Standard and Increased-Dose BEACOPP Chemotherapy Compared with COPP-ABVD for Advanced Hodgkin's Disease

Diehl, Volker; Franklin, Jeremy; Pfreundschuh, Michael; Lathan, B.; Paulus, U.; Hasenclever, Dirk; Tesch, Hans; Herrmann, Richard; Dörken, Bernd; Müller-Hermelink, H. K.; Dühmke, E; Loeffler, Markus

doi:10.1056/nejmoa022473

Cited by 744 publications

(455 citation statements)

References 31 publications

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“…Of note, however, is the use of stimulatory peptide increases bleomycin induced lung toxicity [53] and [54]. Alternatives are Stanford V and escalated BEACOPP [55] and [56] where encouraging results are offset by a marked increase in both short-and long-term toxicities, including infertility, infectious complications and second malignancies so that there is a relevance to use BEACOPP routinely.…”

Section: Advancedmentioning

confidence: 99%

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Human immunodeficiency and Hodgkin lymphoma

Sissolak

Jacobs

2010

Transfusion and Apheresis Science

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Presentation of Hodgkin lymphoma (HL) is distinctive in the infected individual being more advanced, accompanied by B symptoms and the presence of extranodal disease particularly lymphadenopathy of the head and neck. Bone marrow involvement may be found in over 50% of cases. Virtually all co express gamma-herpesvirus. Phenotypically there is prominence of the mixed-cellularity and lymphocyte depleted histopathologic subtypes that define an aggressive clinical course in comparison to other variants. Prior to the induction of cART, median survival was only 1-2 years. Notably the first chemotherapy trial using ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in 21 patients, without treating the viral infection, resulted in a 43% complete remission rate accompanied by severe haematological toxicities but did not extend median survival with this being 1.5 years matching the negative cases.Significant change accompanied concomitant anti-retroviral therapy that could be given safely even with dose intensive regimens exemplified by BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) in 12 patients or the Stanford V regimen (doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin, prednisone) coupled with involved-field radiation for bulky disease studied in 59 patients. BEACOPP extended overall survival (OS) to 83% at 2 years. A similar trend was seen 1 when using the Stanford V regimen with an OS rate of 51% at 3 years, disease-free survival (DFS) of 68% and freedom from progression (FFP) in 60%. Additional benefits accrued from supportive care with stimulatory peptides such as G-CSF and when combined with bacterial prophylaxis results approached that found in the uninfected reference group. Current consensus holds this particular lymphoma as still among the non-AIDS defining cancers being lung, stomach, liver or anal despite these having recently gained more attention as several of these neoplasms may be occurring more commonly in the era of cART.While the relative risk of developing a non-AIDS-defining neoplasm in HIV-infected persons on the average is 2-3 times, the risk for developing HL in HIV-infected cases impressively ranges between 5 and 25 times when compared to the general population. Based on the precedent in which Kaposi sarcoma and the non-Hodgkin lymphomas distinctively alter the course of this retroviral infection in a way indistinguishable from concurrent Hodgkin lymphoma we propose that this entity be similarly regarded and the hypothesis tested in large randomised prospective study.

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Section: Advancedmentioning

confidence: 99%

“…However, it does represent a reasonable alternative particularly with high-risk disease as defined by the International Prognostic Score (IPS) [56] and [57]. Despite the CD20 negative immunophenotype in most of the cases several investigators have studied the role of rituximab in the treatment of classical variants.…”

Section: Advancedmentioning

confidence: 99%

Human immunodeficiency and Hodgkin lymphoma

Sissolak

Jacobs

2010

Transfusion and Apheresis Science

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“…As Hodgkin lymphoma (HL) is a common malignancy in young people (Blumenfeld et al, 2002), fertility preservation is an important issue to address when counselling patients prior to chemotherapy. With current regimens of chemotherapy and radiotherapy a large proportion of patients will be cured of their illness, but with the risk of long-term toxicity, particularly with recently developed intensive chemotherapy programmes such as escalated-dose BEACOPP (Bleomycin, Etoposide, Adriamycin s , Cyclophosphamide, Oncovin s , Procarbazine, Prednisolone) (Diehl et al, 2003).…”

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confidence: 99%

Lack of evidence of disease contamination in ovarian tissue harvested for cryopreservation from patients with Hodgkin lymphoma and analysis of factors predictive of oocyte yield

et al. 2006

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Ovarian cryopreservation is a promising technique to preserve fertility in women with Hodgkin lymphoma (HL) treated with chemotherapy. Thus, the aim of this study was to examine harvested ovarian tissue for subclinical involvement by HL by morphology/ immunohistochemistry, and to define patient and treatment factors predictive of oocyte yield. This was a retrospective analysis of 26 ovarian tissue samples harvested for cryopreservation from women with HL. Histology, immunohistochemistry and follicle density (number mm À3 ) was examined. Disease status and preharvest chemotherapy details were obtained on 24 patients. The median age was 22 years (range 13 -29). Seven of 24 patients had infradiaphragmatic disease at time of harvest. Nine of 20 patients had received chemotherapy preharvest (ABVD (Adriamycin s , Bleomycin, Vinblastine and Dacarbazine) ¼ 7, other regimens ¼ 2). The seven receiving ABVD showed no difference in follicle density compared to patients not receiving treatment (n ¼ 14); (median ¼ 1555 vs 1620 mm 3 P ¼ 0.97). Follicle density measurement showed no correlation with patient age (R 2 ¼ 0.0001, P ¼ 0.99). There was no evidence of HL involvement in the 26 samples examined (95% CI ¼ 0 -11%). In conclusion, subclinical involvement of HL has not been identified in ovarian tissue, even when patients have infradiaphragmatic disease. Furthermore, the quality of tissue harvested does not appear to be adversely affected by patient's age or prior ABVD chemotherapy.

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“…The first is the widespread acceptance of evidence-based up-front treatment tailored towards prognostic factors. For very favorable patients a reduction in number of treatment cycles and radiation dose is warranted, while for unfavorable patients, ever more physicians, at least in Europe, accept escalated BEACOPP as the standard of care [46,47]. The second is the introduction of gemcitabine as a very active drug for treatment of HL patients failing standard up-front and salvage treatments [48].…”

Section: Hodgkin's Lymphoma (Hl)mentioning

confidence: 99%

Changing therapeutic landscape – The last decade

Aurer

2011

Transfusion and Apheresis Science

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Standard and Increased-Dose BEACOPP Chemotherapy Compared with COPP-ABVD for Advanced Hodgkin's Disease

Cited by 744 publications

References 31 publications

Human immunodeficiency and Hodgkin lymphoma

Human immunodeficiency and Hodgkin lymphoma

Lack of evidence of disease contamination in ovarian tissue harvested for cryopreservation from patients with Hodgkin lymphoma and analysis of factors predictive of oocyte yield

Changing therapeutic landscape – The last decade

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