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Predicting Risk of Treatment-related Mortality in Advanced-stage Hodgkin Lymphoma

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Key Points

  • The introduction of chemotherapy regimens, such as MOPP, ABVD, and BEACOPP, have resulted in higher cure rates for Hodgkin lymphoma.
  • The use of BEACOPPescalated in the treatment of advanced-stage Hodgkin lymphoma is associated with higher treatment-related mortality, mainly due to neutropenic infection often related to bacterial or fungal agents. The patient’s age and performance status are also contributing factors to higher treatment-related mortality.
  • Individual risk of treatment-related mortality associated with the BEACOPPescalated regimen can be predicted by an algorithm based on the patient’s age and performance status.

Improvements in radiation therapy and the development of chemotherapy regimens, such as MOPP (mechlorethamine [Mustargen], vincristine, procarbazine [Matulane], and prednisone), and ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), in the treatment of Hodgkin lymphoma have made the cancer among the most curable in adult patients. Outcome for patients was further improved with the introduction of the escalated-dose version of BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), which resulted in increased survival times and overall survival. However, the therapy is also associated with higher treatment-related mortality.

To better understand the relationship between BEACOPPescalated treatment-related mortality and identify incidence, clinical features, and potential risk factors, the German Hodgkin Study Group (GHSG) performed a retrospective analysis of 3,402 patients with advanced-stage Hodgkin lymphoma receiving BEACOPPescalated therapy in GHSG trials HD9, HD12, and HD15. The study was published in the Journal of Clinical Oncology.

The analysis examined the medical records of patients enrolled in the GHSG clinical trials between 1993 and 2008 and found that the overall treatment-related mortality rate was 1.9% (64 out of 3,402). The most frequent cause for treatment-related mortality was neutropenic infection and was often related to bacterial or fungal agents. A comparison of patients treated in university hospitals, primary care hospitals, and private practices found no significant difference in treatment-related mortality rates among patients treated at different levels of care. Patients age ≥ 40 years who had poor performance status (Eastern Cooperative Oncology Group of 2 or Karnofsky < 80%) and patients age ≥ 50 years were at highest risk. Performance status and age were then used to develop a new risk model for treatment-related mortality that precisely identified patients at higher mortality risk (treatment-related mortality of 7.1% for model score ≥ 2). Patients who scored 0 or 1 had treatment-related mortality of 0.9%.

Predicting Risk for Treatment-related Mortality

The individual risk of treatment-related mortality associated with BEACOPPescalated in patients with advanced-stage Hodgkin lymphoma can be predicted by a simple algorithm based on the patient’s age and performance status. High-risk patients should receive special clinical attention, concluded the study authors.

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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