Are two chemotherapies better than one in early unfavorable Hodgkin’s lymphoma?

This study examined the safety and effectiveness of BEACOPP chemotherapy combined with ABVD chemotherapy in patients with early unfavorable Hodgkin lymphoma. This study concluded that the combination of the two chemotherapies was more effective than ABVD alone. The combination increased the rate of negative side effects.

Standard treatment for early Hodgkin lymphoma (stages I and II) is the chemotherapy ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) combined with radiation. This treatment is standard for both favorable and unfavorable disease (a grouping based on the presence or absence of certain risk factors). This treatment is less effective in unfavorable disease than in favorable.

Advanced unfavorable Hodgkin lymphoma (stages III or IV) is often treated with another chemotherapy combination, BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone). BEACOPP can be delivered in an escalated form (higher doses). It is not clear whether escalated BEACOPP followed by ABVD would be effective in early unfavorable Hodgkin lymphoma.

This study included 1,528 patients with early unfavorable Hodgkin lymphoma. They were randomly assigned to one of two groups. Group 1 included 763 patients treated with 2 cycles of escalated BEACOPP followed by 2 cycles of ABVD. Group 2 included 765 patients treated with 4 cycles of ABVD. All patients underwent radiation after chemotherapy. Patients were followed for an average of 43 months. 

Relapse rates (return of the cancer) were lower in group 1 (2.5%) compared to group 2 (8.4%). Five-year freedom from treatment failure was 94.8% in group 1 and 87.7% in group 2.

Severe side effects were more common in group 1 patients (87.1%) compared to group 2 (50.7%). The most common side effects were hair loss and decreased bone marrow activity. This leads to fewer immune cells being produced.

This trial concluded that a combination of chemotherapies was more effective in early unfavorable Hodgkin lymphoma, but with increased rates of negative side effects.