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First-line escalated BEACOPP does not hinder stem cell collection and transplantation strategy in patients with relapsed/refractory Hodgkin’s lymphoma

Bone Marrow Transplantation volume 52, pages 310–312 (2017)Cite this article

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Several trials have demonstrated the superiority of escalated BEACOPP over ABVD or other regimens in advanced stage Hodgkin’s lymphoma (HL) in terms of disease control and relapse rate.1, 2, 3, 4, 5, 6 This efficacy comes, however, at the price of increased chemotherapy-related early and late toxicities,7, 8, 9 raising concerns about its long-term benefits. Whether first-line escalated BEACOPP is associated with better long-term overall survival remains a conflicting issue.10, 11 In relapsed/refractory patients, second-line treatment strategy usually relies on high-dose chemotherapy followed by autologous stem cell transplantation (ASCT). Compared with standard dose BEACOPP or ABVD, escalated BEACOPP is an intensive regimen with higher drug dosage (in particular a 100% increase of etoposide) that displays significant bone marrow toxicity and may have deleterious effects on stem cells. The impact BEACOPP may have on stem cell collection and hence on the therapeutic strategy in relapsing patients has not been evaluated.

To answer this question, we conducted a study on patients enrolled in the 20012 Intergroup Randomized Phase III Trial, which compared treatment with four cycles of escalated BEACOPP, followed by four cycles of BEACOPP at the baseline dose with eight cycles of the standard ABVD regimen in patients with high-risk stage III–IV Hodgkin's disease.9 Among the 549 patients enrolled in the trial, we identified, at the time of analysis in 2012, 91 patients (67 in the ABVD arm and 24 in the BEACOPP arm) with a relapsed/refractory HL who had been considered for ASCT. Additional data on stem cell collection, transplantation and engraftment outcome were requested for 75 patients (Belgium, Egypt, France, Hungary, Sweden and The Netherlands). A total of 64 forms were completed and returned.

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References

  1. Borchmann P, Haverkamp H, Diehl V, Cerny T, Markova J, Ho AD et al. Eight cycles of escalated-dose BEACOPP compared with four cycles of escalated-dose BEACOPP followed by four cycles of baseline-dose BEACOPP with or without radiotherapy in patients with advanced-stage Hodgkin's lymphoma: final analysis of the HD12 trial of the German Hodgkin Study Group. J Clin Oncol 2011; 29: 4234–4242.

    Article  CAS  Google Scholar 

  2. Engert A, Diehl V, Franklin J, Lohri A, Dorken B, Ludwig WD et al. Escalated-dose BEACOPP in the treatment of patients with advanced-stage Hodgkin's lymphoma: 10 years of follow-up of the GHSG HD9 study. J Clin Oncol 2009; 27: 4548–4554.

    Article  Google Scholar 

  3. Engert A, Haverkamp H, Kobe C, Markova J, Renner C, Ho A et al. Reduced-intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin's lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial. Lancet 2012; 379: 1791–1799.

    Article  CAS  Google Scholar 

  4. Federico M, Luminari S, Iannitto E, Polimeno G, Marcheselli L, Montanini A et al. ABVD compared with BEACOPP compared with CEC for the initial treatment of patients with advanced Hodgkin's lymphoma: results from the HD2000 Gruppo Italiano per lo Studio dei Linfomi Trial. J Clin Oncol 2009; 27: 805–811.

    Article  Google Scholar 

  5. Mounier N, Brice P, Bologna S, Briere J, Gaillard I, Heczko M et al. ABVD (8 cycles) versus BEACOPP (4 escalated cycles ⩾4 baseline): final results in stage III-IV low-risk Hodgkin lymphoma (IPS 0-2) of the LYSA H34 randomized trial. Ann Oncol 2014; 25: 1622–1628.

    Article  CAS  Google Scholar 

  6. Viviani S, Zinzani PL, Rambaldi A, Brusamolino E, Levis A, Bonfante V et al. ABVD versus BEACOPP for Hodgkin's lymphoma when high-dose salvage is planned. N Engl J Med 2011; 365: 203–212.

    Article  CAS  Google Scholar 

  7. Engel C, Loeffler M, Schmitz S, Tesch H, Diehl V . Acute hematologic toxicity and practicability of dose-intensified BEACOPP chemotherapy for advanced stage Hodgkin's disease. German Hodgkin's Lymphoma Study Group (GHSG). Ann Oncol 2000; 11: 1105–1114.

