Which is the more effective and safer chemotherapy option for patients with advanced Hodgkin lymphoma?

This study compared the effectiveness and safety of ABVD and BEACOPP chemotherapy for patients with advanced Hodgkin lymphoma (HL). The authors found that while BEACOPP was more effective in the short term, ABVD was as effective in the long term and safer for patients.

Chemotherapy is the standard initial treatment for patients with advanced (stage III or IV) HL. Several chemotherapy combinations are commonly used. These include ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) and BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone).

Clinical trials showed that BEACOPP is more effective for initial control, but is also associated with more side effects compared to ABVD. However, no direct comparison of the effectiveness and safety of ABVD and BEACOPP outside of clinical trials exists.

Data from 397 patients who received chemotherapy for advanced HL was analyzed. 121 patients received BEACOPP and 276 patients received ABVD. Patients’ results were available for an average of 8.7 years.

By the end of treatment, 76% of the ABVD group and 85% of the BEACOPP group had a significant reduction in cancer. Due to side effects, 35% of the BEACOPP group and 5% of the ABVD group required a reduction in the dose of chemotherapy. 20% of the ABVD group and 14% of the BEACOPP group received radiotherapy consolidation (treatment meant to kill any remaining cancer cell after initial therapy) after chemotherapy. 

Side effects during treatment were more common with BEACOPP treatment. Low white blood cells were more common with BEACOPP treatment (61% of patients) than ABVD (24%). More patients developed low red blood cells with BEACOPP treatment (29%) than ABVD (4%).  Severe infections were more common in patients who received BEACOPP (18%) than ABVD (3%). More patients required blood transfusions after BEACOPP treatment (41%) than ABVD (6%).

The difference in treatment results after BEACOPP versus ABVD was lesser over the long term. After 8.7 years, cancer returned (relapsed) in 9% of the BEACOPP group compared to 16.6% of the ABVD group. After 8 years, 90% of the BEACOPP group and 87% of the ABVD group survived. 80% of the BEACOPP group and 75% of the ABVD group survived without cancer worsening. After 8 years, 5.8% of the BEACOPP group and less than 1% of the ABVD group developed a second type of cancer.

The authors concluded that ABVD was a safer treatment for patients with advanced HL and was similarly effective as BEACOPP over the long term.

This study used medical records data which limited the amount of information available for each patient.