IEC方案治疗难治性非霍奇金淋巴瘤的临床研究

目的:探讨IEC方案治疗难治性非霍奇金淋巴瘤的临床疗效.方法:1998年12月～2002年12月应用IEC方案治疗难治性非霍奇金淋巴瘤23例,共用59个周期,每例2～5个周期,平均2.6个周期.结果:化疗结束后完全缓解4例,部分缓解11例,稳定5例,进展3例,总有效率(CR+PR)65.2%.4周后复查完全缓解4例,部分缓解10例,稳定6例,进展3例,总有效率(CR+PR)60.9%.骨髓抑制是主要不良反应,但较其它一些二、三线方案轻,临床易于处理,未出现出血性膀胱炎.结论:IEC方案治疗难治性非霍奇金淋巴瘤疗效与安全性均较高,是治疗难治性非霍奇金淋巴瘤的较好方案.     

改良的CHOPE方案治疗EBV阳性恶性淋巴瘤的临床疗效观察

目的:观察改良的CHOPE方案（环磷酰胺+柔红霉素+长春新碱+泼尼松）治疗EBV阳性的恶性淋巴瘤的临床疗效及毒副反应。方法:本研究采用改良的CHOPE方案联合抗病毒及局部放射治疗,治疗了46例EBV阳性的恶性淋巴瘤。结果:3个疗程评估完全缓解(CR)21例(45.7%),部分缓解(PR)12例(26.1%) ,8例为稳定状态(SD),5例疾病进展（PD）,总有效率为 71.7%。治疗结束后总有效率达81.2%,46例患者1 年总生存率(OS)为78% ,1年无病生存率(DFS)69%;3年OS为34.7%,3 年DFS为31%。结论:总体而言改良的CHOPE方案治疗EBV阳性淋巴瘤有效,毒副反应可安全耐受,但长期生存率仍然较差,因此对于EBV阳性的恶性淋巴瘤患者在强调早期强化疗的基础上应把异基因造血干细胞移植提上议程,以获得更好的治疗效果。     

改良B-NHL-BFM-90方案治疗儿童青少年伯基特淋巴瘤的疗效分析

背景与目的:伯基特淋巴瘤是高度恶性非霍奇金淋巴瘤,进展快,常伴骨髓和中枢侵犯,死亡率高.CHOP方案疗效差,生存率低.伯基特淋巴瘤的最佳化疗方案仍需要积极探讨.本研究总结中山大学肿瘤防治中心近年来采用改良B-NHL-BFM-90方案治疗儿童青少年伯基特淋巴瘤的疗效和生存率.方法:从1999年10月至2006年11月,31例20岁以下经病理确诊的伯基特淋巴瘤患者入组.年龄1.5～20岁,中位年龄5岁;男性20例(64.5%),女性11例(35.5%).临床分期(St Jude分期):Ⅰ期1例(3.2%),Ⅱ期6例(19.4%),Ⅲ期8例(25.8%),Ⅳ期16例(51.6%),Ⅲ/Ⅳ期患者占77.4%.根据临床分期、治疗反应和LDH水平,将患者分为低危组、中危组和高危组.采用改良B-NHL-BFM-90方案治疗,药物包括cyclophosphamide、vincristine、ifosfamide、etoposide、adriamycin、HD-methotrexate、vindesine、dexamethasone、cytarabine/HD-cytarabine和鞘内注射.结果:31例患者中1例于诱导前期死于肿瘤溶解综合征.30例可评价疗效.30例中25例(83.3%)完全缓解,3例(10.0%)部分缓解,2例(6.7%)进展.1例复发.治疗期间大部分患者发生Ⅲ/Ⅳ度骨髓抑制,经积极对症支持治疗可恢复,不影响下一疗程治疗.中位随访33个月(3～98个月),全组3年无事件生存率86.0%;Ⅰ/Ⅱ期100%,Ⅲ/Ⅳ期82.1%;低危组100%,中危组92.0%,高危组70.0%.结论:改良B-NHL-BFM-90方案可明显改善儿童青少年伯基特淋巴瘤的疗效和生存率,毒性可耐受,但需要在有经验的肿瘤中心和血液科中应用.     

