Francesco Merli1, Stefano Luminari2, Paolo G Gobbi2, Nicola Cascavilla2, Caterina Mammi2, Fiorella Ilariucci2, Caterina Stelitano2, Maurizio Musso2, Luca Baldini2, Sara Galimberti2, Francesco Angrilli2, Giuseppe Polimeno2, Potito Rosario Scalzulli2, Angela Ferrari2, Luigi Marcheselli2, Massimo Federico2. 1. Francesco Merli, Caterina Mammi, Fiorella Ilariucci, and Angela Ferrari, Azienda Ospedaliera Arcispedale S. Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS); Reggio Emilia; Stefano Luminari, Luigi Marcheselli, and Massimo Federico, University of Modena and Reggio Emilia, Modena; Paolo G. Gobbi, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia; Nicola Cascavilla and Potito Rosario Scalzulli, IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo; Caterina Stelitano, A.O. Bianchi Melacrino Morelli, Reggio Calabria; Maurizio Musso, Ospedale La Maddalena, Palermo; Luca Baldini, Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano; Sara Galimberti, University of Pisa, Pisa; Francesco Angrilli, Ospedale Santo Spirito, Pescara; and Giuseppe Polimeno, Ospedale "Miulli," Acquaviva delle Fonti, Bari, Italy. francesco.merli@asmn.re.it. 2. Francesco Merli, Caterina Mammi, Fiorella Ilariucci, and Angela Ferrari, Azienda Ospedaliera Arcispedale S. Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS); Reggio Emilia; Stefano Luminari, Luigi Marcheselli, and Massimo Federico, University of Modena and Reggio Emilia, Modena; Paolo G. Gobbi, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia; Nicola Cascavilla and Potito Rosario Scalzulli, IRCCS "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo; Caterina Stelitano, A.O. Bianchi Melacrino Morelli, Reggio Calabria; Maurizio Musso, Ospedale La Maddalena, Palermo; Luca Baldini, Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano; Sara Galimberti, University of Pisa, Pisa; Francesco Angrilli, Ospedale Santo Spirito, Pescara; and Giuseppe Polimeno, Ospedale "Miulli," Acquaviva delle Fonti, Bari, Italy.
Abstract
PURPOSE: The randomized HD2000 trial compared six cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), four escalated plus two standard cycles of BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), and six cycles of COPP-EBV-CAD (cyclophosphamide, lomustine, vindesine, melphalan, prednisone, epidoxorubicin, vincristine, procarbazine, vinblastine, and bleomycin; CEC) in patients with advanced-stage Hodgkin lymphoma. After a median follow-up of 42 months, patients who received BEACOPP were reported to have experienced better progression-free survival (PFS) but not better overall survival (OS) results than those receiving ABVD. We here report a post hoc analysis of this trial after a median follow-up of 10 years. PATIENTS AND METHODS: Three hundred seven patients were enrolled, 295 of whom were evaluable. At the time of our analysis, the median follow-up for the entire group was 120 months (range, 4 to 169 months). RESULTS: The 10-year PFS results for the ABVD, BEACOPP, and CEC arms were 69%, 75%, and 76%, respectively; corresponding OS results were 85%, 84%, and 86%. Overall, 13 second malignancies were reported: one in the ABVD arm and six each in the BEACOPP and CEC arms. The cumulative risk of developing second malignancies at 10 years was 0.9%, 6.6%, and 6% with ABVD, BEACOPP, and CEC, respectively; the risk with either BEACOPP or CEC was significantly higher than that reported with ABVD (P = .027 and .02, respectively). CONCLUSION: With these mature results, we confirm that patients with advanced Hodgkin lymphoma have similar OS results when treated with ABVD, BEACOPP, or CEC. However, with longer follow-up, we were not able to confirm the superiority of BEACOPP over ABVD in terms of PFS, mainly because of higher mortality rates resulting from second malignancies observed after treatment with BEACOPP and CEC.
RCT Entities:
PURPOSE: The randomized HD2000 trial compared six cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), four escalated plus two standard cycles of BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), and six cycles of COPP-EBV-CAD (cyclophosphamide, lomustine, vindesine, melphalan, prednisone, epidoxorubicin, vincristine, procarbazine, vinblastine, and bleomycin; CEC) in patients with advanced-stage Hodgkin lymphoma. After a median follow-up of 42 months, patients who received BEACOPP were reported to have experienced better progression-free survival (PFS) but not better overall survival (OS) results than those receiving ABVD. We here report a post hoc analysis of this trial after a median follow-up of 10 years. PATIENTS AND METHODS: Three hundred seven patients were enrolled, 295 of whom were evaluable. At the time of our analysis, the median follow-up for the entire group was 120 months (range, 4 to 169 months). RESULTS: The 10-year PFS results for the ABVD, BEACOPP, and CEC arms were 69%, 75%, and 76%, respectively; corresponding OS results were 85%, 84%, and 86%. Overall, 13 second malignancies were reported: one in the ABVD arm and six each in the BEACOPP and CEC arms. The cumulative risk of developing second malignancies at 10 years was 0.9%, 6.6%, and 6% with ABVD, BEACOPP, and CEC, respectively; the risk with either BEACOPP or CEC was significantly higher than that reported with ABVD (P = .027 and .02, respectively). CONCLUSION: With these mature results, we confirm that patients with advanced Hodgkin lymphoma have similar OS results when treated with ABVD, BEACOPP, or CEC. However, with longer follow-up, we were not able to confirm the superiority of BEACOPP over ABVD in terms of PFS, mainly because of higher mortality rates resulting from second malignancies observed after treatment with BEACOPP and CEC.
Authors: F Covut; R Pinto; B W Cooper; B Tomlinson; L Metheny; E Malek; H M Lazarus; M de Lima; P F Caimi Journal: Bone Marrow Transplant Date: 2017-03-27 Impact factor: 5.483
Authors: D Ghez; C Fortpied; N Mounier; P Carde; A Perrot; H Khaled; S Amorim; S Ramadan; F L Bras; M Erlanson; C Herbaux; J-P Marolleau; E Nicolas-Virelezier; O Casasnovas; A Stamatoullas-Bastard; C Fermé Journal: Bone Marrow Transplant Date: 2016-11-28 Impact factor: 5.483
Authors: Scott F Huntington; Gottfried von Keudell; Amy J Davidoff; Cary P Gross; Sapna A Prasad Journal: J Clin Oncol Date: 2018-10-04 Impact factor: 44.544