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Blood, 1 February 2007, Vol. 109, No. 3, pp. 905-909.
Prepublished online as a Blood First Edition Paper on October 3, 2006; DOI 10.1182/blood-2006-04-019901.
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CLINICAL TRIALS AND OBSERVATIONS
Risk-adapted BEACOPP regimen can reduce the cumulative dose of chemotherapy for standard and high-risk Hodgkin lymphoma with no impairment of outcome
Eldad J. Dann1,4,
Rachel Bar-Shalom1,4,
Ada Tamir4,
Nissim Haim1,4,
Menachem Ben-Shachar1,
Irit Avivi1,4,
Tzila Zuckerman1,
Mark Kirschbaum2,
Odelia Goor2,
Diana Libster3,
Jacob M. Rowe1,4, and
Ron Epelbaum1,4
From the1 Department of Hematology and Bone Marrow Transplantation, Department of Oncology and Department of Nuclear Medicine, Rambam Medical Center, Haifa, Israel;
2 Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel;
3 Hematology Unit, Hadassah Mount Scopus Hospital, Jerusalem, Israel; and
4 Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
Therapy of Hodgkin disease (HD) is designed to prolong progression-free survival and minimize toxicity. The best regimen to achieve this has not yet been defined. A total of 108 patients with newly diagnosed HD and adverse prognostic factors were prospectively studied between 1999 and 2004. They were assigned to therapy according to defined risk stratification. Patients were defined depending on the International Prognostic Score (IPS). Those with IPS of 3 or higher received 2 cycles of escalated therapy, including bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP [EB]). All others received 2 cycles of standard BEACOPP (SB). Subsequent therapy was prospectively assigned following 2 cycles according to results of early interim 67Ga or positron emission tomography/computed tomography (PET/CT). Following a positive interim scan, 4 cycles of EB were administered, whereas 4 cycles of SB were given to patients with a negative scan. The complete remission rate, the 5-year event-free survival (EFS), and overall survival (OS) rates were 97%, 85% and 90%, respectively. Relapse or progression occurred in 27% of patients with interim positive PET/CT versus 2.3% of negative scans (P < .02). Early interim fluorine-18 2-fluoro-2-deoxy-D-glucose (FDG)–PET/CT is a useful tool for adjustment of chemotherapy on an individual basis. Similar EFS and OS rates were observed for patients in both risk groups.
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