改良的ProMACE/CytaBOM方案治疗非霍奇金淋巴瘤的疗效观察

目的:探讨改良的ProMACE/CytaBOM方案治疗高度恶性非霍奇金淋巴瘤及中度恶性非霍奇金淋巴瘤的疗效.方法:采用改良的ProMACE/CytaBOM方案治疗16例高度恶性非霍奇金淋巴瘤及中度恶性非霍奇金淋巴瘤患者,其中高度恶性9例,7例为初发患者,2例为复发患者;中度恶性7例为复发患者. 结果:7例高度恶性非霍奇金淋巴瘤及中度恶性复发性非霍奇金淋巴瘤达到完全缓解( CR率43.7%),6例达到部分缓解( PR率37.5%),总有效率为81.2%;目前8例仍生存,其中生存时间最长达42个月(2例),仍处于CR期.毒副作用主要为消化道症状、轻度肝功能异常以及骨髓抑制.结论:改良的ProMACE/CytaBOM方案对部分高度恶性非霍奇金淋巴瘤及中度恶性复发性非霍奇金淋巴瘤患者效果好,毒副作用较轻,值得推广使用.     

氟达拉滨联合化疗治疗初治滤泡型淋巴瘤的临床观察

目的:评价氟达拉滨联合化疗治疗初治滤泡型淋巴瘤的疗效和不良反应。方法:研究对象为本院确诊的30例初治滤泡型淋巴瘤患者,其中17例接受FC(氟达拉滨+环磷酰胺)方案治疗,13例接受R-FC(利妥昔单抗+氟达拉滨+环磷酰胺)方案治疗。所有患者均接受2～6个周期的化疗,中位化疗周期数为4.5个周期。结果:30例患者中达完全缓解者26例(86.7%),部分缓解者1例(3.3%),总有效率为90.0%。在各项临床因素中,只有Ki-67表达阳性率对完全缓解有明显影响(P=0.031)。全部30例患者的1、2、3和4年无进展生存率分别为90%、85%、85%和63%。单因素分析发现,国际预后指数评分、Ki-67阳性率、血清乳酸脱氢酶及能否获得完全缓解对无进展生存的影响有统计学意义(P<0.05)。主要不良反应为骨髓抑制、免疫抑制和轻度胃肠道反应。有51.0%的化疗周期发生白细胞计数下降,10.5%的化疗周期发生血小板减少,33.0%的化疗周期发生胃肠反应。全组患者的带状疱疹发生率为30.0%,其中R-FC组的带状疱疹发生率为46.2%,FC组的带状疱疹发生率为17.6%。结论:氟达拉滨为主的联合化疗方案治疗初治滤泡型淋巴瘤的临床缓解率较高,无病生存时间较长,且不良反应可以耐受。     

IMVP-16方案治疗复发和难治性非霍奇金淋巴瘤的临床观察

目的评价IMVP-16方案治疗复发和难治性非霍奇金淋巴瘤的疗效及毒性.方法采用IMVP-16方案治疗32例复发和难治性非霍奇金淋巴瘤,其中复发组18例,难治组14例.结果32例中完全缓解CR 8例(25.0%),部分缓解PR 7例(21.8%),总有效率为46.8%.有效患者中位缓解时间6.4个月.IMVP-16方案治疗后中位生存时间8.3个月,1年总生存率34.1%,2年总生存率19.7%.IMVP-16方案的不良反应主要表现为骨髓抑制,10例患者发生了白细胞减少引起的发热,其中有1例发生了化疗相关性死亡.结论IMVP-16方案治疗复发和难治性非霍奇金淋巴瘤的疗效是肯定的,毒性反应可以耐受,然而此方案的结果并不十分令人满意,仍然需要探索更好的高效、低毒的治疗方案.     

