin's disease resulting from the development of combination chemotherapy. The long-term follow-up of patients with advanced disease treated with MOPP indicates that 66 per cent of those achieving complete remissions have not relapsed and remain off therapy at five and 10 years follow-up. Attempts to make additions, subtractions or modifications in the MOPP regimen have not generally improved the overall survival rate or reduced the toxicity. Development of non-cross-resistant combinations provides a rational approach to the treatment of primary induction failures and those who relapse after short initial remissions. Alternating sequence induction chemotherapy regimens show considerable promise. The use of combined modality approaches to the treatment of localized IB--IIIB Hodgkin's disease has made a significant impact on disease-free survival but has yet to alter actual survival. Combined modality approaches in advanced disease are encouraging but as yet long-term follow-up is not available to assess their worth vis-à-vis existing therapies for advanced disease. Improved survival has brought about concern over late complications, particularly second malignancies. These complications require careful monitoring and must be balanced against any survival benefit seen from combined modality approaches. However, the fact that patients now survive long enough to be potentially at risk for such long-term complications is a testament to the efficacy of modern day aggressive therapy.