Long-Term Outcomes in Hodgkin Lymphoma: The Impact of Initial Therapy

Summary and Comment |
April 20, 2016

Long-Term Outcomes in Hodgkin Lymphoma: The Impact of Initial Therapy

  1. Michael E. Williams, MD, ScM

Ten-year survival was similar with ABVD or BEACOPP, but BEACOPP was associated with a high rate of late second malignancies.

  1. Michael E. Williams, MD, ScM

Maintaining high cure rates while lowering early and late treatment-related toxicity remains a challenge for patients with advanced-stage Hodgkin lymphoma.

Now, Italian investigators have performed a post-hoc analysis of long-term outcomes from a prospective, multicenter, randomized phase III trial of 305 evaluable patients who received induction therapy with one of three regimens: ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), or COPP-EBV-CAD (cyclophosphamide, lomustine, vindesine, melphalan, prednisone, epidoxorubicin, vincristine, procarbazine, vinblastine, and bleomycin).

At a median follow-up of 10 years, no difference was observed among the ABVD, BEACOPP, and COPP-EBV-CAD cohorts in progression-free survival (PFS; 69%, 75%, and 76%, respectively) or overall survival (85%, 84%, and 86%). Thirteen second malignancies were identified, 1 in the ABVD cohort and 6 each in BEACOPP and COPP-EBV-CAD cohorts. Five malignancies occurred in patients who received radiation therapy with initial treatment (median time to development, 90 months); 3 of these developed within or near the radiated area.


Whereas earlier results from this trial showed that fewer primary treatment failures and relapses occurred with BEACOPP versus ABVD, this advantage was lost due to treatment-associated second malignancies after longer follow-up. A response-adapted application of BEACOPP for patients at highest risk of failing ABVD seems useful based on a recent U.S. Intergroup trial (J Clin Oncol 2016 Apr 11; [e-pub]). In that trial, patients who remained positron emission tomography (PET)-positive after 2 cycles of ABVD and were switched to escalated BEACOPP had a markedly better than expected 2-year PFS of 64%. Such an approach would spare the 70% of patients destined to be cured by ABVD from receiving the more toxic BEACOPP regimen.

Editor Disclosures at Time of Publication

  • Disclosures for Michael E. Williams, MD, ScM at time of publication Consultant / Advisory board Celgene; Gilead; Takeda; TG Therapeutics; Bristol-Myers Squibb Speaker's bureau Research to Practice Grant / Research support Celgene; Janssen; Allos; Pharmacyclics; Gilead Leadership positions in professional societies Lymphoma Research Foundation (Scientific Advisory Board); American Board of Internal Medicine (Chair, Hematology Subspecialty Board; Member, Council)


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