title: Escalated-dose BEACOPP in the treatment of patients with advanced-stage Hodgkin's lymphoma: 10 years of follow-up of the GHSG HD9 study.
abstract: OBJECTIVE
  The HD9 trial of the German Hodgkin Study Group compared two different doses (baseline and escalated) of the bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) chemotherapy regimen in 1,196 patients with advanced-stage Hodgkin's lymphoma (HL). The previous analysis with 5 years median follow-up had indicated improved tumor control with BEACOPP escalated. Since the long-term safety and efficacy of this regimen has been debated, we report the 10-year follow-up.
  
  
  METHODS
  Patients received one of three chemotherapy regimens: eight cycles of cyclophosphamide, vincristine, procarbazine, and prednisone (COPP) alternating with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD); eight cycles of BEACOPP baseline; or eight cycles of BEACOPP escalated.
  
  
  RESULTS
  Median follow-up was 111 months. At 10 years, freedom from treatment failure (FFTF) was 64%, 70%, and 82% with OS rates of 75%, 80%, and 86% for patients treated with COPP/ABVD (arm A), BEACOPP baseline (arm B), and BEACOPP escalated (arm C), respectively (P < .001). BEACOPP escalated was significantly better than BEACOPP baseline in terms of FFTF (P < .0001) and OS (P = .0053). A total of 74 second malignancies (6.2%) were documented, including acute myeloid leukemia (0.4%, 1.5%, and 3.0%), non-Hodgkin's lymphoma (2.7%, 1.7%, and 1.0%), and solid tumors (2.7%, 3.4%, and 1.9%). The corresponding overall secondary malignancy rates were 5.7%, 6.6%, and 6.0%, respectively.
  
  
  CONCLUSIONS
  The 10-year follow-up of the HD9 trial demonstrates a stabilized significant improvement in long-term FFTF and OS for BEACOPP escalated in advanced-stage HL. These results challenge ABVD as standard of care for this patient population.
authors.affiliation: Klinik I für Innere Medizin, Universitätsklinik Köln, Kerpener Strasse 62, 50931 Köln, Germany. a.engert@uni-koeln.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Engert
authors.forename: Volker
authors.initials: V
authors.lastname: Diehl
authors.forename: Jeremy
authors.initials: J
authors.lastname: Franklin
authors.forename: Andreas
authors.initials: A
authors.lastname: Lohri
authors.forename: Bernd
authors.initials: B
authors.lastname: Dörken
authors.forename: Wolf-Dieter
authors.initials: WD
authors.lastname: Ludwig
authors.forename: Peter
authors.initials: P
authors.lastname: Koch
authors.forename: Mathias
authors.initials: M
authors.lastname: Hänel
authors.forename: Michael
authors.initials: M
authors.lastname: Pfreundschuh
authors.forename: Martin
authors.initials: M
authors.lastname: Wilhelm
authors.forename: Lorenz
authors.initials: L
authors.lastname: Trümper
authors.forename: Walter-Erich
authors.initials: WE
authors.lastname: Aulitzky
authors.forename: Martin
authors.initials: M
authors.lastname: Bentz
authors.forename: Mathias
authors.initials: M
authors.lastname: Rummel
authors.forename: Orhan
authors.initials: O
authors.lastname: Sezer
authors.forename: Hans-Konrad
authors.initials: HK
authors.lastname: Müller-Hermelink
authors.forename: Dirk
authors.initials: D
authors.lastname: Hasenclever
authors.forename: Markus
authors.initials: M
authors.lastname: Löffler
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001761:Bleomycin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D003606:Dacarbazine / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D011344:Procarbazine; D014750:Vincristine; D014747:Vinblastine; D005047:Etoposide; D003606:Dacarbazine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone