| Literature DB >> 29360414 |
Andrea Gallamini1, Corrado Tarella1, Simonetta Viviani1, Andrea Rossi1, Caterina Patti1, Antonino Mulé1, Marco Picardi1, Alessandra Romano1, Maria Cantonetti1, Giorgio La Nasa1, Livio Trentin1, Silvia Bolis1, Davide Rapezzi1, Roberta Battistini1, Daniela Gottardi1, Paolo Gavarotti1, Paolo Corradini1, Michele Cimminiello1, Corrado Schiavotto1, Guido Parvis1, Roberta Zanotti1, Guido Gini1, Andrés J M Ferreri1, Piera Viero1, Maurizio Miglino1, Atto Billio1, Abraham Avigdor1, Alberto Biggi1, Federico Fallanca1, Umberto Ficola1, Michele Gregianin1, Agostino Chiaravalloti1, Giuseppe Prosperini1, Fabrizio Bergesio1, Stephane Chauvie1, Chiara Pavoni1, Alessandro Massimo Gianni1, Alessandro Rambaldi1.
Abstract
Purpose To investigate the progression-free survival (PFS) of patients with advanced Hodgkin lymphoma (HL) after a risk-adapted treatment strategy that was based on a positive positron emission tomography scan performed after two doxorubicin, vinblastine, vincristine, and dacarbazine (ABVD) cycles (PET2). Patients and Methods Patients with advanced-stage (IIB to IVB) HL were consecutively enrolled. After two ABVD cycles, PET2 was performed and centrally reviewed according to the Deauville five-point scale. Patients with a positive PET2 were randomly assigned to four cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) followed by four cycles of standard BEACOPP with or without rituximab. Patients with a negative PET2 continued ABVD, and those with a large nodal mass at diagnosis (≥ 5 cm) in complete remission with a negative PET at the end of chemotherapy were randomly assigned to radiotherapy or no further treatment. The primary end point was 3-year PFS. Results Of 782 enrolled patients, 150 (19%) had a positive and 630 (81%) a negative PET2. The 3-year PFS of all patients was 82%. The 3-year PFS of those with a positive and negative PET2 was 60% and 87%, respectively ( P < .001). The 3-year PFS of patients with a positive PET2 assigned to BEACOPP with or without rituximab was 63% versus 57% ( P = .53). In 296 patients with both interim and post-ABVD-negative PET who had a large nodal mass at diagnosis, radiotherapy was randomly added after chemotherapy without a significant PFS improvement (97% v 93%, respectively; P = .29). The 3-year overall survival of all 782 patients was 97% (99% and 89% for PET2 negative and positive, respectively). Conclusion The PET-driven switch from ABVD to escalated BEACOPP is feasible and effective in high-risk patients with advanced-stage HL.Entities:
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Year: 2018 PMID： 29360414 DOI： 10.1200/JCO.2017.75.2543
Source DB: PubMed Journal: J Clin Oncol ISSN： 0732-183X Impact factor: 44.544