Comparing chemotherapy regimens for advanced Hodgkin lymphoma

This study compared three chemotherapy combinations, standard dose BEACOPP, increased dose BEACOPP, and COPP-ABVD, for advanced Hodgkin lymphoma. The authors concluded that increased-dose BEACOPP was more effective.

The standard chemotherapies for advanced Hodgkin lymphoma (stage III or IV or those with additional risk factors) are MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) and ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine). Roughly 30% to 40% of patients progress after these treatments or they do not respond. Other treatment options are therefore needed. Prior studies have suggested that increased doses of chemotherapy agents could improve response rates.

The current study compared three chemotherapy combinations to examine whether increased doses improved response rates. This study included 1201 patients aged 15 to 65 who were randomly assigned to one of three groups. Group 1 included 469 patients treated with standard doses of BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone). Group 2 included 466 patients treated with increased doses of BEACOPP. Group 3 included 260 patients treated with COPP-ABVD (cyclophosphamide, vincristine, procarbazine, and prednisone plus ABVD). 64% of Group 3 and 71% of Groups 1 and 2 also received radiation. Patients were followed for 51 to 72 months.

Five-year freedom from treatment failure was 76% for Group 1, 87% for Group 2, and 69% for Group 3. Five-year overall survival (time from treatment until death from any cause) was 88% for Group 1, 91% for Group 2, and 83% for Group 3. Overall survival was significantly improved in Group 2 compared to Group 3.

Serious infections occurred in 16% of those in Group 1 and 22% of Group 2. Group 2 experienced a greatly increased rate of blood toxicities (low levels of different types of blood cells) compared to Groups 1 and 3.

This study concluded that increased doses of BEACOPP improved tumor control and overall survival compared to COPP-ABVD, but with increased negative side effects. 

This study recruited patients from 1993-1998, and was published in 2003. The study stopped recruiting patients for the COPP-ABVD group due it being less effective.