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Hodgkin Lymphoma
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Dennis A. Eichenauer, Andreas Engert
The GHSG HD15 study investigated whether consolidation RT can be restricted to larger (≥2.5 cm) PET-positive residual lymphoma. In addition, the study compared three chemotherapy approaches, i.e. eight cycles of escalated BEACOPP, six cycles of escalated BEACOPP, and eight cycles of a time-dense variant of BEACOPPbaseline termed BEACOPP-14. According to the final analysis of the trial, patients are sufficiently treated with 6 cycles of escalated BEACOPP and RT can be safely restricted to PET-positive residual lymphoma ≥2.5 cm.18,19 The HD18 study then evaluated treatment reduction to a total of four cycles of escalated BEACOPP if a complete metabolic response was achieved after two cycles of chemotherapy. The 5-year PFS rates were similar for patients receiving standard treatment consisting of six or eight cycles of BEACOPPescalated and those treated with four cycles of BEACOPPescalated (90.8% vs. 92.2%) (Figure 29.2). Thus, four cycles of escalated BEACOPP were adopted as standard of care for patients achieving an early metabolic response according to interim PET/CT within the GHSG. In patients with a positive interim PET/CT after two cycles of escalated BEACOPP, the addition of rituximab in the subsequent chemotherapy cycles did not result in improved outcomes.20,21
Hodgkin Lymphoma
Published in Dongyou Liu, Tumors and Cancers, 2017
The key adverse effect of MOPP- or BEACOPP-containing regimens is infertility, although ABVD appears to spare long-term testicular and ovarian function. Complications related to radiotherapy include hypothyroidism, cardiac disease, and impairment of pulmonary function.
Specific Therapy for Lymphomas
Published in Tariq I Mughal, John M Goldman, Sabena T Mughal, Understanding Leukemias, Lymphomas, and Myelomas, 2017
Tariq I Mughal, John M Goldman, Sabena T Mughal
Many efforts are currently devoted to improving on the results achieved by treatment with ABVD, which of course has been a significant advance from the historical treatment with MOPP. Newer combinations such as the seven-drug combination known as Stanford V (mechlorethamine, daunorubicin, vinblastine, vincristine, bleomycin, etoposide, and prednisolone), developed at Stanford, California, USA, and the BEACOPP regimen (bleomycin, etoposide, daunorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), developed by the German Hodgkin Lymphoma Study Group (GHLSG), have resulted in better results, particularly in high-risk patients, and further studies are in progress. Current studies carried out by GHLSG, comparing ABVD with BEACOPP suggest a better outcome with the latter, but there have been concerns about an increased risk of treatment-related (secondary) leukemia, and further studies are in progress.
Nodular lymphocyte-predominant Hodgkin lymphoma: current management strategies and evolving approaches to individualize treatment
Published in Expert Review of Hematology, 2023
Dennis A. Eichenauer, Sylvia Hartmann
An analysis using the British Columbia Cancer Agency (BCCA) database retrospectively evaluated ABVD and ABVD-like protocols in advanced NLPHL. A total of 42 patients were included. The 10-year lymphoma recurrence rate with either NLPHL histology or histological transformation into aggressive B-NHL was roughly 40%. The 10-year OS was 83.5% [37]. Treatment with escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) and other BEACOPP variants resulted in a better disease control. An analysis including 144 patients with advanced NLPHL who had treatment within the randomized GHSG HD9, HD12 and HD15 studies indicated 10-year PFS and OS rates of 69.8% and 87.4%, respectively. Histological transformation into aggressive B-NHL occurred in only 1.4% of patients and was thus less frequent than in patients treated with ABVD and ABVD-like protocols [15]. However, the excellent lymphoma-specific outcomes with BEACOPP chemotherapy have to be balanced against the increased acute and possibly also long-term toxicity associated with this intensive protocol.
Cardiac conduction system exposure with modern radiotherapy techniques for mediastinal Hodgkin lymphoma irradiation
Published in Acta Oncologica, 2022
Pierre Loap, Alfredo Mirandola, Ludovic De Marzi, Viviana Vitolo, Amelia Barcellini, Alberto Iannalfi, Rémi Dendale, Youlia Kirova, Ester Orlandi
This retrospective observational study included patients treated at the Institut Curie (Paris, France) for localized unfavorable mediastinal HL with standard first line chemotherapy regimens (ABVD or BEACOPP) and subsequent consolidation irradiation with involved-site DIBH-VMAT, according to ILROG recommendations [8]. Radiotherapy records from thirty patients treated between January 2018 and May 2020 were selected from the institutional database by random sampling and anonymized. Median age of included patients was 30 years, 17 patients were women, and ECOG performance status ranged between 0 and 2. While all patients had intermediate stage HL according to EORTC criteria, eight patients initially presented with bulky disease. All patients had mediastinal disease, which was localized in the lower mediastinum (i.e., below the take-off of the left main stem coronary artery [12]) for 22 patients (73.3%) and limited to the upper mediastinum for eight patients (26.7%); 15 patients (50.0%) had additional neck targets and two patients (6.7%) axillary targets. ABVD regimen was delivered to 27 patients and the three other patients received BEACOPP chemotherapy. All patients received a consolidative dose of 30 Gy according to ESMO guidelines.
Efficacy and safety of front-line treatments for advanced Hodgkin lymphoma: a systematic literature review
Published in Expert Review of Hematology, 2020
Mehul Dalal, Jatin Gupta, Kim Price, Athanasios Zomas, Harry Miao, Ajibade Ashaye
Although ABVD and BEACOPP are efficacious treatment options for advanced-stage HL, both are associated with several tolerability issues and short- and long-term side effects. The Skoetz review found that use of BEACOPP resulted in a statistically significant increase in incidence of AML and MDS (p = 0.02), and BEACOPPESC in an increase in Grade 3/4 hematological events compared with ABVD [6]. This was also true in the additional studies found in our review. Elderly patients treated with BEACOPPBASE had higher rates of Grade 4 acute toxicity vs ABVD/COPP [21]. Mounier et al., 2014 showed higher rates of anemia and leukopenia in the BEACOPP4+4 treatment group vs ABVD [46]. Chemotherapy-induced neutropenia is another common side-effect of HL treatment, and can result in dose-modifications or treatment delays [35,128]. One study reported neutropenia in 90% of patients treated with BEACOPP4+4 [84]. This compares with results from the Skoetz meta-analysis, in which patients treated with BEACOPPESC vs ABVD had a statistically significant increase in neutropenia (p < 0.0001) [6]. Risk of neutropenia can be managed using G-CSF [125], which in our review ranged from use as primary prophylaxis [19] and use with certain treatments such as BEACOPPESC [84], to secondary prophylaxis for patients with severe neutropenia [39]. ABVD and BEACOPP may also be associated with side effects not identified in this review. For example, alkylating agents in the BEACOPP regimen can affect fertility [129].