A. Roque1,2, C. Afonso1, D. Neves1, A. Pinto1, D. Mota1,2, R. Guilherme1,2, M. Gomes1, L. Ribeiro1
1 Clinical Haematology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, 2 Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Background: The majority of the patients (pts) with classical Hodgkin lymphoma (cHL) can be cured, even in advanced stages. However, the best first-line treatment regimens are still on the debate, and despite recent evidence from clinical trials comparing ABVD vs BEACOPP escalated (BEACOPPesc), data from real life are scarce.
Aims: To compare the outcome and complications of first-line chemotherapy with ABVD (6–8 cycles) vs BEACOPPesc (6 cycles) in the treatment of advanced stage cHL.
Methods: We perform a retrospective analysis of cHL adult pts treated in our institution, between 2008 and 2017; only advanced stages (GHSG criteria), who received a first-line treatment according to ABVD or BEACOPPesc, were included.
Results: We analysed 71 pts, mainly female (56.3%), with a median age at diagnosis of 32 years (18–60). The most prevalent histological subtype was nodular sclerosis (80.3%). Ann Arbor stage IV was observed in 56.3% (n = 40) pts, B symptoms in 49.3% (n = 35), bulky disease in 42.3% (n = 30), mediastinal mass>1/3 in 8.5% (n = 6) and extra-nodal involvement in 26.8% (n = 19). In this cohort, 39.4% (n = 28) of pts had an IPS≥3. All factors were balanced between the two arms.
ABVD was performed in 34 (47.9%) pts and BEACOPPesc in 37 (52.1%).
Overall response rate (ORR) was 87.3% (80.6% of complete responses), with no difference between the two arms (82.4% vs 91.9%; p = NS).
For a median follow-up of 40.9 (0.3–119) months, progression-free survival (PFS) at 5 years was 74.9% (95%CI 61.9–84.0), with 66.9% and 82.9% in ABVD and BEACOPPesc arms, respectively. BEACOPPesc resulted in a higher PFS (HR = 0.16; p = 0.047; 95%CI 1.10–1.17).
Overall survival (OS) at 5 years was 91.0% (95%CI 74.4–97.0) – 92.7% in ABVD and 91.0% in BEACOPPesc – with no difference between the two arms (HR = 1.43; p = 0.638; 95%CI 0.32–6.43).
The incidence of haematological toxicities and infection (grade≥2, according to CTCAE v5.0) between two arms was similar. There was no difference in the proportion of patients that had needed treatment adjustment due to toxicities (14.7 vs 18.9%) between ABVD and BEACOPPesc arms.
Conclusion: In our cohort, we did not verify significant differences in OS between ABVD and BEACOPPesc in cHL pts, probably due to a short follow-up time. However, BEACOPPesc arm had a better PFS, with comparable toxicities, making it a promising regimen for advanced stage cHL pts.