Feasibility and efficacy of dose‐dense and dose‐intense ABVD for high‐risk patients with advanced Hodgkin lymphoma

Feasibility and efficacy of dose‐dense and dose‐intense ABVD for high‐risk patients with advanced Hodgkin lymphoma: reply to D'Arco et al

“…However, different drug composition, dose intensity and recycling intervals across such regimens might influence the predictive significance of FDG uptake after only two cycles of chemotherapy. As in our study, the PET2‐positive patients reported by D'Arco et al () became PET‐negative after two further courses of treatment and maintained, after treatment completion, their disease‐free status at a substantial follow‐up. Along the same line, the most recent analysis of the GHSG HD18 trial demonstrated a substantial progression‐free survival (PFS) for PET2‐positive patients who started and continued their treatment with escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) (Borchmann et al , ).…”

“…In addition, patients with metabolically active lymphoma lesions after four courses of ABVD DD‐DI were considered as failures and diverted per protocol to salvage. Therefore, D'Arco et al () correctly highlight that management of these latter type of patients was not addressed in our trial. We feel, however, that the availability of conformal techniques resulting in low treatment volumes and dosing may certainly allow a safe radiotherapy delivery in the case of residual mediastinal FDG uptake in patients treated with ABVD DD‐DI .…”

“…The escalated BEACOPP platform had the merit of demonstrating the highly favourable impact of upfront treatment intensification (‘first hit’ principle) in terms of primary disease control and a reduced need for consolidation radiotherapy (Engert et al , ). Data from D'Arco et al () and our Phase II trial (Russo et al , ) show that the ‘first hit’ principle can be also exploited, safely and efficiently, by modifying the ABVD scheduling. So, pending the results of ongoing studies testing the superiority of strategies incorporating novel agents, such as brentuximab vedotin, in frontline chemotherapy, intensified ABVD variants may deserve further exploration through randomized trials.…”

“…We read with deep interest the report of D'Arco et al (), presenting a series of newly diagnosed patients with advanced Hodgkin lymphoma (HL) treated according to the dose‐dense (DD) and dose‐intense (DI) ABVD schedule (doxorubicin, bleomycin, vinblastine, dacarbazine: ABVD DD‐DI ) described in a phase II study from our group (Russo et al , ).…”

Liposomal doxorubicin supercharge‐containing front‐line treatment in patients with advanced‐stage diffuse large B‐cell lymphoma or classical Hodgkin lymphoma: Preliminary results of a single‐centre phase II study

“…To this end, several trials have explored the therapeutic activity and safety of modified R-CHOP and ABVD with changes regarding mostly hydroxydaunorubicin doseintensity and/or dose density. [41][42][43][44] By analysing the data, positive interim-FDG-PET scans average rates were 33% (range, 30%-37%) for intensified R-CHOP and 15% (range, 13%-31%) for intensified ABVD. [41][42][43][44] Noteworthy, haematological and/or extra-haematological Grade ≥3 toxicity occurrence in these trials ranged between 36% and 68%.…”