Annals of Oncology Advance Access published online on July 16, 2009
Annals of Oncology, doi:10.1093/annonc/mdp271
Two cycles of escalated BEACOPP followed by four cycles of ABVD utilizing early-interim PET/CT scan is an effective regimen for advanced high-risk Hodgkin's lymphoma
1 Department of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer and Sackler School of Medicine, Tel Aviv University, Tel Aviv
2 Department of Hematology, Laniado Hospital, Netanya
3 Department of Hematology, Soroka Medical Center, Beer-Sheva
4 Department of Hematology and Bone Marrow Transplantation, Rambam Medical Center, Haifa
5 Department of Hematology, Hadassah University Hospital, Jerusalem, Israel
* Correspondence to: Dr A. Avigdor, Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel. Tel: +972-3-5302588; Fax: +972-3-5305343; E-mail: abraham.avigdor{at}sheba.health.gov.il
Background: Escalated combination therapy with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone (escBEACOPP) regimen is superior to cyclophosphamide, vincristine, procarbazine and prednisone alternating with doxorubicin, bleomycin, vinblastine and dacarbazine (COPP–ABVD) for advanced-stage Hodgkin's lymphoma (HL) patients. However, the original schedule of eight cycles of escBEACOPP was associated with significant toxicity. This study was conducted in an attempt to reduce the toxicity of the original schedule, while attempting to preserve improved initial tumor control.
Patients and methods: Forty-five newly diagnosed patients with advanced-stage HL and International Prognostic Score 
3 received two initial cycles of escBEACOPP and then were evaluated by positron emission tomography (PET)/computed tomography scan. If a good imaging response was obtained, they were treated by four cycles of ABVD.
Results: Following the first two cycles of escBEACOPP, the overall response was 100% and at the end of all therapy, 40 (89%) patients were in complete response (disappearance of all clinical evidence of disease and PET negativity), three (7%) in partial response (PET-positive residual lesions and a size reduction of the majority of large masses by >50%), while two (4%) had progressive disease. After a median follow-up of 48 months, progression-free survival (PFS) and overall survival at 4 years were 78% and 95%, respectively. The 4-year PFS for early PET-negative patients (n = 31) and early PET-positive patients (n = 13) were 87% and 53%, respectively (P = 0.01).
Conclusions: These data indicate that combined escBEACOPP–ABVD may improve the outcome in patients with high-risk advanced HL. The potential benefit of early-interim PET activity as a guide to continuing therapy in these patients merits further study in the future.
chemotherapy, Hodgkin's lymphoma, PET/CT scan
Received for publication November 22, 2008. Revision received April 10, 2009. Accepted for publication April 15, 2009.