PF478 DOES ESCALATED BEACOP‐DACARBAZINE DO THE SAME AS ESCALATED BEACOP‐PROCARBAZINE FOR UNFAVORABLE HODGKIN'S LYMPHOMA?

Abstract

Background:The management of Tunisian Adult Hodgkin's lymphoma (HL) has been standardized since 1999. Since 2008 we individualized four therapeutic groups according age, stage (Ann Arbor), EORTC criteria and GHSG criteria. So for patients aged less than 60 years we considered unfavorable group who have advanced stage III‐IV Ann Arbor and II stage with large mediastinal mass. This group received the escalated BEACOPP (esc‐BEACOPP) protocol differently to other three groups.Aims:We report in this study the therapeutic results of the national protocol of Adult HL (MDH2015) for this group and demonstrate the place of Dacarbazine.Methods:Our study is prospective monocentric interesting 76 patients followed between June 2015 and December 2017 for HL stage III‐IV and stage II with large mediastinal mass and treated according MDH2015 protocol. The median age was 29 years [14–58 years].B symptoms were found in 67% of our patients. Our patients were stage III‐IV Ann Arbor in 83% of cases and stage II with large mediastinal mass in 17%. For advanced stage, 68% of patients have IPS>2. The MDH 2015 protocol is based on a strategy adapted to the therapeutic response to 2 cycles of esc‐BEACOPP. We considered as a primary failure, patients hadn’t achieved response≥75% after 4 cycles of esc‐BEACOPP.Our patients had received in this protocol Dacarbazine 250 mg/m2 three days/cycle instead of Procarbazine (esc‐BEACOPD).Results:Response≥75% to 2 courses of esc‐BEACOPD was achieved in 43% of patients and the response rate at the end of treatment was 92%. Fourteen patients (19%) had primary failure. In the multivariate analysis, the advanced stage Ann Arbor (III‐IV) and response<75% after 2 cycles of esc‐BEACOPD were an independent predictive factor of primary failure, with respectively p = 0.01 and p < 0.001. The relapse rate was 10%. The median follow‐up was 25 months [5–46 months]. Event free survival (EFS), relapse free survival (RFS) and overall survival (OS) at 2 years were respectively, 77%, 90% and 90%. In multivariate analysis, the prognostic factors for poor OS were large mediastinal mass (p = 0.05), response<75% at 2 courses (p = 0.04). The EFS is better without large mediastinal mass (p = 0.03) and without lymphopenia (p = 0.02). Fifty per cent of neutropenia was happened. Febrile neutropenia was noted in 24% of cases. No treatment related mortality was noted.Summary/Conclusion:Compared to MDH 2008 (third version of Tunisian prospective protocol), the use of Dacarbazine instead of Procarbazine is equally effective in term of response rate and the survivals (EFS, RFS and OS). The toxicity is the same.