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Long-Term Trial Finds Similar Survival Rates With Several Chemotherapy Regimens for Advanced Hodgkin Lymphoma

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Key Points

  • Neither BEACOPP nor CEC was associated with significantly better 10-year progression-free survival vs ABVD, according to long-term follow-up of the Italian HD2000 trial.
  • No significant differences in overall survival were observed among treatment groups.

In the long-term follow-up of the Italian HD2000 trial reported by Merli et al in the Journal of Clinical Oncology, no significant differences in overall or progression-free survival were observed after 10 years among patients with previously untreated advanced Hodgkin lymphoma receiving ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine; six cycles), BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone; four escalated plus two standard cycles), or COPP-EBV-CAD (cyclophosphamide, lomustine, vindesine, melphalan, prednisone, epidoxorubicin, vincristine, procarbazine, vinblastine, and bleomycin [CEC]; six cycles). In a report after a median follow-up of 42 months, BEACOPP was associated with improved progression-free survival but not overall survival vs ABVD.

10-Year Outcomes

The analysis involved 295 patients with a median follow-up of 120 months (range, 4–169 months). Ten-year progression-free survival was 69% with ABVD, 75% with BEACOPP (adjusted hazard ratio [HR] = 0.73, 95% confidence interval [CI] = 0.42–1.24, vs ABVD), and 76% with CEC (adjusted HR = 0.72, 95% CI = 0.42–1.24, vs ABVD). Ten-year overall survival was 85% with ABVD, 84% with BEACOPP, and 86% with CEC (overall P = .892).

A total of 13 second malignancies were reported, consisting of 1 in the ABVD group and 6 each in the BEACOPP and CEC groups, representing cumulative 10-year risks of 0.9%, 6.6% (P = .027), and 6.0% (P = .02). All second malignancies except 1 were diagnosed in patients in complete remission, and 8 of the 13 malignancies resulted in death.

The investigators concluded: “With these mature results, we confirm that patients with advanced Hodgkin lymphoma have similar [overall survival] results when treated with ABVD, BEACOPP, or CEC. However, with longer follow-up, we were not able to confirm the superiority of BEACOPP over ABVD in terms of [progression-free survival], mainly because of higher mortality rates resulting from second malignancies observed after treatment with BEACOPP and CEC.”

The study was supported in part by Gruppo Amici dell’Ematologia, Reggio Emilia, Italy.

Francesco Merli, MD, of the Istituto di Ricovero e Cura a Carattere Scientifico, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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