title: ABVD versus BEACOPP for Hodgkin's lymphoma when high-dose salvage is planned.
abstract: BACKGROUND
  BEACOPP, an intensified regimen consisting of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone, has been advocated as the new standard of treatment for advanced Hodgkin's lymphoma, in place of the combination of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD).
  
  
  METHODS
  We randomly assigned 331 patients with previously untreated and unfavorable Hodgkin's lymphoma (stage IIB, III, or IV, or an international prognostic score of ≥3 on a scale of 0 to 7, with higher scores indicating increased risk), to receive either BEACOPP or ABVD, each followed by local radiotherapy when indicated. Patients with residual or progressive disease after the initial therapy were to be treated according to a state-of-the-art high-dose salvage program. The median follow-up period was 61 months.
  
  
  RESULTS
  The 7-year rate of freedom from first progression was 85% among patients who had received initial treatment with BEACOPP and 73% among those who had received initial treatment with ABVD (P=0.004), and the 7-year rate of event-free survival was 78% and 71%, respectively (P=0.15). A total of 65 patients (20 in the BEACOPP group, and 45 in the ABVD group) went on to receive the intended high-dose salvage regimen. As of the cutoff date, 3 of the 20 patients in the BEACOPP group and 15 of the 45 in the ABVD group who had had progressive disease or relapse after the initial therapy were alive and free of disease. After completion of the overall planned treatment, including salvage therapy, the 7-year rate of freedom from a second progression was 88% in the BEACOPP group and 82% in the ABVD group (P=0.12), and the 7-year rate of overall survival was 89% and 84%, respectively (P=0.39). Severe adverse events occurred more frequently in the BEACOPP group than in the ABVD group.
  
  
  CONCLUSIONS
  Treatment with BEACOPP, as compared with ABVD, resulted in better initial tumor control, but the long-term clinical outcome did not differ significantly between the two regimens. (Funded by Fondazione Michelangelo; ClinicalTrials.gov number, NCT01251107.).
authors.affiliation: Milan Cancer Institute, Milan, Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Viviani
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Zinzani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rambaldi
authors.forename: Ercole
authors.initials: E
authors.lastname: Brusamolino
authors.forename: Alessandro
authors.initials: A
authors.lastname: Levis
authors.forename: Valeria
authors.initials: V
authors.lastname: Bonfante
authors.forename: Umberto
authors.initials: U
authors.lastname: Vitolo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pulsoni
authors.forename: Anna Marina
authors.initials: AM
authors.lastname: Liberati
authors.forename: Giorgina
authors.initials: G
authors.lastname: Specchia
authors.forename: Pinuccia
authors.initials: P
authors.lastname: Valagussa
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.forename: Francesco
authors.initials: F
authors.lastname: Zaja
authors.forename: Enrico M
authors.initials: EM
authors.lastname: Pogliani
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pregno
authors.forename: Manuel
authors.initials: M
authors.lastname: Gotti
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallamini
authors.forename: Delia
authors.initials: D
authors.lastname: Rota Scalabrini
authors.forename: Gianni
authors.initials: G
authors.lastname: Bonadonna
authors.forename: Alessandro M
authors.initials: AM
authors.lastname: Gianni
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D003606:Dacarbazine / Q000009:adverse effects / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005047:Etoposide / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D011344:Procarbazine / Q000009:adverse effects / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012074:Remission Induction; D016879:Salvage Therapy; D014747:Vinblastine / Q000009:adverse effects / Q000627:therapeutic use; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D001761:Bleomycin; D011344:Procarbazine; D014750:Vincristine; D014747:Vinblastine; D005047:Etoposide; D003606:Dacarbazine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone