title: Risk-adapted BEACOPP regimen can reduce the cumulative dose of chemotherapy for standard and high-risk Hodgkin lymphoma with no impairment of outcome.
abstract: Therapy of Hodgkin disease (HD) is designed to prolong progression-free survival and minimize toxicity. The best regimen to achieve this has not yet been defined. A total of 108 patients with newly diagnosed HD and adverse prognostic factors were prospectively studied between 1999 and 2004. They were assigned to therapy according to defined risk stratification. Patients were defined depending on the International Prognostic Score (IPS). Those with IPS of 3 or higher received 2 cycles of escalated therapy, including bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP [EB]). All others received 2 cycles of standard BEACOPP (SB). Subsequent therapy was prospectively assigned following 2 cycles according to results of early interim 67Ga or positron emission tomography/computed tomography (PET/CT). Following a positive interim scan, 4 cycles of EB were administered, whereas 4 cycles of SB were given to patients with a negative scan. The complete remission rate, the 5-year event-free survival (EFS), and overall survival (OS) rates were 97%, 85% and 90%, respectively. Relapse or progression occurred in 27% of patients with interim positive PET/CT versus 2.3% of negative scans (P<.02). Early interim fluorine-18 2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT is a useful tool for adjustment of chemotherapy on an individual basis. Similar EFS and OS rates were observed for patients in both risk groups.
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Medical Center, Haifa, Israel. e_dann@rambam.health.gov.il
authors.forename: Eldad J
authors.initials: EJ
authors.lastname: Dann
authors.forename: Rachel
authors.initials: R
authors.lastname: Bar-Shalom
authors.forename: Ada
authors.initials: A
authors.lastname: Tamir
authors.forename: Nissim
authors.initials: N
authors.lastname: Haim
authors.forename: Menachem
authors.initials: M
authors.lastname: Ben-Shachar
authors.forename: Irit
authors.initials: I
authors.lastname: Avivi
authors.forename: Tzila
authors.initials: T
authors.lastname: Zuckerman
authors.forename: Mark
authors.initials: M
authors.lastname: Kirschbaum
authors.forename: Odelia
authors.initials: O
authors.lastname: Goor
authors.forename: Diana
authors.initials: D
authors.lastname: Libster
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Rowe
authors.forename: Ron
authors.initials: R
authors.lastname: Epelbaum
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use* / Q000633:toxicity; D001761:Bleomycin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D016903:Drug Monitoring / Q000379:methods; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction; D012306:Risk; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D011344:Procarbazine; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone