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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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Submitted April 26, 2006
Accepted September 18, 2006
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 Dann*, Rachel Bar-Shalom, Ada Tamir, Nissim Haim, Menachem Ben-Shachar, Irit Avivi, Tzila Zuckerman, Mark Kirschbaum, Odelia Goor, Diana Libster, Jacob M. Rowe, and Ron Epelbaum
Rambam Medical Center, Israel
Technion, Israel Institute of Technology, Israel
Tel Aviv Sourasky Medical Center, Israel
Hadassah Mount Scopus Hospital, Israel
* Corresponding author; email: e_dann{at}rambam.health.gov.il.
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. 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 received 2 cycles of escalated BEACOPP (EB), including bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone. All others received 2 cycles of standard BEACOPP (SB). Subsequent therapy was prospectively assigned following two cycles according to results of early interim GA67 or 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 (EFS) and overall survival (OS) 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<0.02). Early interim FDG-PET/CT is a useful tool for adjustment of chemotherapy on an individual basis. Similar EFS and OS were observed for patients in both risk groups.
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