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, Patrice Carde, Simonetta Viviani, Monica Bellei, Catherine Fortpied, Martin Hutchings, Alessandro M Gianni, Pauline Brice, Olivier Casasnovas, Paolo G Gobbi, Pier Luigi Zinzani, Jehan Dupuis, Emilio Iannitto, Alessandro Rambaldi, Josette Brière, Laurianne Clément-Filliatre, Marian Heczko, Pinuccia Valagussa, Jonathan Douxfils, Julien DepausMassimo Federico, Nicolas Mounier

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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 (HR ABVD 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.

langue originaleAnglais
Pages (de - à)6565-6575
Nombre de pages11
journalCancer medicine
Volume9
Numéro de publication18
Les DOIs
Etat de la publicationPublié - 1 sept. 2020

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    André, M. P. E., Carde, P., Viviani, S., Bellei, M., Fortpied, C., Hutchings, M., Gianni, A. M., Brice, P., Casasnovas, O., Gobbi, P. G., Zinzani, P. L., Dupuis, J., Iannitto, E., Rambaldi, A., Brière, J., Clément-Filliatre, L., Heczko, M., Valagussa, P., Douxfils, J., ... Mounier, N. (2020). Long-term overall survival and toxicities of ABVD vs BEACOPP in advanced Hodgkin lymphoma: A pooled analysis of four randomized trials. Cancer medicine, 9(18), 6565-6575. https://doi.org/10.1002/cam4.3298