PURPOSE: In patients with early unfavorable Hodgkin's lymphoma (HL), combined modality treatment with four cycles of ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) and 30 Gy involved-field radiotherapy (IFRT) results in long-term tumor control of approximately 80%. We aimed to improve these results using more intensive chemotherapy. PATIENTS AND METHODS: Patients with newly diagnosed early unfavorable HL were randomly assigned to either four cycles of ABVD or an intensified treatment consisting of two cycles of escalated BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone) followed by two cycles of ABVD (2 + 2). Chemotherapy was followed by 30 Gy IFRT in both arms. The primary end point was freedom from treatment failure (FFTF); secondary end points included progression-free survival (PFS) and treatment-related toxicity. RESULTS: With a total of 1,528 qualified patients included, the 2 + 2 regimen demonstrated superior FFTF compared with four cycles of ABVD (P < .001; hazard ratio, 0.44; 95% CI, 0.30 to 0.66), with a difference of 7.2% at 5 years (95% CI, 3.8 to 10.5). The difference in 5-year PFS was 6.2% (95% CI, 3.0% to 9.5%). There was more acute toxicity associated with 2 + 2 than with ABVD, but there were no overall differences in treatment-related mortality or secondary malignancies. CONCLUSION: Intensified chemotherapy with two cycles of BEACOPP escalated followed by two cycles of ABVD followed by IFRT significantly improves tumor control in patients with early unfavorable HL.
RCT Entities:
PURPOSE: In patients with early unfavorable Hodgkin's lymphoma (HL), combined modality treatment with four cycles of ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) and 30 Gy involved-field radiotherapy (IFRT) results in long-term tumor control of approximately 80%. We aimed to improve these results using more intensive chemotherapy. PATIENTS AND METHODS: Patients with newly diagnosed early unfavorable HL were randomly assigned to either four cycles of ABVD or an intensified treatment consisting of two cycles of escalated BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone) followed by two cycles of ABVD (2 + 2). Chemotherapy was followed by 30 Gy IFRT in both arms. The primary end point was freedom from treatment failure (FFTF); secondary end points included progression-free survival (PFS) and treatment-related toxicity. RESULTS: With a total of 1,528 qualified patients included, the 2 + 2 regimen demonstrated superior FFTF compared with four cycles of ABVD (P < .001; hazard ratio, 0.44; 95% CI, 0.30 to 0.66), with a difference of 7.2% at 5 years (95% CI, 3.8 to 10.5). The difference in 5-year PFS was 6.2% (95% CI, 3.0% to 9.5%). There was more acute toxicity associated with 2 + 2 than with ABVD, but there were no overall differences in treatment-related mortality or secondary malignancies. CONCLUSION: Intensified chemotherapy with two cycles of BEACOPP escalated followed by two cycles of ABVD followed by IFRT significantly improves tumor control in patients with early unfavorable HL.
Authors: Paul J Bröckelmann; Helen Goergen; Ulrich Keller; Julia Meissner; Rainer Ordemann; Teresa V Halbsguth; Stephanie Sasse; Martin Sökler; Andrea Kerkhoff; Stephan Mathas; Andreas Hüttmann; Matthias Bormann; Andreas Zimmermann; Jasmin Mettler; Michael Fuchs; Bastian von Tresckow; Christian Baues; Andreas Rosenwald; Wolfram Klapper; Carsten Kobe; Peter Borchmann; Andreas Engert Journal: JAMA Oncol Date: 2020-06-01 Impact factor: 31.777
Authors: Catherine S Diefenbach; Joseph M Connors; Jonathan W Friedberg; John P Leonard; Brad S Kahl; Richard F Little; Lawrence Baizer; Andrew M Evens; Richard T Hoppe; Kara M Kelly; Daniel O Persky; Anas Younes; Lale Kostakaglu; Nancy L Bartlett Journal: J Natl Cancer Inst Date: 2016-12-31 Impact factor: 13.506
Authors: Paul J Bröckelmann; Dennis A Eichenauer; Tina Jakob; Markus Follmann; Andreas Engert; Nicole Skoetz Journal: Dtsch Arztebl Int Date: 2018-08-06 Impact factor: 5.594
Authors: Anita Kumar; Carla Casulo; Joachim Yahalom; Heiko Schöder; Paul M Barr; Philip Caron; April Chiu; Louis S Constine; Pamela Drullinsky; Jonathan W Friedberg; John F Gerecitano; Audrey Hamilton; Paul A Hamlin; Steven M Horwitz; Alexandra G Jacob; Matthew J Matasar; Gianna N McArthur; Susan J McCall; Alison J Moskowitz; Ariela Noy; Maria L Palomba; Carol S Portlock; David J Straus; Nicholas VanderEls; Stephanie L Verwys; Joanna Yang; Anas Younes; Andrew D Zelenetz; Zhigang Zhang; Craig H Moskowitz Journal: Blood Date: 2016-07-25 Impact factor: 22.113