Long-Term Results of PET-Adapted Therapy for Advanced Hodgkin Lymphoma


Key Points

  • Intensification with escalated BEACOPP after positive PET2 was associated with good outcomes.
  • No significant difference in outcome was observed with the addition of rituximab to BEACOPP.

As reported by Gallamini et al in the Journal of Clinical Oncology, the Italian GITIL/FIL HD 0607 trial has shown good long-term outcomes with the switch from ABVD (doxorubicin, vinblastine, vincristine, and dacarbazine) to escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) after positive interim positron emission tomography (PET) findings in patients with advanced Hodgkin lymphoma.

Study Details

In the trial, 782 patients with stage IIB to IVB disease from 25 Italian centers and 1 Israeli center were enrolled between June 2008 and June 2014. Patients underwent PET/computed tomography (PET2) after two cycles of ABVD. Patients with positive PET2 were randomized to four cycles of escalated BEACOPP followed by four cycles of standard BEACOPP with or without rituximab (Rituxan). Patients with negative PET2 continued ABVD; those with a large nodal mass at diagnosis (≥ 5 cm) in complete remission with negative PET at the end of chemotherapy were randomized to radiotherapy or no further treatment. The primary endpoint was 3-year progression-free survival (PFS).

Progression-Free Survival

Of the 782 patients, 150 (19%) had a positive PET2 and 630 (81%) a negative PET2. Three-year PFS was 82% among all patients, including 60% among those with positive PET2 vs 87% among those with negative PET2 (P < .001). Three-year PFS among patients with a positive PET2 assigned to BEACOPP was 63% with vs 57% without rituximab (P = .53). Among 296 patients with negative interim and post-ABVD PET who had a large nodal mass at diagnosis, 3-year PFS was 97% with vs 93% without radiotherapy (P = .29). Three-year overall survival was 97% among all patients, including 99% among PET2-negative and 89% among PET2-positive patients.

The investigators concluded, “The PET-driven switch from ABVD to escalated BEACOPP is feasible and effective in high-risk patients with advanced-stage [Hodgkin lymphoma].”

The study was supported by Associazione Italiana per la Ricerca sul Cancro, Associazione Italiana Lotta alla Leucemia Sezione di Bergamo, and Cassa di Risparmio di Cuneo.

Alessandro Rambaldi, MD, of Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, is the corresponding author for the Journal of Clinical Oncology article.

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