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Review
. 2020 Sep;9(18):6565-6575.
doi: 10.1002/cam4.3298. Epub 2020 Jul 25.

Long-term overall survival and toxicities of ABVD vs BEACOPP in advanced Hodgkin lymphoma: A pooled analysis of four randomized trials

Marc P E André  1 , Patrice Carde  2 , Simonetta Viviani  3   4 , Monica Bellei  5 , Catherine Fortpied  6 , Martin Hutchings  7 , Alessandro M Gianni  3   4 , Pauline Brice  8 , Olivier Casasnovas  9 , Paolo G Gobbi  10 , Pier Luigi Zinzani  11 , Jehan Dupuis  12 , Emilio Iannitto  13 , Alessandro Rambaldi  14 , Josette Brière  8 , Laurianne Clément-Filliatre  15 , Marian Heczko  16 , Pinuccia Valagussa  3   4 , Jonathan Douxfils  17 , Julien Depaus  1 , Massimo Federico  18 , Nicolas Mounier  19
Affiliations
Review

Long-term overall survival and toxicities of ABVD vs BEACOPP in advanced Hodgkin lymphoma: A pooled analysis of four randomized trials

Marc P E André et al. Cancer Med. 2020 Sep.

Abstract

Purpose: We explored the potential overall survival (OS) benefit of bleomycin, etoposide, doxorubicin (Adriamycin), cyclophosphamide, vincristine (Oncovin), procarbazine, and prednisone (BEACOPP) over doxorubicin (Adriamycin), bleomycin, vinblastine, and dacarbazine (ABVD) in a pooled analysis of four randomized trials.

Patients and methods: Primary objective was to evaluate the OS impact of BEACOPP using individual patient data. Secondary objectives were progression-free survival (PFS), secondary cancers, and use of autologous stem cell transplantation (ASCT).

Results: About 1227 patients were included. The 7-year OS was 84.3% (95% CI 80.8-87.2) for ABVD vs 87.7% (95% CI 84.5-90.2) for BEACOPP. Two follow-up periods were identified based on survival curves and hazard ratio (HR) over time. For the first 18 months, there was no difference. For the second period of ≥18 months, ABVD patients had a higher death risk (HRABVD vs BEACOPP = 1.59; 95% CI 1.09-2.33). A Cox model stratified by trial and evaluating the effect of treatment and International Prognostic Index (IPI) score as fixed effects showed that both were statistically significant (treatment, P = .0185; IPI score, P = .0107). The 7-year PFS was 71.1% (95% CI 67.1-74.6) for ABVD vs 81.1% (95% CI 77.5-84.2) for BEACOPP (P < .001). After ABVD, 25 secondary cancers (4.0%) were reported with no myelodysplasia (MDS)/acute myeloid leukemia (AML) compared to 36 (6.5%) after BEACOPP, which included 13 patients with MDS/AML. Following ABVD, 86 patients (13.8%) received ASCT vs 39 (6.4%) for BEACOPP.

Conclusions: This analysis showed a slight improvement in OS for BEACOPP and confirmed a PFS benefit. Frontline use of BEACOPP instead of ABVD increased secondary leukemia incidence but halved the requirement for ASCT.

Keywords: ABVD; BEACOPP; Hodgkin lymphoma; overall survival; progression-free survival; secondary cancers.

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Conflict of interest statement

The authors do not have any relevant conflict of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Kaplan‐Meier curve for overall survival of all patients included in the four studies comparing ABVD and BEACOPP. ABVD, doxorubicin, bleomycin, vinblastine, and dacarbazine; BEACOPP, bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone
FIGURE 2
FIGURE 2
Kaplan‐Meier curve for progression‐free survival of all patients included in the four studies comparing ABVD and BEACOPP. ABVD, doxorubicin, bleomycin, vinblastine, and dacarbazine; BEACOPP, bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone
See this image and copyright information in PMC

References

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