ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) as front-line therapy for Hodgkins lymphoma in Hispanic patients: A single center experience from Texas-Mexico Border.

Abstract

e19514 Background: Population-based studies in Hodgkin Lymphoma (HL) have shown reduced survival in patients of Hispanic ethnicity as compared with non-Hispanic Whites. ABVD is the most commonly used regimen for HL in the United States. We retrospectively reviewed the charts of Hispanic patients with HL treated at a single institution located along the Texas-Mexico border. Methods: We performed a chart review of Hispanic patients with HL treated at our institution over an 8 year period. Prognostic (Stage, International Prognostic Score) and predictive (results of interim and end of therapy PET scan) factors were recorded. Relative dose intensity (RDI: fraction of drug dose administered to the standard dose) of each chemotherapy drug was calculated.Treatment delays and their causes were recorded. Quantitative variables were described using median, inter-quartile range, minimum and maximum observations. Categorical variables were described using frequency and proportions. Kaplan – Meier curves were used to show relapse-free survival. Results: Base line characteristics are shown in table. A total of 24 patients were treated in the time frame of whom 45% were dependent on charity care. All were treated with ABVD or an ABVD-like regimen. After a median follow-up of 43 months, relapse rate for the entire cohort was 45.8%. ( 33.3% in early stage and 53.3% in advanced stage disease). Of the patients who relapsed 45% were unable to receive a stem cell transplant based salvage therapy. The RDI for each chemotherapy drug in ABVD was as follows: Doxorubicin (98.8%), Bleomycin (82.1%), vinblastine (97.9%) and dacarbazine (100%). The mean and median delay in completing chemotherapy was 9.9 and 5.5 days respectively (range 0-56). Conclusions: HL patients of Hispanic ethnicity have a high relapse rate with ABVD despite optimal delivery of the regimen. As medically underserved minority patients face significant barriers in accessing stem cell rescue based salvage treatments, decreasing the relapse rate with upfront therapy can help in addressing the disparity seen in survival. Non ABVD regimens shown to have a higher upfront remission rate like escalated dose BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) or A-AVD (brentuximab vedotin, doxorubicin, vinblastine, dacarbazine) should be studied in these patients.[Table: see text]