Abstract
Treatment with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) or escalated(e)-BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone) remains the international standard of care for advanced-stage classical Hodgkin lymphoma (HL). We performed a retrospective, multicentre analysis of 221 non-trial (“real-world”) patients, aged 16–59 years, diagnosed with advanced-stage HL in the Anglia Cancer Network between 2004 and 2014, treated with ABVD or eBEACOPP, and compared outcomes with 1088 patients in the Response-Adjusted Therapy for Advanced Hodgkin Lymphoma (RATHL) trial, aged 18–59 years, with median follow-up of 87.0 and 69.5 months, respectively. Real-world ABVD patients (n=177) had highly similar 5-year progression-free survival (PFS) and overall survival (OS) compared with RATHL (PFS 79.2% vs 81.4%; OS 92.9% vs 95.2%), despite interim positron-emission tomography-computed tomography (PET/CT)-guided dose-escalation being predominantly restricted to trial patients. Real-world eBEACOPP patients (n=44) had superior PFS (95.5%) compared with real-world ABVD (HR 0.20, p=0.027) and RATHL (HR 0.21, p=0.015), and superior OS for higher-risk (international prognostic score ≥3 [IPS 3+]) patients compared with real-world IPS 3+ ABVD (100% vs 84.5%, p=0.045), but not IPS 3+ RATHL patients. Our data support a PFS, but not OS, advantage for patients with advanced-stage HL treated with eBEACOPP compared with ABVD and suggest higher-risk patients may benefit disproportionately from more intensive therapy. However, increased access to effective salvage therapies might minimise any OS benefit from reduced relapse rates after frontline therapy.
Highlights
Treatment with ABVD or escalated(e)-BEACOPP remains the international standard of care for the management of adult patients with advanced-stage classical Hodgkin lymphoma (HL)
In 2009, 10-year follow-up data from the German Hodgkin Study Group (GHSG) HD9 trial showed a significant improvement in both disease control and overall survival (OS) for patients treated upfront with standard-dose BEACOPP or eBEACOPP, compared with alternating cycles of COPP and ABVD [1]
Of these 250 patients, 29 were excluded, including 25 who were treated in the Response-Adjusted Therapy for Advanced Hodgkin Lymphoma (RATHL) trial, three who were treated with regimens other than ABVD or eBEACOPP, and one who died before commencing therapy
Summary
Treatment with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) or escalated(e)-BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone) remains the international standard of care for the management of adult patients with advanced-stage classical Hodgkin lymphoma (HL). In 2009, 10-year follow-up data from the German Hodgkin Study Group (GHSG) HD9 trial showed a significant improvement in both disease control (time-to-treatment-failure) and overall survival (OS) for patients treated upfront with standard-dose BEACOPP or eBEACOPP, compared with alternating cycles of COPP (cyclophosphamide, vincristine, procarbazine, and prednisone) and ABVD [1]. In RATHL, all patients received two cycles of ABVD followed by an interim positronemission tomography-computed tomography (PET/CT) scan (iPET2) to guide further treatment intensity. Patients with a negative iPET2 scan (Deauville score 1–3) were randomised 1:1 to receive a further four cycles of ABVD or AVD (without bleomycin). Patients with a positive iPET2 scan (Deauville score 4–5) had their treatment intensified and received either a further three cycles of eBEACOPP or four cycles of BEACOPP-14 (standard-dose BEACOPP delivered every 14 days), without randomisation. The 3-year follow-up results of RATHL have been published [2]
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