Abstract
Abstract 1564
Therapy of Hodgkin lymphoma (HL) is designed to prolong survival and minimize toxicity; however, an intense debate is ongoing over whether ABVD or BEACOPP should be used upfront and whether a long-term survival benefit is obtained with the BEACOPP regimen. The current study was aimed to personalize therapy based on individual risk factors and interim scintigraphy. Design and Methods: 124 patients with newly diagnosed HL and adverse prognostic factors were prospectively studied between 7/1999 and 8/2005. Patients with early unfavorable and advanced disease were eligible for the study. Study participants were assigned to therapy based on their International Prognostic Score (IPS). Those with an IPS of ≥3 were assigned to 2 cycles of escalated BEACOPP (EB). All others received 2 cycles of standard BEACOPP (SB). Subsequent therapy was prospectively allocated according to the results of early interim GA67 or PET/CT. Four cycles of EB or SB were administered following a positive or negative scan, respectively. Results: Complete remission (CR) rate, 10-year progression free (PFS) and overall survival (OS) were 97%, 87% and 88%, respectively, at a median follow-up of 89 months (5–144). Only 38% of patients, mostly with a bulky mediastinal mass, received radiation therapy. PFS and OS were similar in both groups. Predictive value of negative interim Ga67 or PET/CT was 87% and 93%, respectively. Fertility status was assessed in 38 females aged <40 years (Table). Twenty four of these patients received 6 cycles of SB, 8 patients had 2 cycles of EB and 4 cycles of SB, 3 patients were treated with 2 cycles of SB and 4 cycles of EB and one patient received 6 cycles of EB. Thirty six females did not have disease progression and 34 of them were found to preserve their cyclic ovarian function (COF). Twenty six females were co-treated with 6 cycles of GNRH agonist triptorelin (Decapeptyl 3.75 mg) for 6 months. 19 patients conceived during the follow-up (30 pregnancies), delivering 23 babies. Deliveries were reported for up to seven years from diagnosis. Notably, the female receiving 6 cycles of EB, co-administered with the GNRH agonist, was among those who conceived and delivered a healthy baby. Conclusion: Six cycles of tailored BEACOPP administered to HL patients with adverse prognostic factors provide encouraging long-term PFS and OS, and fertility is preserved in most females following reduction in the number of chemotherapy cycles and GNRH agonist co-administration.
Total . | Pts with preserved cyclic ovarian function . | PPD . | Ovarian failure . | Pregnancies . | Pregnant women . | Newborns . |
---|---|---|---|---|---|---|
38 | 34 (89%) | 2 | 2 | 30 | 19 | 23 |
with GNRH agonist, n=26 | 23 (92%) | 2 | 23 | 14 | 18 | |
without GNRH agonist, n=12 | 11 (92%) | 7 | 5 | 5 |
Total . | Pts with preserved cyclic ovarian function . | PPD . | Ovarian failure . | Pregnancies . | Pregnant women . | Newborns . |
---|---|---|---|---|---|---|
38 | 34 (89%) | 2 | 2 | 30 | 19 | 23 |
with GNRH agonist, n=26 | 23 (92%) | 2 | 23 | 14 | 18 | |
without GNRH agonist, n=12 | 11 (92%) | 7 | 5 | 5 |
Off Label Use: GNRH agonist triptorelin was simultaneously administered for fertility preservation.
Author notes
Asterisk with author names denotes non-ASH members.
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