Adding rituximab to escalated BEACOPP therapy in Hodgkin Lymphoma patients with a positive PET scan

This study assessed the effectiveness of using escalated BEACOPP plus rituximab chemotherapy in patients with advanced stage Hodgkin Lymphoma. The study concluded that adding rituximab to the standard escalated BEACOPP regimen did not significantly improve time to disease progression.

Hodgkin Lymphoma (HL) is generally considered a curable disease. Even patients diagnosed with advanced stage disease have good outcomes. However, some patients are at higher risk for treatment failure. Positron emission tomography (PET) scans have previously shown to identify patients at higher risk of treatment failure. A positive PET scan during treatment indicates some residual disease, while a negative PET scan indicates that there is no detectable disease.

Previous studies have shown that increasing the treatment intensity of patients who are at higher risk for treatment failure may result in better patient outcomes. 

This study examined patients with advanced HL who had a positive PET scan after 2 rounds of escalated BEACOPP (escBEACOPP). 440 patients met these inclusion criteria. 220 patients were randomized to continue escBEACOPP treatment. 220 patients were randomized to escBEACOPP plus rituximab treatment (R-escBEACOPP). The average follow-up time was 33 months.

Patients in both groups had good outcomes. The 3-year progression free survival rate (time from treatment to disease progression) in the escBEACOPP group was 91.4%. The 3-year progression free survival rate in the R-escBEACOPP group was 93.0%. There was no significant difference in 3-year progression free survival rates between the two groups. There was also no significant difference in overall survival (time from treatment to death from any cause) between the two groups.

Both groups experienced very high levels of leukopenia (a condition where the number of white blood cells decreases) as a side effect of their treatment. 95% of escBEACOPP and 96% of R-escBEACOPP patients experienced leukopenia. The next most common side effect was severe infections, with 23% of escBEACOPP and 20% of R-escBEACOPP patients experiencing a severe infection.   

The authors concluded that adding rituximab to escalated BEACOPP therapy for patients with advanced stage HL and a positive PET scan did not improve time to disease progression. The authors noted, however, that patients with positive PET scans had very high progression-free survival rates overall.