engleski

The switch from ABVD to eBEACOPP as front-line therapy for high-risk patients stage III-IV Hodgkin lymphoma (CHL) patients results in an inversion of event-free survival (EFS) of prognostic groups

When ABVD is used as the chemotherapy backbone for newly diagnosed cHL, patients with favorable stage I-II (EF), unfavorable stage III (EU), favorable stage III-IV (Hasenclever index 0-2) (AF) and unfavorable stage III-IV (Hasenclever index ≥3) (AU) differ in EFS with the latter having the worst prognosis. GHLSG has reported that the introduction of eBEACOPP-based chemotherapy for EU and advanced stage groups annuls this difference. To our knowledge, no other group has reproduced these findings. Since 2010, after the end of accrual into the EORTC 20012 trial, we recommend eBEACOPP as front-line therapy for AU. During 2014/5 this recommendation was extended to AF and EU patients. Here we analyze the outcome of different prognostic groups of newly diagnosed cHL patients below 60 years of age treated at our institution during the period of almost 5 years when eBEACOPP was used as initial treatment only for AU patients. There were 13 patients in the EF group, one was treated with ABVD only, one with radiotherapy (RT) only, and 11 with the combination of ABVD and RT. None relapsed or died. 38 patients were in the EU group. All started ABVD, two switched to eBEACOPP because of interim PET positivity ; 33 received RT and five chemotherapy only. Two progressed immediately after RT, additional 8 relapsed, 2 died. EFS at three years was 72% and OS 97%. 20 patients were in the AF group. All received ABVD, three switched to eBEACOPP because of interim PET positivity ; four received additional RT. Two patients died, one due to sepsis after switching to eBEACOPP and one, treated with ABVD, due to bleomycin-related pneumonitis ; additional two relapsed. EFS at three years was 79% and OS 90%. 34 patients were in the AU group. 30 started treatment with eBEACOPP and 4 with ABVD, one switched to eBEACOPP because of interim PET positivity ; 10 received additional RT. One patient died during treatment, presumably due to pulmonary embolism ; one relapsed. EFS at three years was 94% and OS 97%. The difference in EFS between EU and AF is statistically significant (p=0.023) (Figure 1). If eBEACOPP is used for front-line treatment only in patients with high-risk advanced stage disease, this results in paradoxical inversion of EFS between prognostic groups. eBEACOPP should be considered for all newly diagnosed HL patients younger than 60, except those in the lowest risk group.

ABVD, eBEACOPP, Hodgkin lymphoma

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