ProMACE—cytaBOM方案治疗非霍奇金淋巴瘤的临床疗效观察

目的观察ProMACE-cytaBOM方案一线治疗中高度恶性非霍奇金淋巴瘤(NHL)的近期和远期疗效.方法采用ProMACE-cytaBOM方案一线治疗30例中高度恶性非霍奇金淋巴瘤,并进行疗效分析.结果全组总有效率(CR+PR)为86.7%,完全缓解(CR)率为66.7%,中位缓解期为9(3～58)个月.中位生存时间为35(1.5～68)个月,全组1、3、5年生存率分别为56.7%、45.3%、45.3%.Ⅱ～Ⅲ期、中度恶性、来源于B细胞、无巨大肿块、LDH正常、化疗≥4个周期者的生存率高于Ⅳ期、高度恶性、来源于T细胞、有巨大肿块、LDH不正常、化疗＜4个周期者,但无显著性差异(P＞0.05).治疗后疗效达到CR者的长期生存率明显高于无效者(P＜0.05).主要的不良反应为骨髓抑制和胃肠道反应,患者均可耐受.结论ProMACE-cytaBOM方案是治疗中高度NHL的1个安全有效的化疗方案.     

剂量调整 B-NHL-BFM95方案治疗儿童非霍奇金淋巴瘤临床研究

目的：探讨改良 B-NHL-BFM95方案治疗儿童非霍奇金淋巴瘤的临床疗效和毒副反应。方法入组20例经病理确诊的14岁以下非霍奇金淋巴瘤患者,均接受改良 B-NHL-BFM95方案治疗,未行放疗。结果近期疗效：18例（900%）CR,2例（100%）PD。治疗期间大部分患者出现Ⅲ、Ⅳ度骨髓抑制,经对症处理恢复正常,不影响下一步治疗。中位随访55个月,全组3 a 无事件生存率800%,Ⅰ~Ⅱ期1000%,Ⅲ~Ⅳ期600%;低危组1000%,中危组857%,高危组500%。结论改良 B-NHL-BFM-95方案治疗儿童非霍奇金淋巴瘤,特别是低、中危儿童非霍奇金淋巴瘤疗效显著,毒副反应可耐受。     

原发纵隔B细胞淋巴瘤疗效分析

目的 分析原发纵隔B细胞淋巴瘤的治疗疗效和失败原因.方法 搜集14年间收治的病理让实的原发纵隔B细胞淋巴瘤46例,其中Ⅰ期14例,Ⅱ期23例,Ⅲ期3例,ⅣA期6例.21例接受手术治疗,其中开胸探查术19例,纵隔镜活检术2例.37例Ⅰ+Ⅱ期中,8例接受单纯化疗,29例接受化疗+放疗,Ⅲ+Ⅳ期以化疗为主.放疗多采用纵隔加颈部照射野,中位剂量为45.00 Gy(16.95～61.00 Gy).化疗采用CHOP方案27例,三代化疗方案(MACOP-B,ProMACE/CytaBOM,m-BACOD,PmMACE-MOPP)9例,高剂量化疗加自体外周血干细胞移植(HDCT/APBSCT)10例.化疗+美罗华16例.化疗周期多为6～8个.结果 全组患者首程治疗后达完全缓解19例,部分缓解14例,病变进展11例,未评价2例.全组11例死于肿瘤.全组5年总生存率为35%.Ⅰ+Ⅱ期和Ⅲ+Ⅳ期2年总生存率分别为79%和51%,5年总生存率分别为63%和0(X2=4.35,P=0.037),2年无进展生存率分别为63%、11%(x2=17.77,P=0.000).治疗后达完全缓解者5年总生存率为80%,部分缓解者为50%,病变进展者为0(X2=19.58,P=0.003).19例治疗中病变进展或治疗后复发,腹腔淋巴结受侵和远处结外器官受侵最常见.结论 晚期患者生存率低,需要探讨更为有效的全身治疗方案,放疗可改善局部控制率.     

