Analysis of dose-intensified combined modality treatment in patients with early unfavourable Hodgkin lymphoma
The German Hodgkin Study Group (GHSG) has been performing clinical trials for patients with Hodgkin lymphoma (HL) for 30 years, reported Prof. Peter Borchmann at the European Haematology Association Congress. Nearly 15000 patients have been randomised and treated in prospectively randomised trials. Patients with HL are divided in three risk groups according to the initial staging and additional clinical risk factors: early favourable, early unfavourable and advanced-stage risk groups.
The rationale for the GHSG HD14 trial was to improve the prognosis of patients with early unfavourable disease. Thus, the HD14 trial compared the old standard treatment (4 courses of ABVD followed by localised radiotherapy) with a more intensive regimen consisting of 2 courses of BEACOPP escalated followed by 2 courses of ABVD and the same radiotherapy as in the standard arm.
A total of 1645 patients from 346 centres were included in the trial. The third interim analysis with 1127 patients lead to the termination of this study because of the significantly better outcome for patients treated with BEACOPP and ABVD. The progression free survival (PFS) was significantly better than for patients treated with 4 courses of ABVD (97 per cent versus 91 per cent at 3 years).
Overall, there were more patients with progressive disease, relapse and a higher mortality in those receiving 4 cycles of ABVD. Thus, 2 x BEACOPP escalated followed by 2 x ABVD plus 30 Gy radiotherapy is the new standard treatment for patients with early unfavourable HL within the GHSG.
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