ESCALATED BEACOPP FOR ADVANCED STAGE HODGKIN LYMPHOMA

NEW YORK (Reuters Health) Sep 03 - A new, escalated-dose chemotherapy regimen improves long-term freedom from treatment failure and overall survival in patients with advanced-stage Hodgkin's disease, according to a report in the August 24th Journal of Clinical Oncology.

"(This) more efficient regimen should be the standard of care for patients with advanced Hodgkin lymphoma," Dr. Andreas Engert from Universitatsklinik Koln, Germany, told Reuters Health by email.

Dr. Engert and colleagues in the German Hodgkin Study Group evaluated 10-year follow-up results of the HD9 trial, which compared 2 different doses (baseline and escalated) of the bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) chemotherapy regimen in 1196 patients with advanced-stage Hodgkin's lymphoma.

Complete remission occurred at a higher frequency with BEACOPP escalated (96%) than with BEACOPP baseline (88%). It was also superior to the 85% achieved with COPP/ABVD (COPP alternated with doxorubicin, bleomycin, vinblastine, and dacarbazine), the authors report.

Freedom from treatment failure at 10 years was significantly higher after BEACOPP escalated (82%) than after BEACOPP baseline (70%) or COPP/ABVD (64%). Results were similar for overall survival at 10 years (86%, 80%, and 75%, respectively).

BEACOPP escalated caused more acute hematologic toxicity (leukopenia, thrombocytopenia, and anemia) and more grade 3/4 infections than did BEACOPP baseline, the researchers note.

The estimated 10-year cumulative incidence of secondary acute myeloid leukemia and myelodysplastic syndrome was significantly higher after BEACOPP escalated (3.2%) than after BEACOPP baseline (2.2%).

"(BEACOPP escalated) is somewhat more toxic compared to ABVD," Dr. Engert said. "However, with adequate management (i.e., growth factors, prophylactic antibiotics) and adaptation of the dose level given to patients' individual tolerability, this regimen is safe also in the outpatient setting."

J Clin Oncol 2009.