非霍奇金淋巴瘤骨髓侵犯化疗的研究

目的 研究非霍奇金淋巴瘤(NHL)骨髓侵犯(BMI)化疗方案.方法 将54例NHL患者分为两组;A组10例NHL患者BMI后用改良BFM方案化疗;B组44例无发现BMI的患者用CHOP方案化疗.结果 A组CR 80%,总有效率90%,1年和3年生存率90%和70%;B组CR率56.8%,有效率88.6%,5年生存率50%.两组化疗毒副作用都能耐受.结论 CHOP方案适合用于无BMI的NHL;改良BFM方案适合应用于有BMI的NHL.     

Stanford V program for locally extensive and advanced Hodgkin lymphoma: the Memorial Sloan-Kettering Cancer Center experience

BackgroundThe Stanford group has reported excellent results with the Stanford V regimen for patients with bulky and/or advanced Hodgkin lymphoma (HL). However, Gobbi reported markedly inferior failure-free survival (FFS) comparing Stanford V to other regimens but included major deviations from the original program. We retrospectively examined whether treatment at our institution carefully following Stanford V guidelines would confirm the original Stanford outcome data.Patients and methodsFrom June 1995 to May 2002, 126 patients with either locally extensive or advanced HL were treated with the 12-week Stanford V chemotherapy program followed by 36-Gy involved-field radiotherapy to sites initially ≥5 cm and/or to macroscopic splenic disease. Overall, 26% had stage IV disease and 20% had international prognostic score (IPS) ≥4. Overall survival (OS), disease-specific survival, progression-free survival (PFS), FFS, and freedom from second relapse (FF2R) were determined.ResultsThe 5- and 7-year OS were 90% and 88%, respectively. The 5-year FFS was 78%. IPS ≥4 was a significant independent predictor of worse OS and PFS. The FF2R was 64% at 3 years.ConclusionStanford V with appropriate radiotherapy is a highly effective regimen for locally extensive and advanced HL.     

自体造血干细胞移植治疗霍奇金淋巴瘤38例临床疗效及预后影响因素分析

目的 探讨自体造血干细胞移植（ASCT）治疗霍奇金淋巴瘤（HL）的临床疗效以及影响预后的因素。方法 回顾2007年10月至2021年10月于郑州大学附属肿瘤医院经ASCT治疗的HL38例患者资料,Kaplan-Meier和Cox方法分析移植后疗效以及预后影响因素。结果 38例移植患者均获得造血重建。全组患者移植前后CR率分别为55.3%和81.6%,5年PFS和OS分别为76.1%和79.0%。单因素分析显示B症状、IPS评分、移植前缓解状态、结外受累和预处理方案（均P<0.05）是影响HL患者ASCT预后的因素,多因素分析显示B症状（P<0.05）是影响5年PFS的独立危险因素。结论 ASCT治疗高危、复发难治HL患者的疗效显著,有B症状是影响移植预后的独立危险因素。     

Two escalated followed by six standard BEACOPP in advanced-stage high-risk classical Hodgkin lymphoma: high cure rates but increased risk of aseptic osteonecrosis

