Combination Chemotherapy With Nitrogen Mustard, Vincristine, Procarbazine and Prednisone in Previously Treated Patients With Hodgkin's Disease

Combination chemotherapy with fourdrugs—nitrogen mustard, vincristine,procarbazine and prednisone—was usedin 27 previously treated patients withadvanced progressive Hodgkin’s disease.Six 2-week cycles of chemotherapy wereadministered in the following schedule:nitrogen mustard, 6 mg./sq.M. I.V., andvincristine, 1.4 mg./sq.M. I.V., on days1 and 8 of each cycle; procarbazine,100 mg./sq.M. by mouth daily throughout each cycle, and prednisone, 40mg./sq.M. orally each day of cycles 1and 4. Each cycle was followed by a2-week period during which no drug wasgiven. Twenty-two patients had StageIV disease and 17 had systemic symptoms at the time of drug administration.All patients had histories of previoustherapy. Two received chemotherapyalone, 15 had radiotherapy alone and10 had both chemotherapy and radiotherapy. Nineteen out of the 27 patients(70%) had complete responses (total regression of all lesions) to the four drugcombination and five patients (19%) hadpartial responses (50% regression of alllesions). Fourteen out of the 19 whoresponded completely are still in unmaintained remission 1-24 months from therapy completion. Eighteen out of the 19who responded completely are still surviving from 6 to 30 months after thestart of combination chemotherapy.Those patients treated previously withboth radiotherapy and chemotherapy didnot respond as well as patients treatedwith prior radiotherapy alone. In general, therapy was well tolerated, withleukopenia being the major dosage-limiting toxicity. There was a progressivelypoorer tolerance to the drugs with increasing extent of prior radiotherapy.

Submitted on May 12, 1970 Revised on July 20, 1970 Accepted on July 27, 1970