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Blood, Vol. 92 No. 12 (December 15), 1998:
pp. 4560-4567
Moderate Dose Escalation for Advanced Stage Hodgkin's Disease
Using the Bleomycin, Etoposide, Adriamycin, Cyclophosphamide,
Vincristine, Procarbazine, and Prednisone Scheme and Adjuvant
Radiotherapy: A Study of the German Hodgkin's Lymphoma Study Group
H. Tesch,
V. Diehl,
B. Lathan,
D. Hasenclever,
M. Sieber,
U. Rüffer,
A. Engert,
J. Franklin,
M. Pfreundschuh,
K.P. Schalk,
G. Schwieder,
G. Wulf,
G. Dölken,
P. Worst,
P. Koch,
N. Schmitz,
U. Bruntsch,
C. Tirier,
U. Müller, and
M. Loeffler for the German Hodgkin's Lymphoma Study Group (Chairman Prof V. Diehl)
From the Klinik I für Innere Medizin, Universität
Köln, Köln, Germany; the Institute for Medical Informatics,
Leipzig, Germany; Med. Klinik Homburg, Stuttgart, Germany;
Lübeck, Germany; Göttingen, Germany; Freiburg, Germany;
Mannheim, Germany; Münster, Germany; Kiel, Germany;
Nürnberg, Germany; Essen-Werden, Germany; and München re.
d. Isar, Germany.
The BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide,
vincristine, procarbazine, and prednisone) regimen, a rearranged and
accelerated version of the standard COPP/adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy, has been
shown to be effective and safe in a previous pilot study for advanced stage Hodgkin's disease (HD). The present study aimed to determine a
maximum practicable dose of three drugs, ie, etoposide, adriamycin, and
cyclophosphamide, for which acute toxicities were acceptable and to
assess the feasibility of the escalated scheme. Sixty untreated patients with advanced stage HD were enrolled in this study.
Radiotherapy was given in 44 patients (73%) after chemotherapy to
initial bulk lesions and residual disease. Granulocyte-colony
stimulating factor (G-CSF) was given from day 8 to prevent prolonged
neutrocytopenia and severe infections. The intended doses of
adriamycin, etoposide, and cyclophosphamide in the BEACOPP schedule
could be substantially escalated: adriamycin from 25 to 35, cyclophosphamide from 650 to 1,200, and etoposide from 100 to 200 mg/m2. The major toxicities were leukocytopenia and
thrombocytopenia with considerable heterogeneity between individual
patients. Of 60 patients, 56 (93%) achieved a complete remission (CR).
At a median observation of 32 months, the rates of survival and freedom from treatment failure (FFTF) were estimated to be 91% (95%
confidence interval 83% to 99%) and 90% (82% to 98%). These
results show that a moderate dose escalation of adriamycin,
cyclophosphamide, and etoposide of the baseline BEACOPP regimen is
feasible. The escalated BEACOPP regimen shows very encouraging results
in advanced stage HD and is now being compared in a randomized phase
III study with BEACOPP at baseline dose level.
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