Two cycles of escalated BEACOPP followed by four cycles of ABVD
Diehl V. et al.; NEJM, 2003. 8 X escBEACOPP have high incidence of acute and long term toxicities: â Grade 3/4 leukopenia (98%), thrombocytopenia (70%), ...
Two cycles of escalated BEACOPP followed by four cycles of ABVD utilizing early-interim PET/CT scan for patients with advanced highrisk Hodgkin’s lymphoma A. Avigdor, S. Bulvik, I. Levi, E. Dann, A. Nagler, I. Ben-Bassat and A. Polliack
On behalf of the Israel Cooperative Lymphoma Group
GHLSG-HD9: escBEACOPP is superior to COPP/ABVD COPP/ ABVD
Escalated BEACOPP %
CR
85
96
NS
Early progression (at 5 yr)
10
2
50%
PD- >50% increase in the largest diameter of any residual PETpositive lesion identified in the early interim PET/CT or when any new PET-positive findings developed
Characteristics of patients Total Median age yrs (range) Male sex n (%)
45 27 (18-59) 32 (71)
Histology: n (%) Nodular sclerosis Mixed cellularity Unclassified
Stages: n (%)
34 (75) 7 (15) 4 (10)
IIB III IV
3 (7) 9 (20) 33 (73)
Bulky mediastinum n (%) Extranodal involvement: n (%)
15 (33) 33 (73)
Bone marrow Bone Lung Liver
15 22 9 5
International prognostic score n (%) 3 4-5 6-7
31 (69) 13 (29) 1 (2)
Response after completing all therapy according to early-interim PET results Early interim PET results Negative n=31 (71%)
Positive n=13 (29%)
Total* n=44
CR
30
9
39 (89%)
PR
-
3
3 (7%)
PD
1
1
2 (4%)
*One patient - non-FDG-avid disease at the time of diagnosis. CR at the end of therapy.
Overall survival 1.00
0.75
l a vi vr u s 0.50 ll ar e v o 0.25
4-yr - 95% 0.00 0
20
40
60
months
80
100
Progression-free survival 1.00
l a vi 0.75 vr u s e er -f 0.50 n oi s s er g or 0.25 p
4-yr - 78% 0.00 0
20
40
60
months
80
100
Outcome of patients according to results of early FDG-PET *Early PET negative (pts.) 31
CR 30
CR 27
PD 1
Relapse 3
*non FDG-avid – 1 patient.
*Early PET positive (pts.) 13
End of therapy
Follow up
CR 7
CR 9
PR/PD 4
Relapse 2
The role of early-interim PET as predictive of progression-free survival PET-
PET+
4-yr: 87% vs. 53%
Early PET predicted the outcome in 75% of patients (33/44) Positive predictive value – 45% Negative predictive value – 87%
Combined escBEACOPP - ABVD: adverse effects 2 X escBEACOPP
ABVD All therapy
Leukopenia grade 3-4 (%)
83
24
Thrombocytopenia grade 3-4 (%)
23
4
Infections grade 4 (%)
4
0
Hospitalization (%)
44
12
Avascular necrosis (n)
1
Cognitive impairment (n)
1
AML/MDS (n)
0
Toxic deaths (n)
0
Two cycles of escBEACOPP followed by four cycles of ABVD in patients with advanced HL and high IPS score: Conclusions Therapy is well tolerated and associated with
relatively low rates of acute toxicities. Higher survival rates than expected for high risk
advanced stage HL patients, receiving other ABVD containing regimens Early-interim PET had a relatively high NPV but a
much lower PPV. The results of early-interim PET had a significant
long-term prognostic role in the treatment of those patients receiving this regimen.
Thanks to all the participating centers: Chaim Sheba Medical center Soroka Medical Center Rambam Medical Center Assaf-Harofeh Hospital Laniado Hospital Tel-Aviv Medical Center Barzilai Medical Center Hadassah Medical Center Golda-Hasharon Hospital Meir Hospital Rabin Medical Center Shaare-Zedek Hospital
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