ABVD Compared With BEACOPP Compared With CEC for the Initial Treatment of Patients With Advanced Hodgkin's Lymphoma: Results From the HD2000 Gruppo Italiano per lo Studio dei Linfomi Trial

Abstract

Purpose To compare doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) versus bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) versus cyclophosphamide, lomustine, vindesine, melphalan, prednisone, epidoxirubicin, vincristine, procarbazine, vinblastine, and bleomycin (COPPEBVCAD; CEC) for advanced Hodgkin's lymphoma (HL). Patients and Methods Three hundred seven patients with advanced HL (stage IIB, III, and IV) were randomly assigned to receive six courses of ABVD, four escalated plus two standard courses of BEACOPP, or six courses of CEC, plus a limited radiation therapy program. Results After a median follow-up of 41 months, BEACOPP resulted in a superior progression-free survival (PFS), with a significant reduction in risk of progression (hazard ratio [HR] = 0.50) compared with ABVD. No differences between BEACOPP and CEC, or CEC and ABVD were observed. The 5-year PFS was 68% (95% CI, 56% to 78%), 81% (95% CI, 70% to 89%), and 78% (95% CI, 68% to 86%), for ABVD, BEACOPP, and CEC, respectively (BEACOPP v ABVD, P = .038; CEC v ABVD and BEACOPP v CEC, P = not significant [NS]). The 5-year overall survival was 84% (95% CI, 69% to 92%), 92% (95% CI, 84% to 96%), and 91% (95% CI, 81% to 96%) for ABVD, BEACOPP, and CEC, respectively (P = NS). BEACOPP and CEC resulted in higher rates of grade 3-4 neutropenia than ABVD (P = .016); BEACOPP was associated with higher rates of severe infections than ABVD and CEC (P = .003). Conclusion As adopted in this study BEACOPP is associated with a significantly improved PFS compared with ABVD, with a predictable higher acute toxicity.

Hodgkin lymphoma: MOPP chemotherapy to PD‐1 blockade and beyond

“…The overall response rate for COPP alternating with ABVD chemotherapy was 75% compared to 86% in patients receiving escalated BEACOPP and the failure free survival at 10 years was 64% for patients receiving COPP alternating with ABVD chemotherapy compared to 82% for patients receiving escalated BEACOPP. Similar results were seen in a study conducted by Federico et al [11]. In this case, escalated BEACOPP chemotherapy was compared to ABVD chemotherapy or the CEC regimen.…”

“…The escalated BEACOPP regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) was developed by the German Hodgkin Lymphoma Study Group and has been compared to ABVD chemotherapy in randomized control trials [10][11][12]. These studies have shown a higher complete response rate and improved progression free survival with the use of escalated BEACOPP.…”

Prognostic factors for advanced‐stage human immunodeficiency virus‐associated classical Hodgkin lymphoma treated with doxorubicin, bleomycin, vinblastine, and dacarbazine plus combined antiretroviral therapy: A multi‐institutional retrospective study

“…It is noteworthy that the CR rate to ABVD observed in our cohort was comparable to the response rates to ABVD reported in immunocompetent HL patients with advanced-stage disease. 3,4,22 After a median follow-up of approximately 5 years, the patients in our cohort had 5-year PFS and OS rates of 69% and 78%, respectively. In the study by Spina et al, 21 patients experienced 3-year freedom from progression and OS rates of 60% and 51%, respectively, and the study by Montoto et al produced 5-year event-free survival and OS rates of 59% and 88%, respectively.…”

“…The 5-year PFS and OS rates in our cohort also were comparable to the survival rates reported in immunocompetent patients with advanced-stage HL. 3,4,22 Few studies have previously analyzed the prognostic value of the CD4-positive cell count. In the study by Hentrich et al, a CD4-positive count <200 cells/lL was not associated with PFS or OS after adjusting for covariates.…”

“…In randomized, controlled studies that include immunocompetent patients with classical HL, it has been demonstrated that the combination of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) is effective and is probably less toxic than more intensive regimens. 3,4 A recent study demonstrated an improvement in the outcome of patients with HIV-associated HL compared with their immunocompetent counterparts when treated with standard regimens. 5,6 However, a standard of care in HIV-positive individuals has not been established, because, in general, HIVpositive patients are excluded from clinical trials, and data on their outcomes are rather scant.…”