Abstract

Despite recent therapeutic advances, the treatment of Hodgkin’s disease remains controversial. Among the most commonly used regimens are ABVD, Stanford V and BEACOPP. Studies of Stanford V have shown conflicting outcomes with some excellent and some much less good results. To address this discrepancy we reviewed 113 patients with previously untreated Hodgkin’s disease, all of whom were HIV negative, who received the Stanford V regimen from physicians in the Nebraska Lymphoma Study Group between January 1997 and January 2006. The median age was 36 years (range 15–88) with only 10 patients over 60 years of age. Fifty-two (46%) of the total were males. Seventy-eight (68%) had nodular sclerosis, subtype and 69 (61%) were stage I and II. Constitutional symptoms were present in 36 (32%) patients. Tumor bulk > 5cm was evident in 68 (60%). Four or more nodes were involved in 57 (50%) and 84 (78%) received radiotherapy. Median follow up was 63 months (range 8–114). Univariate analysis of the data identified 4 adverse risk factors which included age > 60 years, stages III or IV, constitutional symptoms, and mixed cellularity subtype. Complete remission or unconfirmed complete remission was achieved in 82(72%), 21 (18%) had partial response, 2 had progression of disease (PD) and 3 were unable to be evaluated. There were 5 early deaths; 3 of which were definitely related to the treatment. For the entire group, the 5 year overall survival (OS) was 84% and the 5-year event free survival (EFS) was 74%. However, the results were dependent on the presence or absence of the adverse risk factors of age >60, stage III or IV, non-nodular sclerosis histological subtype, and B symptoms as shown below:

Risk Factors
0 (N=53)1–2(N=50)3–4(N=10)
OS 100% 90% 40% 
EFS 87% 82% 20% 
Risk Factors
0 (N=53)1–2(N=50)3–4(N=10)
OS 100% 90% 40% 
EFS 87% 82% 20% 

The Stanford V regimen represented an excellent treatment for patients with stage IA and IIA nodular sclerosis Hodgkin’s disease under the age of 60 and patients with 1–2 adverse risk factors did only slightly less well. The regimen yielded a much poorer outcome in patients with multiple adverse risk factors.

Author notes

Disclosure: No relevant conflicts of interest to declare.