    Article  CAS  Google Scholar 

  8. Wongso D, Fuchs M, Plutschow A, Klimm B, Sasse S, Hertenstein B et al. Treatment-related mortality in patients with advanced-stage Hodgkin lymphoma: an analysis of the German Hodgkin study group. J Clin Oncol 2013; 31: 2819–2824.

    Article  Google Scholar 

  9. Carde P, Karrasch M, Fortpied C, Brice P, Khaled H, Casasnovas O et al. Eight cycles of ABVD versus four cycles of BEACOPPescalated plus four cycles of BEACOPPbaseline in stage III to IV, International Prognostic Score ⩾3, high-risk Hodgkin lymphoma: first results of the phase III EORTC 20012 Intergroup Trial. J Clin Oncol 2016; 34: 2028–2036.

    Article  CAS  Google Scholar 

  10. Skoetz N, Trelle S, Rancea M, Haverkamp H, Diehl V, Engert A et al. Effect of initial treatment strategy on survival of patients with advanced-stage Hodgkin's lymphoma: a systematic review and network meta-analysis. Lancet Oncol 2013; 14: 943–952.

    Article  Google Scholar 

  11. Merli F, Luminari S, Gobbi PG, Cascavilla N, Mammi C, Ilariucci F et al. Long-term results of the HD2000 trial comparing ABVD versus BEACOPP versus COPP-EBV-CAD in untreated patients with advanced Hodgkin lymphoma: a Study by Fondazione Italiana Linfomi. J Clin Oncol 2016; 34: 1175–1181.

    Article  CAS  Google Scholar 

  12. Morschhauser F, Brice P, Ferme C, Divine M, Salles G, Bouabdallah R et al. Risk-adapted salvage treatment with single or tandem autologous stem-cell transplantation for first relapse/refractory Hodgkin's lymphoma: results of the prospective multicenter H96 trial by the GELA/SFGM study group. J Clin Oncol 2008; 26: 5980–5987.

    Article  Google Scholar 

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Acknowledgements

We are indebted to Drs Lugtenburg (EORTC), Jaubert (LYSA), Blanc (LYSA), Pignon (LYSA), Eisenmann (LYSA), Gonzales (LYSA), Kernels (LYSA), Devidas (LYSA), Helias (LYSA), Thyss (LYSA), Christian (LYSA), Coiffier (LYSA), Bron (EORTC), Castaigne (LYSA), Eghbali (LYSA), Baars (EORTC), Fitoussi (LYSA), Raemaekers (EORTC) and Van Imhoff (EORTC), who contributed to this research. We also thank the EORTC Headquarters team, in particular, Bart Meulemans and Alice Preumont. This publication was supported by Fonds Cancer (FOCA) from Belgium.

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Authors and Affiliations

  1. Department of Hematology, Gustave Roussy, Villejuif, France

    D Ghez, P Carde & C Fermé

  2. EORTC Headquarters, Brussels, Belgium

    C Fortpied & S Ramadan

  3. Department of Onco-Hematology, CHU l’Archet, Nice, France

    N Mounier

  4. Department of Hematology, CHU Nancy-Brabois, Vandoeuvre Les Nancy, France

    A Perrot

  5. Department of Medical Oncology, National Cancer Institute, Cairo, Egypt

    H Khaled

  6. Department of Oncology and Hematology, Hopital Saint-Louis APHP, Université Paris Diderot, Paris, France

    S Amorim

  7. Unité Hémopathies Lymphoïdes, Hôpital Henri Mondor, Creteil, France

    F L Bras

  8. Department of Oncology, Umea Universitet, Umea, Sweden

    M Erlanson

  9. Department of Clinical Hematology, Hôpital Claude Huriez, Université de Lille 2, Lille, France

    C Herbaux

  10. Department of Hematology, CHU Amiens, Université Picardie Jules Verne, Amiens, France

    J-P Marolleau

  11. Department of Hematology, Leon Bérard Cancer Center, Lyon, France

    E Nicolas-Virelezier

  12. Department of Hematology, CHU Dijon, Dijon, France

    O Casasnovas

  13. Department of Hematology, Centre Henri Becquerel, Rouen, France

    A Stamatoullas-Bastard

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  1. D Ghez
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  15. A Stamatoullas-Bastard
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  16. C Fermé
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on behalf of EORTC, LYSA, LYMG and NLG cooperating groups

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Correspondence to D Ghez.

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Ghez, D., Fortpied, C., Mounier, N. et al. First-line escalated BEACOPP does not hinder stem cell collection and transplantation strategy in patients with relapsed/refractory Hodgkin’s lymphoma. Bone Marrow Transplant 52, 310–312 (2017). https://doi.org/10.1038/bmt.2016.271

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