BackgroundFrom 1999, Norwegian guidelines recommend two escalated (esc) BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisolone) followed by six standard (s) BEACOPP for patients with advanced-stage classical Hodgkin lymphoma (HL) with an international prognostic score (IPS) ≥4. We evaluated retrospectively the experience with this recommendation at the Norwegian Radium Hospital, also including all IPS 3 patients treated with the same regimen.Patients and methodsForty-seven patients were treated between June 1999 and December 2008. IPS was 3 in 10 patients and ≥4 in 37.ResultsThirty-five patients received eight cycles of BEACOPP, 12 patients received one to six cycles only, mainly due to toxicity. Sixty percent of patients had dose reductions. With median follow-up of survivors of 89 months, 5-year progression-free and overall survival are 84% [95% confidence interval (CI) 73% to 95%] and 91% (95% CI 82% to 100%), respectively. Toxicity was considerable with grade 3 or more infections/febrile neutropenia in 66% of patients, including one death and three cases of Pneumocystis jiroveci pneumonia. Of note, 10 patients (21%) experienced symptomatic aseptic osteonecrosis, of whom 3 have had hip replacement surgery after treatment.ConclusionTwo escBEACOPP plus six sBEACOPP is efficacious in advanced-stage high-risk HL. We document a high incidence of aseptic bone necrosis, possibly related to prednisolone.     

Multicentre phase II study of the baseline BEACOPP regimen for patients with advanced-stage Hodgkin's lymphoma

A German Hodgkin's lymphoma (HL) study group designed the BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisolone) regimen. In the BEACOPP regimen, treatment intervals were shortened and the dose-intensity was increased compared with those in the ABVD regimen (doxorubicin, bleomycin, vinblastine and darcarbacine), resulting in a long-term disease-free survival rate of approximately 75-80%. In the present study, we evaluated the safety and efficacy of the BEACOPP regimen. Between April 2001 and February 2004, 20 patients with HL of stage IIB or higher who had received no previous treatment were enrolled. The patients were aged 17-69 years (median 22 years). The histologic types were mixed cellularity in four cases and nodular sclerosis in 16 cases. The stages were stage IIB in four cases, stage III in 12 cases, and stage IV in four cases. Nineteen (95%) of the 20 patients achieved complete remission. The 3-year survival rate was 100% and the 3-year progression-free survival rate was 89.7%. Adverse drug reactions were grade 4 neutropenia in 12 patients, grade 3-4 thrombocytopenia in seven patients, and grade 3 or higher non-hematologic toxicities in two patients (stomatitis in one patient and ALT/AST elevation in one patient). The BEACOPP regimen for advanced-stage HL showed an excellent complete remission rate and high efficacy even in stage III/IV patients. However, a long-term risk of the BEACOPP regimen is the development of secondary leukemia or myelodysplastic syndrome. Therefore, long-term follow-up of these patients, including monitoring for toxicities, is necessary.     

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

BackgroundTreatment with escalated BEACOPP achieved a superior time to treatment failure over ABVD in patients with disseminated Hodgkin lymphoma. However, recent clinical trials have failed to confirm BEACOPP overall survival (OS) superiority over ABVD. In addition, the gain in low-risk patients is still a matter of debate.Patients and methodsWe randomly compared ABVD (8 cycles) with BEACOPP (escalated 4 cycles ≥baseline 4 cycles) in low-risk patients with an International Prognostic Score (IPS) of 0–2. The primary end point was event-free survival (EFS). This parallel group, open-label phase 3 trial was registered under #RECF0219 at French National Cancer Institute.ResultsOne hundred and fifty patients were randomized in this trial (ABVD 80, BEACOPP 70): 28 years was the median age, 50% were male and IPS was 0–1 for 64%. Complete remission rate was 85% for ABVD and 90% for BEACOPP. Progression or relapses were more frequent in the ABVD patients than in the BEACOPP patients (17 versus 5 patients). With a median follow-up period of 5.5 years, seven patients died: six in the ABVD arm and one in the BEACOPP arm (HL 3 and 0, 2nd cancer 2 and 1, accident 1 and 0). The EFS at 5 years was estimated at 62% for ABVD versus 77%, for BEACOPP [hazards ratio (HR) = 0.6, P = 0.07]. The progression-free survival (PFS) at 5 years was 75% versus 93% (HR = 0.3, P = 0.007). The OS at 5 years was 92% versus 99% (HR = 0.18, P = 0.06).ConclusionFewer progressions/relapses were observed with BEACOPP, demonstrating the high efficacy of the more intensive regimen, even in low-risk patients. However, additional considerations, balancing treatment-related toxicity and late morbidity due to salvage may help with decision-making with regard to treatment with ABVD or BEACOPP.     

