Survivorship and Patients Perspective
Sandra Basic-Kinda, Dino Dujmovic, Ivo Radman, Martina Moric Peric, Ida Hude, Nadira Durakovic, Marijo Vodanovic, Margareta Dobrenic, Marko Kralik, Lea Galunic-Bilic, Snjezana Dotlic, Igor Aurer
University Hospital Centre Zagreb, Medical School, University of Zagreb, Zadar General Hospital, Croatia
We started using eBEACOPP for front-line treatment of cHL patients 15 years ago; first within clinical trials, then in high-risk patients with advanced disease and finally in all younger than 60 except those with limited stage and favorable prognosis. Here we describe our experience.
We treated 112 patients, 19–69 years old (median 29). Median follow-up is 40 months. 5-year PFS is 94% and OS 97%.
All patients were treated in an outpatient setting, with regular check-ups or telephone contacts at least twice weekly. Toxicity during therapy was significant, 50% patients were hospitalized, mostly for infectious complications. Granulocytopenia gr. 4 occurred in 94%, anemia gr. 3–4 in 67% and trombocytopenia gr. 3–4 in 61% of patients. Non-hematological, non-infectious toxicity was rare; 12% had neuropathy, most recovered. 2 patients developed allergy to etoposide. 3 patients died of toxicity; 2 of infection, both failed to report early symptoms. The third died suddenly at home, probably due to pulmonary embolism. All remaining patients responded to therapy; 3 relapsed. 2 of the relapses occurred in areas that could have been irradiated. The 3rd was PET negative after 2 cycles of eBEACOPP, so treatment was stopped after the 4th.
Slightly more than 50% of women resumed spontaneous menstrual cycles. Other late toxicities were rare. Avascular hip necrosis decreased significantly after we stopped using methlyprednisolone and reduced the number of days on steroids to 8 per cycle. A single patient developed secondary cancer, acute myeloid leukemia. 2 patients have symptomatic heart disease, both were older than 60 at time of treatment and had mediastinal irradiation.
In conclusion, eBEACOPP is a very effective and feasible outpatient regimen for front-line treatment of patients with cHL younger than 60 provided it is delivered by a dedicated and experienced team. Acute toxicity is almost universal; in order to avoid unnecessary deaths patients must be disciplined and have fast access to adequate medical care. Treatment reductions should only be performed after careful considerations. In patients interested in preserving fertility sperm cryopreservation should be offered to men and GnRH analogues to women. Other late toxicities are rare, and most cHL survivors treated with eBEACOPP are able to return to a normal and productive life.