Escalated beacopp x 2 + abvd x 4 is superior to abvd x 6 in advance stage classical hodgkin lymphoma: experience in a tertiary center

Introduction: Classical Hodgkin lymphoma (cHL) is a curable disease but results in advanced stages are suboptimal when treated with standard treatment ABVD with 10%–15% of primary refractoriness and 30% of relapses, although 5 years overall survival (OS) around 88%–90%. First-line treatment with more intensive schemes such as escalated BEACOPP has improved progression-free survival (PFS) in these patients, although associating greater toxicity. However, escalated BEACOPP did not improve OS when compared to ABVD due to the efficacy of rescue treatments, but assuming a high toxic cost. We present our experience to optimize first-line treatment in advanced cHL. Methods: We retrospectively analyzed patients with advanced stage cHL (IIB-IV) treated with curative intent in our center between December 2008 and December 2022 (Table 1). In the period 2008–2011, patients were treated with ABVD x 6. During the period 2011–2022, we implemented a strategy intermediate PET guided (PET2) after escalated BEACOPP (x 2). With PET2 negative, we continued with ABVD/AVD x 4; in PET2 positive patients we continued with escalated BEACOPP x 4. Both groups received radiotherapy on bulky masses. We evaluate the efficacy of this strategy by comparing results and toxicity in the two study periods. Results: In the 2008–11 period, 21 patients received standard treatment with ABVD and during the 2011–22 period, 60 the intensified one (S). In PET2, 55 (91.6%) of patients in the intensified group achieved CR and 5 (8.4%) PR versus 5 (23.8%) CR, 14 (66.7%) PR and 2 (9.52%) refractory patients in the ABVD group. At the end of treatment, 58 patients (96.6%) achieved CR in the intensified treatment group and 15 (71.4%) in the ABVD group. There where 4 (19%) refractory patients in ABVD group versus 2 (3.3%) in the intensified group. PFS for the intensified treatment group was 90.8% at 5 years versus 57.1% for the ABVD group (p = 0.00025). OS for the intensified treatment group was 98.1% versus 85.7% for the ABVD group at 5 years (p = 0.01). The incidence of admissions for febrile neutropenia tended to be higher in the intensified group (15% vs. 4.76%, p = 0.44) and no significant differences were observed in the incidence of secondary malignancies or infertility. There were no toxic deaths in any group. Keywords: Hodkin lymphoma, PET-CT No conflicts of interests pertinent to the abstract.