title: Impact of Bleomycin and Vincristine Dose Reductions in Patients With Advanced Hodgkin Lymphoma Treated With BEACOPP: An Analysis of the German Hodgkin Study Group HD12 and HD15 Trials.
abstract: OBJECTIVE
  The role of bleomycin and vincristine in the treatment of patients with advanced Hodgkin lymphoma (HL) is unclear, and the impact of dose reductions of these drugs on outcome and tolerability has not been systematically assessed. Because both drugs can cause significant toxicity and are frequently discontinued, we performed an analysis of patients with HL treated with BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone) in the German Hodgkin Study Group HD12 and HD15 trials.
  
  
  METHODS
  Characteristics and outcome of patients were analyzed with respect to discontinuation of bleomycin and/or vincristine.
  
  
  RESULTS
  With 3,309 patients with HL analyzed, bleomycin was discontinued in 17.6% and vincristine in 32.6%. A total of 157 patients (4.7%) received ≤ four cycles of bleomycin, and 218 (6.6%) received ≤ three cycles of vincristine; these were compared with patients receiving > four cycles of bleomycin or > three cycles of vincristine, respectively. After a median follow-up of 59 and 67 months for progression-free survival (PFS) and overall survival (OS), respectively, there was no significant difference in PFS or OS in patients receiving ≤ or > four cycles of bleomycin (5-year PFS difference, 1.7%; 95% CI, -4.2% to 7.6%; 5-year OS difference, 1.5%; 95% CI, -2.6% to 5.5%). Similarly, there was no significant difference in patients receiving ≤ or > three cycles of vincristine (5-year PFS difference, -1.3%; 95% CI, -5.6% to 3.1%; 5-year OS difference, -0.1%; 95% CI, -3.1% to 2.9%).
  
  
  CONCLUSIONS
  Bleomycin and vincristine discontinuation because of drug-specific adverse effects does not affect the efficacy of treatment in this setting.
authors.affiliation: All authors: University Hospital of Cologne, Cologne, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Haverkamp
authors.affiliation: All authors: University Hospital of Cologne, Cologne, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Böll
authors.affiliation: All authors: University Hospital of Cologne, Cologne, Germany.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Eichenauer
authors.affiliation: All authors: University Hospital of Cologne, Cologne, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Sasse
authors.affiliation: All authors: University Hospital of Cologne, Cologne, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Fuchs
authors.affiliation: All authors: University Hospital of Cologne, Cologne, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Borchmann
authors.affiliation: All authors: University Hospital of Cologne, Cologne, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Diehl
authors.affiliation: All authors: University Hospital of Cologne, Cologne, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Engert
authors.affiliation: All authors: University Hospital of Cologne, Cologne, Germany. bastian.von-tresckow@uk-koeln.de.
authors.forename: Bastian
authors.initials: B
authors.lastname: von Tresckow
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage* / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006689:Hodgkin Disease / Q000188:drug therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D011344:Procarbazine / Q000008:administration & dosage / Q000009:adverse effects; D012372:ROC Curve; D013997:Time Factors; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D001761:Bleomycin; D011344:Procarbazine; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone