title: Hodgkin lymphoma: an Australian experience of ABVD chemotherapy in the modern era.
abstract: Approximately 560 new cases of Hodgkin lymphoma (HL) are diagnosed annually in Australia. Standard first-line therapy is ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine). It is unknown how survival outcomes in patients receiving ABVD in current clinical practice, with routine positron emission tomography (PET) imaging and modern supportive measures, compare with results from published trials. This is a retrospective multi-centre study of patients with previously untreated HL between November 1999 and December 2014 receiving ABVD induction. Baseline characteristics, treatment details, toxicity and outcome data were collected from hospital records. The primary endpoint was overall survival (OS). Secondary endpoints included overall response rate (ORR), progression-free survival (PFS), response to treatment and toxicity. One hundred and eighty-nine eligible patients were identified. Median age was 32 years (range 17-79). Nodular-sclerosing HL was the most common subtype (78 %), 44 % had B symptoms and 11 % had marrow involvement. Median number of cycles of ABVD administered was 6 (range 3-8). Eighteen patients (11 %) had dose delay, 21 (13 %) had dose reductions and 11 (8 %) had both. The ORR, defined predominantly by PET scan, was 96 % (CR 89 %). Five-year OS and PFS were 93 and 84 %, respectively in early disease (stage I-IIA) and 89 and 63 % in advanced disease (stage IIB, III and IV). No poor prognostic factors were identified on multivariate testing. The most common grade 3/4 toxicity was neutropenia (53 %). Our study confirms the excellent prognosis and manageable toxicity in HL patients receiving ABVD in phase III studies are reflected in patients treated in routine clinical practice in the modern era.
authors.affiliation: Eastern Health, Monash University Clinical School, Melbourne, Australia.
authors.forename: Azim
authors.initials: A
authors.lastname: Jalali
authors.affiliation: Eastern Health, Monash University Clinical School, Melbourne, Australia.
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Ha
authors.affiliation: Department of Oncology & Clinical Haematology, Olivia Newton-John Cancer & Wellness Centre, Austin Hospital, Melbourne, Australia.|Department of Oncology, Northern Hospital, Melbourne, Australia.
authors.forename: Geoff
authors.initials: G
authors.lastname: Chong
authors.affiliation: Department of Oncology & Clinical Haematology, Olivia Newton-John Cancer & Wellness Centre, Austin Hospital, Melbourne, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Grigg
authors.affiliation: Eastern Health, Monash University Clinical School, Melbourne, Australia.
authors.forename: Joe
authors.initials: J
authors.lastname: Mckendrick
authors.affiliation: Eastern Health, Monash University Clinical School, Melbourne, Australia.|Department of Oncology & Clinical Haematology, Olivia Newton-John Cancer & Wellness Centre, Austin Hospital, Melbourne, Australia.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Schwarer
authors.affiliation: Eastern Health, Monash University Clinical School, Melbourne, Australia.
authors.forename: Rowan
authors.initials: R
authors.lastname: Doig
authors.affiliation: Department of Oncology, Northern Hospital, Melbourne, Australia.
authors.forename: Anis
authors.initials: A
authors.lastname: Hamid
authors.affiliation: Eastern Health, Monash University Clinical School, Melbourne, Australia. Eliza.Hawkes@onjcri.org.au.|Department of Oncology & Clinical Haematology, Olivia Newton-John Cancer & Wellness Centre, Austin Hospital, Melbourne, Australia. Eliza.Hawkes@onjcri.org.au.
authors.forename: Eliza A
authors.initials: EA
authors.lastname: Hawkes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000453:epidemiology / Q000209:etiology; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000008:administration & dosage / Q000009:adverse effects; D016208:Databases, Factual; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008171:Lung Diseases / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin
keywords: ABVD; Chemotherapy; Hodgkin lymphoma; Survival; Toxicity