Abstract
Ninety evaluable, previously untreated adult patients with clinically staged early and advanced Hodgkin's disease were treated with chemotherapy alone using various regimens. Their mean age was 32.3 years. Thirty-six patients (40%) had Stage I or II and 54 (60%) had Stage III or IV. Seventy-four percent of patients had one or more of the B symptoms and 66% had unfavorable histology. Complete remission (CR) was achieved in 75 out of 90 patients (83% at a 95% confidence interval), partial remission in 9 (10%), and treatment failure in 6. Using adjusted regression analysis, unfavorable histology, bulky abdominal disease, pleural involvement and receiving a total dose-intensity (TDI) less-than-or-equal-to 0.80 were negatively associated with the likelihood of achieving CR. At a median follow-up of 45 months (range, 5-172), 86% of patients were alive and 82% were disease-free. The overall median survival has not been reached, but the projected 5-year survival probability was 82%. The estimated median (+/- SE) time-to-treatment failure for those who achieved initial CR was 103 (+/- 27.7) months. The Cox proportional hazards model predicted that poor performance status, bulky abdominal disease, age older than 40 years, and unfavorable histology had an independent, adverse influence on survival. Variables identified by the proportional hazards model were used to construct a prognostic index (PI) model to stratify patients into three prognostically different groups. We conclude that the results of chemotherapy only are encouraging and the rationale is practical and acceptable in those countries where radiotherapy units are not readily available.