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Although the BEACOPP chemotherapy regimen produces better initial tumor control than the commonly used and less toxic ABVD regimen, the two regimens produce similar overall survival among patients with advanced Hodgkin’s lymphoma. These results were published in the New England Journal of Medicine.

Hodgkin’s lymphoma is a cancer of the lymph system. It is diagnosed by the presence of a cell that is characteristic of the disease, the Reed-Sternberg cell. Hodgkin’s lymphoma typically begins in the lymph nodes in one region of the body and then spreads throughout the lymph system. It may spread outside the lymph system to other organs, such as the lungs, liver, bone, and bone marrow.

A chemotherapy regimen known as ABVD is commonly used in the initial treatment of Hodgkin’s lymphoma. Researchers in Germany have suggested that an alternative regimen—known as BEACOPP—may provide more effective tumor control. The BEACOPP regimen is highly toxic, however (with a roughly 3% rate of treatment-related death), making it important to determine whether the long-term benefits outweigh the risks.

A factor that may help equalize long-term outcomes among patients treated with ABVD or BEACOPP is the availability of effective secondary treatment if initial treatment fails. Patients who experience lymphoma progression after initial treatment may be treated with high-dose chemotherapy and stem-cell transplantation. This secondary approach to treatment has toxicities similar to escalated BEACOPP, but is reserved for patients who truly need it.

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To compare ABVD and BEACOPP in the initial treatment of advanced Hodgkin’s lymphoma, researchers in Italy conducted a study among 331 patients with previously untreated and unfavorable Hodgkin’s lymphoma (Stage IIB, III, or IV, or an international prognostic score of 3 or higher).

Study participants were treated with either ABVD or BEACOPP, followed by radiation therapy when appropriate. Patients who did not have a complete response to initial treatment (or who relapsed after initial treatment) received secondary treatment with high-dose chemotherapy and autologous stem cell transplantation.

  • Seven-year freedom from first progression was 85% among patients treated with BEACOPP and 73% among patients treated with ABVD.
  • 20 patients in the BEACOPP group and 45 patients in the ABVD group went on to receive high-dose secondary therapy.
  • Seven-year overall survival was 89% among patients in the BEACOPP group and 84% among patients in the ABVD group. This difference between study groups did not meet the criteria for statistical significance, suggesting that it could have occurred by chance alone.

These results suggest that BEACOPP may provide better initial tumor control than ABVD. The availability of effective secondary treatment, however, produced similar overall survival in the two study groups. Initial treatment with ABVD may allow many patients to avoid highly toxic treatment without compromising survival.

Reference: Viviani S, Zinzani PL, Rambaldi A et al. ABVD versus BEACOPP for Hodgkin’s lymphoma when high-dose salvage is planned. New EnglandJournal of Medicine. 2011;365:203-12.