***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: PURPOSE In a series of trials , doxorubicin , bleomycin , vinblastine , and dacarbazine ( ABVD ) and mechlorethamine , vincristine , procarbazine , prednisone , doxorubicin , bleomycin , and vinblastine ( MOPP/ABV ) have been identified as effective treatments for Hodgkin 's disease . We compared these regimens as initial chemotherapy for Hodgkin 's disease . PATIENTS AND METHODS Adult patients ( N = 856 ) with advanced Hodgkin 's disease were r and omly assigned to treatment with ABVD or MOPP/ABV . The major end points were failure-free and overall survival , life-threatening acute toxicities , and serious long-term toxicities , including cardiomyopathy , pulmonary toxicity , myelodysplastic syndromes ( MDS ) , and secondary malignancies . RESULTS The rates of complete remission ( 76 % v 80 % , P = .16 ) , failure-free survival at 5 years ( 63 % v 66 % , P = .42 ) , and overall survival at 5 years ( 82 % v 81 % , P = .82 ) were similar for ABVD and MOPP/ABV , respectively . Clinical ly significant acute pulmonary and hematologic toxicity were more common with MOPP/ABV ( P = .060 and .001 , respectively ) . There was no difference in cardiac toxicity . There were 24 deaths attributed to initial treatment : nine with ABVD and 15 with MOPP/ABV ( P = .057 ) . There have been 18 second malignancies associated with ABVD and 28 associated with MOPP/ABV ( P = .13 ) . Thirteen patients have developed MDS or acute leukemia : 11 were initially treated with MOPP/ABV , and two were initially treated with ABVD but subsequently received MOPP-containing regimens and radiotherapy before developing leukemia ( P = .011 ) . CONCLUSION ABVD and the MOPP/ABV hybrid are effective therapies for Hodgkin 's disease . MOPP/ABV is associated with a greater incidence of acute toxicity , MDS , and leukemia .  ABVD should be considered the st and ard regimen for treatment of advanced Hodgkin 's disease PURPOSE At present , treatment results for patients with advanced-stage Hodgkin 's disease remain unsatisfactory . St and ard chemotherapy M(C)OPP ( nitrogen mustard ( cyclophosphamide ) . vincristine , procabazine , and prednisone ) . ABVD ( adriamycine , bleomycine , vinblastine , and dacarbacine ) or M(C)OPP/ABVD + /- radiotherapy fail to achieve long-term complete remission in 35 % to 50 % of these patients . The BEACOPP ( bleomycin , etoposide , adriamycine , cyclophosphamide , vincristine , procarbazine , and prednisone ) regimen was developed to improve treatment results by dose intensification achieved by reduced duration of treatment ( time intensification ) and addition of etoposide . PATIENTS AND METHODS Thirty untreated patients with advanced Hodgkin 's disease stage IIB IV according to the Ann Arbor classification were treated with the time intensified BEACOPP regimen . Each patient was scheduled to receive eight cycles of chemotherapy with consolidating radiotherapy to sites of initial bulk disease and to residual tumor remaining after chemotherapy . RESULTS All patients were evaluable for assessment of toxicity , treatment response , freedom from treatment failure ( FFTF ) and survival ( SV ) . Of 30 treated patients , 29 patients received the intended eight cycles of BEACOPP . One patient in clinical CR , terminated the chemotherapy at his own request after six cycles and is at this time , 48 months after the end of treatment , in complete remission . Toxicity was tolerable with WHO grade 3/4 leucopenia in 28 % of chemotherapy cycles and one severe ( WHO grade 3 ) infection . No treatment-related death occurred . Cycles could generally be given on schedule . Complete remission ( CR ) was achieved in all but two patients ( 93 % ) . At present , only one patient has relapsed . At a median follow-up of 40 months , FFTF-rate is 89 % ( lower confidence limit : 80 % ) . One patient died due to progressive disease . CONCLUSION The BEACOPP regimen is feasible at moderate hematopoeitic toxicity . With a FFTF-rate of 89 % at a median follow-up of 40 months , the treatment results are very encouraging . A prospect i ve r and omised trial has been initiated to compare the BEACOPP regimen with the st and ard COPP/ABVD regimen in advanced-stage Hodgkin 's disease Anthracyclines are a group of drugs that are useful in the treatment of Hodgkin 's disease , but have been associated with severe , and in some cases lethal , cardiac toxicity . Apparently , cardiac toxicity is more frequent after 10 years of anthracycline therapy , but no longer studies of cardiac toxicity have been reported . Four hundred and seventy-six patients with Hodgkin 's disease , stages III and IV , were r and omly assigned to receive ABVD ( doxorubicin , bleomycin , vinblastine and dacarbazine ) compared with EBVD ( epirubicin instead of doxorubicin ) and MBVD ( mitoxantrone instead of doxorubicin ) at st and ard doses . The endpoint was the presence of a clinical cardiac event ( CCE ) or abnormalities in equilibrium radionuclide angiocardiography ( ERNA ) and echocardiogram . The patients did not receive radiation therapy and when relapsed they were censored from cardiac toxicity . The median follow-up was 11.5 years ( range 7.5 - 14.8 years ) . CCE was observed in 17 % in the MBVD arm , 9 % in the ABVD arm and 6 % in the EBVD arm ( P < 0.001 ) . Mortality associated with CCE was 12 % with MBVD , 7 % with ABVD and 2 % with EBVD . Abnormalities in ERNA and echocardiogram were observed 6 - 36 months before the presence of a CCE . An excess in the st and ard mortality ratio was observed with the 3 regimens when compared with the general population : 19.4 for EBVD , 46.0 for ABVD and 67.8 for MBVD , which was confirmed with an increase in absolute excess risk/10,000 person-years of 15.6 , 39.0 and 58.7 , respectively . Overall survival was better in patients treated with EBVD because less cardiac events were observed . The use of mitoxantrone was associated with a high rate of relapse and cardiac events . Thus , we would not recommend use of the drug in Hodgkin 's disease . ERNA and echocardiogram are early detection tests for cardiac toxicity and can be employed in surveillance studies PURPOSE To investigate whether combined-modality treatment ( CMT ) with two cycles of doxorubicin , bleomycin , vinblastine , and dacarbazine ( ABVD ) followed by extended-field radiotherapy ( EF-RT ) is superior to EF-RT alone in patients with early favorable Hodgkin 's lymphoma ( HL ) . PATIENTS AND METHODS Between 1993 and 1998 , 650 patients with newly diagnosed , histology-proven HL in clinical stages IA to IIB without risk factors were enrolled onto this multicenter study and r and omly assigned to receive 30 Gy EF-RT plus 10 Gy to the involved field ( arm A ) or two cycles of ABVD followed by the same radiotherapy ( arm B ) . Results At a median observation time of 87 months , there was no difference between treatment arms in terms of complete response rate ( arm A , 95 % ; arm B , 94 % ) and overall survival ( at 7 years : arm A , 92 % ; arm B , 94 % ; P = .43 ) . However , freedom from treatment failure was significantly different , with 7-year rates of 67 % in arm A ( 95 % CI , 61 % to 73 % ) and 88 % in arm B ( 95 % CI , 84 % to 92 % ; P < or= .0001 ) . This was due mainly to significantly more relapses after EF-RT only ( arm A , 22 % ; arm B , 3 % ) . No patient treated with CMT experienced relapse before year 3 . Relapses were treated mainly with bleomycin , etoposide , doxorubicin , cyclophosphamide , vincristine , procarbazine , and prednisone , or with the combination cyclophosphamide , vincristine , procarbazine , and prednisone/ABVD ;  treatment of relapse was significantly more successful in arm A than in arm B ( P = .017 ) . In total , there were 39 second malignancies , with 21 in arm A and 18 in arm B , respectively . The incidence was approximately 0.8 % per year during years 2 to 9 and was highest in older patients ( P < .0001 ) and those with " B " symptoms ( P = .012 ) . CONCLUSION CMT consisting of two cycles of ABVD plus EF-RT is more effective than EF-RT alone In contrast to younger patients , the prognosis of elderly patients with advanced Hodgkin 's disease ( HD ) has not improved substantially over the last 20 years . We thus carried out a prospect ively r and omized study ( HD9(elderly ) ) to compare the BEACOPP regimen in this setting against st and ard COPP-ABVD .  