Abstract |
INTRODUCTION Escalated BEACOPP (escBEACOPP: bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) significantly improves overall response rates (ORRs) and prolongs progression‑free survival (PFS) in patients with advanced‑stage Hodgkin lymphoma (HL). However, 6 to 8 cycles of escBEACOPP are associated with increased acute toxicity and late complications. OBJECTIVES We aimed to determine the role of early positron emission tomography-computed tomography (PET‑CT) response assessment in a de‑escalation strategy. PATIENTS AND METHODS We retrospectively analyzed 188 consecutive patients with advanced‑stage HL treated at diagnosis. Patients received 2 cycles of escBEACOPP followed by an early PET‑CT response assessment performed after 2 cycles of chemotherapy (PET2). Patients with an active disease continued therapy with escBEACOPP, while those with negative PET2 were de‑escalated to ABVD ( doxorubicin, bleomycin, vinblastine, dacarbazine). Radiotherapy was allowed in patients with stage IIBX. RESULTS PET2 allowed for de‑escalation of therapy in 141 patients (75%). Their ORR was 92.2%, with a complete remission (CR) rate of 91.5%; 10‑year PFS and overall survival (OS) were 87.2% and 95%, respectively. In the whole cohort, ORR was 87.8% (CR, 85.6%), while the 10‑year PFS and OS were 79.3% and 89.4%, respectively. Hematological and thromboembolic complications were significantly more frequent in patients treated with 6 escBEACOPP cycles, including febrile neutropenia (25 patients, [53.2%] vs 7 [5%]), serious anemia (35 [74.5%] vs 11 [7.8%]), or thrombocytopenia (16 [34%] vs 7 [5%]) (P <0.001 for all comparisons with de‑escalation strategy) as well as pulmonary embolism (3 [6.4%] vs 0) (P = 0.02). CONCLUSIONS The early de‑escalation strategy allows for effective treatment of advanced HL, with a comparable efficacy to that of 6 to 8 cycles of escBEACOPP, but with significantly reduced toxicity.
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Authors | Monika Długosz-Danecka, Sebastian Szmit, Anna Kocurek, Paweł Koźlik, Agnieszka Giza, Dagmara Zimowska-Curyło, Bogdan Małkowski, Anna Sowa-Staszczak, Jarosław Kużdżał, Wojciech Jurczak |
Journal | Polish archives of internal medicine
(Pol Arch Intern Med)
Vol. 129
Issue 4
Pg. 259-266
(04 30 2019)
ISSN: 1897-9483 [Electronic] Poland |
PMID | 30945698
(Publication Type: Journal Article)
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Chemical References |
- Bleomycin
- Procarbazine
- Vincristine
- Etoposide
- Doxorubicin
- Cyclophosphamide
- Prednisone
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Topics |
- Adult
- Antineoplastic Combined Chemotherapy Protocols
(adverse effects, therapeutic use)
- Bleomycin
(adverse effects, therapeutic use)
- Cyclophosphamide
(adverse effects, therapeutic use)
- Dose-Response Relationship, Drug
- Doxorubicin
(adverse effects, therapeutic use)
- Etoposide
(adverse effects, therapeutic use)
- Female
- Follow-Up Studies
- Hodgkin Disease
(diagnostic imaging, drug therapy, physiopathology)
- Humans
- Male
- Middle Aged
- Positron Emission Tomography Computed Tomography
- Prednisone
(adverse effects, therapeutic use)
- Procarbazine
(adverse effects, therapeutic use)
- Retrospective Studies
- Survival Analysis
- Treatment Outcome
- Vincristine
(adverse effects, therapeutic use)
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