Phase 2 study of rituximab-ABVD in classical Hodgkin lymphoma

Abstract

In classical Hodgkin lymphoma, circulating clonotypic malignant cells express CD20, which potentially explains the observed activity of rituximab. This multicenter phase 2 study investigated the combination of rituximab-ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) for stage II-IV untreated classical Hodgkin lymphoma. A goal was to assess the behavior of circulating clonotypic B cells clinically. Of 49 evaluable patients, 69% had stage IIB-IV disease; 8% had CD20(+) Hodgkin and Reed-Sternberg cells. Rituximab-ABVD was generally well tolerated. Delivered relative dose intensity was 94% for AVD and 79% for bleomycin. After 6 cycles, 81% of patients were in complete remission. Only 8% received radiation therapy. The actuarial 3-year event-free and overall survival rates were 83% and 98%, respectively. EBV copy number in plasma fell dramatically during cycle 1 in patients with EBV(+) tumors. Persistence of detectable circulating clonotypic B cells was associated with a greater relapse frequency (P < .05). Rituximab-ABVD and clonotypic B cells warrant additional study in classical Hodgkin lymphoma.

Trial registration: ClinicalTrials.gov NCT00369681.

Figure 1

Survival outcomes with rituximab-ABVD in classical Hodgkin lymphoma. (A) EFS and overall survival after treatment initiation, estimated by the Kaplan-Meier method. An event is defined as relapse, progression, or death. (B) EFS in patients with early unfavorable or advanced disease. (C) EFS according to the International Prognostic Score (IPS) in patients with advanced disease. (D) EFS according to the interim PET result.