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June 9, 2009 (Berlin, Germany) — A chemotherapy dieting of escalated BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone) additional 2 cycles of ABVD (adriamycin, bleomycin, vinblastine, and dacarbacine) was decidedly bigger in agreement of progression-free adaptation than the accepted dieting of 4 cycles of ABVD in patients with aboriginal abortive Hodgkin's lymphoma (HL).
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The finding, presented actuality at the 14th Congress of the European Hematology Association, comes from a abstraction conducted in 1645 patients by the German Hodgkin Abstraction Accumulation (GHSG). The HD14 balloon was concluded early, on the third acting analysis, because of the decidedly bigger outcomes for patients advised with the amalgam dieting over ABVD (both were followed by 30 Gy involved-field radiotherapy [IF-RT]).
Patients in this abstraction had aboriginal abortive HL — analytic stage 1 or 2 and accident factors, including ample mediastinal mass, extranodal disease, aerial corpuscle sedimentation rate, and 3 or added areas affected.
Currently, accepted analysis for such patients is 4 cycles of ABVD followed by 30 Gy IF-RT. In this study, accepted analysis was compared with 2 cycles of escalated BEACOPP additional 2 cycles of ABVD, analogously followed by 30 Gy IF-RT. The escalated BEACOPP dieting uses college doses of some of the constituents, with granulocyte colony-stimulating agency support. The differences amid escalated and accepted BEACOPP are, respectively, 200 vs 100 mg/m2 for etoposide, 35 vs 25 mg/m2 for doxorubicin, and 1200 vs 650 mg/m2 for cyclophosphamide.
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After 3 years, progression-free adaptation was apparent in 97% of patients in the escalated BEACOPP accumulation and 91% in the ABVD group. Freedom from analysis abortion was 95% in the escalated BEACOPP accumulation and 91% in the ABVD group.
A antecedent GHSG balloon (GHSG HD11) that compared 4 cycles of ABVD with BEACOPP, followed by either 30 or 20 Gy IF-RT, showed no aberration with account to outcomes, and admitting accomplished antecedent absolution rates, about 15% of patients with aboriginal unfavorable-stage HL relapsed aural 5 years and addition 5% suffered from accelerating disease.
As a result, the advisers agitated analysis for aboriginal abortive HL in the HD14 trial. Patients in the escalated BEACOPP accumulation showed a cogent aberration in agreement of bump control. "In a altered study, we begin a [progression-free survival] of 86% afterwards 5 years of advancing analysis in advanced-stage HL, so we articular that we should try this aforementioned dieting in aboriginal unfavorable-stage patients. HL is a awful curable disease, with 70% of patients accomplishing a cure over the continued term, but there is still allowance for beforehand in this accurate accumulation of patients with aboriginal abortive disease," abstraction investigator Andreas Engert, MD, armchair of GHSG and assistant of centralized medicine, Uniklinik Köln in Germany, told Medscape Oncology. Commenting on the study, Peter Johnson, MD, from the Cancer Research UK Centre at Southampton General Hospital, accustomed the allegation but acicular out that abounding patients in this abstraction had beefy ache and/or systemic (B) symptoms. In added countries, these patients would accept a abounding beforehand of at atomic 6 cycles of chemotherapy, he said.
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"It is an accomplished and annoying abstraction but it would be difficult to acclaim acceptance of the beginning arm of this abstraction as the accepted of care, decidedly after an all-embracing aberration in survival. The advice is acutely important and provides added abutment for the abstraction that analysis accession can be able in those patients with difficult disease, alike at an aboriginal stage," Dr. Johnson added.
Now Aim to Abate Toxicity
"It is still aboriginal on in the trial, so we charge to attending at longer-term follow-up, but we anticipate we are abreast to the beam in agreement of ability in these patients. A aberration amid the 2 groups of 6% of patients after progression at 3 years is clinically meaningful, but I anticipate the aim now is to abate toxicity," Dr. Engert acicular out.
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Hematological adverse contest were added accepted in the escalated BEACOPP accumulation than in the ABVD group, including leukopenia (22% vs 81%), thrombocytopenia (<1% vs 24%), and anemia (1% vs 10%). Infection in the escalated BEACOPP accumulation was additionally college than in the ABVD accumulation (3% vs 8%). However, bloodshed was college in the ABVD accumulation than in the escalated BEACOPP accumulation (2.2% vs1.0%). Abstraction board are ecology the furnishings of analysis on fertility.
Robert Pytlik, MD, a hematologist from Charles University General Hospital in Prague, Czech Republic, has advised several patients with the escalated BEACOPP dieting and begin it is about able-bodied tolerated. "We carefully chase the GHSG and amusement according to this. This is absolutely an beforehand in abortive aboriginal HL and it shows that accession at the ancient point is beneficial. I attention HL as an advancing lymphoma, not indolent, so ancient accessible accession can advance results."
The majority (95%) of the abstraction was adjourned Deutsche Krebshilfe (German Cancer Aid), and the butt was adjourned by Amgen, Chugai, and Roche. Dr. Engert is armchair of the GHSG. Dr. Johnson and Dr. Pytlik accept appear no accordant banking relationships.
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14th Congress of the European Hematology Association: Abstract 0553. Presented June 6, 2009.
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