Autologous stem cell transplantation for patients with active Hodgkin's lymphoma: long-term outcome of 61 patients from a single institution

Sixty-one patients with refractory or relapsed Hodgkin's lymphoma (HL) underwent high-dose chemotherapy and autologous stem cell transplantation (ASCT). All patients had active HL at the time of ASCT: 13 patients had partial remission, 14 refractory disease, 18 sensitive relapse, 4 resistant relapse, and 12 nontreated relapse. Overall transplant-related mortality (TRM) was 16.4% at 1 year. Twenty-eight patients (46%) achieved complete remission (CR). Actuarial 5-year overall survival (OS) and progression-free survival (PFS) were 51% and 47%, respectively. Patients with positive gallium-67 scintigraphy at 3 - 6 months after transplantation had a worse PFS at 5 years (28%) than those with negative 67Ga scan (80%) (p = 0.016), whereas no statistical differences were observed between patients with residual mass and those in CR according to computed tomography scan. In multivariate analysis, bulky disease at diagnosis, bone marrow stem cells, and stage IV at transplant were the only adverse prognostic factors significantly influencing OS. Bulky disease at diagnosis and stage IV at transplant adversely influenced PFS. Although long-term outcome of patients with active HL at the time of ASCT is poor due to a high TRM and a low CR after transplantation, a subgroup of patients with no adverse prognostic factors at ASCT gain benefit from this treatment.     

IDO表达对CD20+弥漫大B细胞淋巴瘤RCHOP方案治疗的预后的影响

目的探讨IDO表达对CD20+弥漫大B细胞淋巴瘤(DLBCL)RCHOP方案治疗的预后的影响。方法回顾性选取经组织活检诊断为DLBCL的60例患者临床资料,所有患者均经免疫组化检测CD20蛋白阳性表达,先后通过RCHOP方案治疗,分析IDO阳性与阴性表达患者预后差异。结果非GCB型、临床分期Ⅲ~Ⅳ期、有B症状、化疗效果为PD+SD的CD20+DLBCL患者IDO表达阳性率高于GCB型、临床分期Ⅰ~Ⅱ期、无B症状、化疗效果为PR+CR患者(P<0.05)。IDO阳性患者1年、3年无进展生存率分别为72.22%、36.11%,低于IDO阴性患者的91.67%、70.83%(P<0.05);IDO阳性患者1年、3年总生存率分别为83.33%、50.00%,低于IDO阴性患者的95.83%、79.17%(P<0.05)。Logisitic回归分析显示非GCB型、临床分期为Ⅲ~Ⅳ期、有B症状、IPI评分为3~5分、IDO阳性表达均是导致CD20+DLBCL患者RCHOP方案治疗不良预后的独立危险因素。结论IDO高表达患者近期疗效较差,3年无进展与总生存率较低。IDO表达水平可以作为DLBCL患者独立预后因素。     

Treatment outcomes and relative dose intensity of chemotherapy in patients with advanced Hodgkin lymphoma