Between February 1993 and 1998 , 75 patients aged 66 - 75 years with newly diagnosed HD in advanced stages were recruited into the HD9 trial as a separate stratum ( HD9(elderly ) ) . Patients were assigned to eight alternating cycles of COPP and ABVD or eight cycles of BEACOPP in baseline doses . Radiotherapy was given to initial bulky or residual disease . In total , 68 of 75 registered patients were assessable : 26 were treated with COPP-ABVD and 42 with BEACOPP  baseline . There were no significant differences between COPP-ABVD and BEACOPP in terms of complete remission ( 76 % ) , overall survival ( 50 % ) and freedom from treatment failure ( FFTF ) ( 46 % ) at 5 years . At a median follow-up of 80 months , a total of 37 patients died : 14/26 patients ( 54 % ) treated with COPP-ABVD and 23/42 patients ( 55 % ) with BEACOPP . Two patients ( 8 % ) treated with COPP-ABVD and nine patients ( 21 % ) treated with BEACOPP  died of acute toxicity . Hodgkin-specific FFTF at 5 years was 55 % after COPP-ABVD and 74 % after BEACOPP ( P=0.13 ) . Thus , there are no differences in survival between these regimens in elderly patients BACKGROUND Data on factors influencing inclusion of Hodgkin 's lymphoma ( HL ) patients in r and omized clinical trials ( RCT ) are limited and , for the present study they were analyzed in a RCT for III/IV HL . PATIENTS AND METHODS All patients with stage III/IV HL referred to the Saint-Louis Hospital between January 2003 and May 2007 were studied . A Groupe d'Etudes des Lymphomes de l'Adulte/European Organisation for Research and Treatment of Cancer RCT , to compare ABVD ( doxorubicin , bleomycin , vinblastine , dacarbazine ) with increased-dose BEACOPP ( bleomycin , etoposide , doxorubicin , cyclophosphamide , vincristine , procarbazine , prednisone ) , was open for recruitment . Non inclusion criteria and physician 's reasons for non-recruitment were prospect ively recorded . The reasons for patient 's refusal were collected retrospectively . Logistic regression analyses were carried out in order to identify factors predicting inclusion . RESULTS A total of 102 patients were diagnosed , among whom 51 % were included . Seven patients were ineligible , 22 refused to participate , and 21 were not enrolled due to the physician 's decision . Main reasons for patients ' refusal were st and ard treatment preference and concerns about experimental arm toxicity , mainly infertility risk . Conditions that could hamper accurate follow-up and toxicity concerns accounted for most of the physicians ' reasons . Adverse prognostic factors [ B symptoms ( odds ratio , OR = 5.35 ) and international prognostic score > or =3 ( OR = 2.69 ) ] were independently associated with inclusion . CONCLUSION Despite an attractive protocol , only 51 % of patients were included . It highlights concerns about selection of patients and the difficulty to obtain informed consent with better prognostic profile patients BACKGROUND Faced with unsatisfactory results of treatment for advanced Hodgkin 's disease , we investigated three combinations of chemotherapy . METHODS From 1993 to 1998 , 1201 eligible patients 15 to 65 years of age who had newly diagnosed Hodgkin 's disease in unfavorable stage IIB or IIIA or stage IIIB or IV were r and omly assigned to receive eight cycles of cyclophosphamide , vincristine , procarbazine , and prednisone alternating with doxorubicin , bleomycin , vinblastine , and dac 
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There were no differences between both regimens for secondary malignancies , treatment-related mortality or infertility .
AUTHORS ' CONCLUSIONS This meta- analysis showed that adult patients between 16 and 60 years of age with early unfavourable or advanced stage HL benefited from chemotherapy including escalated BEACOPP regarding PFS , but there was no significant difference in OS .