Standard treatment for Hodgkin's disease produces complete responses and cures in the majority of patients. There are, however, long-term toxicities associated with various treatments. Patients treated with radiation therapy (primarily early stage patients) appear to be at steadily increasing risk of second solid tumors that occur within the irradiated fields. Long-term side effects associated with the administration of combination chemotherapy depend on the particular regimen: MOPP chemotherapy causes infertility for most men and for women treated over the age of 26 years. There is also a small increased risk of secondary acute leukemia (about 2-3% in 10 years). The leukemia risk is enhanced when radiation therapy is combined with MOPP. ABVD is associated with the risk of decreased heart and/or lung function. This protocol was designed to show that new drug combination is as effective as the current treatment for all clinical stages of Hodgkin's disease and may have the advantage of fewer long-term side effects than the current therapies. The design of the study is the following: clinical stage IA (except peripheral IA), IB, IIA, IIB, an IIIA without massive enlargement of the mediastinum will receive EPOCH chemotherapy every three weeks. Clinical stage IIIB, IVA, IBV, or any stage with massive mediastinal enlargement will receive EPOCH plus G-CSF every two weeks. Patients with massive mediastinal disease will also receive mantle radiation therapy. We will determine the complete response, rate and the durability of the complete responses as well as follow all long-term toxicities.