The present retrospective study was undertaken to investigate the association of relative dose intensity (RDI) with the outcome of patients with advanced stage Hodgkin lymphoma (HL) receiving ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and escalated BEACOPP regimens (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone). A total of 114 patients with HL treated between 2004 and 2013 were enrolled for evaluation. The association of variables with overall survival (OS) and progression-free survival (PFS) was analysed using univariate and multivariate Cox proportional hazards models. The median age of patients was 39 years, and the majority were male and had stage IV disease. A total of 54 patients received ABVD and 60 received BEACOPP chemotherapy with 24 and four deaths, respectively. Patients in the BEACOPP group were significantly younger with lower Charlson comorbidity index (CCI) and better performance status in comparison with the ABVD group, making the comparison of groups not possible. In the ABVD group, RDI was not significantly associated with OS (P=0.590) or PFS (P=0.354) in a multivariate model where age was controlled. The low number of events prevented this analysis in the BEACOPP group. The age of patients was strongly associated with both OS and PFS; all statistically significant predictors for OS and PFS from univariate analyses (chemotherapy regimen, CCI, RDI, performance status) lost their effect in multivariate analyses where age was controlled. Based on these observations, it was concluded that RDI was not associated with OS or PFS after age is controlled, neither in all patients combined nor in the ABVD group.     

Primary refractory and relapsed Hodgkin lymphoma with unfavorable prognosis

In this retrospective clinical study 100 patients with primary unfavorable prognosis stage II Hodgkin lymphoma (HL) (n = 50) or stage IV HL (n = 50). The ABVD chemotherapy allowed to achieve remission in 90% of cases with 5-year relapse-free survival (RFS) and overall survival (OS) of 64% and 92%, the basic BEACOPP regimen lead to the same 90% remission rate with 74% DFS and 94% OS. These results for ABVD and basic BEACOPP regimens are characterized by similar statistic values (p = 1.0; p = 0.6; p = 0.9), although the use basic BEACOPP lead to statically valid decrease of grade III-IV toxicity (p = 0.005). The occurrence of primary refractory HL was slightly higher in basic BEACOPP group (18% versus 10% in ABVD group), although this difference had no statistical value (p = 0.3) and was probably due to higher number of patients with > 1 extranodal localizations. The occurrence of primary refractory HL correlated to disease stage: 6% in stage II and 22% in stage IV (p = 0.04). HL relapse frequency in ABVD and BEACOPP groups was similar (12% and 8%), there was no statistically valid difference (p = 0.5). In ABVD and basic BEACOPP recipients with stage II/IV HL the primary refractory disease rate was 15%, relapse rate was 10%. Five-year OS in primary refractory and relapsed patients was lower, than in general patient population (64% and 70% compared to 80%), although the difference had no statistical significance (p = 0.6, p = 0.7).     

Could BEACOPP be the new standard for the treatment of advanced Hodgkin's lymphoma?

In 1992, the German Hodgkin Study Group (GHSG) developed the BEACOPP regimen for further improving the outcome of patients with advanced Hodgkin's lymphoma (HL). Since then, BEACOPP has been introduced in 3 different prospective randomized clinical trials of the GHSG to find an equilibrium between maximal efficacy and least toxicity with the BEACOPP principle for the treatment of advanced stage HL. In the HD9 trial of the GHSG, with 1,186 patients, after a median observation time of 7 years, the rates for FFTF are 85 percent and for overall survival 90 percent for dose-escalated BEACOPP, and for COPP/ABVD (C/ABVD comparable to ABVD) the rate for FFTF is 67 percent and for overall survival it is 79 percent. These superior BEACOPP results are obtained inspite of a higher rate of secondary AML/MDS in the escalated BEACOPP arm. The number of toxic deaths during treatment, however, was lower for escalated BEACOPP (1.6 percent) than for C/ABVD (1.8 percent). The majority of patients were treated in an outpatient setting, in a multicenter study with more than 400 centers, including 120 private doctors, located in Germany and 9 other European countries. To reduce acute and long-term toxicity, the GHSG started in the consecutive studies HD12 and HD15 for advanced stage HL to de-escalate BEACOPP by reducing the number of escalated BEACOPP cycles and by applying the baseline dose BEACOPP, a time dense regimen, called BEACOPP-14. The excellent results obtained with the BEACOPP principle challenge the seemingly global consensus that ABVD is the gold standard treatment strategy for advanced stage HL.