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Russell J, Collins A, Fowler A, Karanth M, Saha C, Docherty S, Padayatty J, Maw K, Lentell I, Cooke L, Hodson A, Shah N, Sadullah S, Grigoropoulos N, Qian W, Kirkwood AA, Uttenthal BJ, Johnson P, Follows GA. Advanced Hodgkin lymphoma in the East of England: a 10-year comparative analysis of outcomes for real-world patients treated with ABVD or escalated-BEACOPP, aged less than 60 years, compared with 5-year extended follow-up from the RATHL trial. Ann Hematol 2021; 100:1049-1058. [PMID: 33641019 PMCID: PMC7960595 DOI: 10.1007/s00277-021-04460-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/10/2021] [Indexed: 10/31/2022]
Abstract
Treatment with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) or escalated(e)-BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone) remains the international standard of care for advanced-stage classical Hodgkin lymphoma (HL). We performed a retrospective, multicentre analysis of 221 non-trial ("real-world") patients, aged 16-59 years, diagnosed with advanced-stage HL in the Anglia Cancer Network between 2004 and 2014, treated with ABVD or eBEACOPP, and compared outcomes with 1088 patients in the Response-Adjusted Therapy for Advanced Hodgkin Lymphoma (RATHL) trial, aged 18-59 years, with median follow-up of 87.0 and 69.5 months, respectively. Real-world ABVD patients (n=177) had highly similar 5-year progression-free survival (PFS) and overall survival (OS) compared with RATHL (PFS 79.2% vs 81.4%; OS 92.9% vs 95.2%), despite interim positron-emission tomography-computed tomography (PET/CT)-guided dose-escalation being predominantly restricted to trial patients. Real-world eBEACOPP patients (n=44) had superior PFS (95.5%) compared with real-world ABVD (HR 0.20, p=0.027) and RATHL (HR 0.21, p=0.015), and superior OS for higher-risk (international prognostic score ≥3 [IPS 3+]) patients compared with real-world IPS 3+ ABVD (100% vs 84.5%, p=0.045), but not IPS 3+ RATHL patients. Our data support a PFS, but not OS, advantage for patients with advanced-stage HL treated with eBEACOPP compared with ABVD and suggest higher-risk patients may benefit disproportionately from more intensive therapy. However, increased access to effective salvage therapies might minimise any OS benefit from reduced relapse rates after frontline therapy.
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Affiliation(s)
- James Russell
- Department of Haematology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ UK
| | - Angela Collins
- Department of Haematology, Norfolk and Norwich University Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY UK
| | - Alexis Fowler
- Department of Haematology, Peterborough City Hospital, Peterborough and Stamford Hospitals NHS Foundation Trust, Edith Cavell Campus, Bretton Gate, Peterborough, PE3 9G UK
| | - Mamatha Karanth
- Department of Haematology, West Suffolk Hospital, West Suffolk NHS Trust, Hardwick Lane, Bury St Edmunds, IP33 2QZ UK
| | - Chandan Saha
- Department of Haematology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ UK
| | - Suzanne Docherty
- Department of Haematology, Norfolk and Norwich University Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY UK
| | - Joseph Padayatty
- Department of Haematology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ UK
| | - Kyaw Maw
- Department of Haematology, James Paget University Hospital, James Paget University Hospitals NHS Foundation Trust, Lowestoft Road, Gorleston-on-Sea, Great Yarmouth, NR31 6LA UK
| | - Isabel Lentell
- Department of Haematology, West Suffolk Hospital, West Suffolk NHS Trust, Hardwick Lane, Bury St Edmunds, IP33 2QZ UK
| | - Lisa Cooke
- Department of Haematology, The Queen Elizabeth Hospital, King’s Lynn NHS Foundation Trust, Gayton Rd, King’s Lynn, PE30 4ET UK
| | - Andrew Hodson
- Department of Haematology, Ipswich Hospital, Ipswich Hospital NHS Trust, Heath Rd, Ipswich, IP4 5PD UK
| | - Nimish Shah
- Department of Haematology, Norfolk and Norwich University Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY UK
| | - Shalal Sadullah
- Department of Haematology, James Paget University Hospital, James Paget University Hospitals NHS Foundation Trust, Lowestoft Road, Gorleston-on-Sea, Great Yarmouth, NR31 6LA UK
| | - Nicholas Grigoropoulos
- Department of Haematology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ UK
| | - Wendi Qian
- Department of Haematology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ UK
| | - Amy A. Kirkwood
- Cancer Research UK and University College London Cancer Trials Centre, University College London, 90 Tottenham Court Road, London, W1T 4TJ UK
| | - Benjamin J. Uttenthal
- Department of Haematology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ UK
| | - Peter Johnson
- Cancer Research UK Centre, University of Southampton, University Road, Southampton, SO17 1BJ UK
| | - George A. Follows
- Department of Haematology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ UK
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