Risk Adapted BEACOPP Regimen Based on Early Scintigraphy Can Reduce the Cumulative Dose of Chemotherapy for Standard and High Risk Hodgkin Lymphoma (HD) with No Impairment of Outcome.

A prospective study evaluating the outcome of HD pts whose chemotherapy was tailored based on results of scans performed after 1or 2 cycles of chemotherapy reducing the cumulative chemotherapy for early responders and maximizing the dose for late responders. Study was initiated in 1999 for patients with classical HD age 18–65y. Eligibility criteria were either stage I, II with unfavorable features (see table) or any stage III or IV HD. Those with I-II B or bulky or any Stage III-IV were defined according to IPS. Patients with standard risk were treated with 2 cycles of standard BEACOPP (SB). Those with high risk were treated with 2 cycles of escalated BEACOPP (EB). GA⁶⁷ or FDG PET scan was performed at diagnosis and after the 1st or 2nd cycle for 57 and 55 pts respectively. If the early scan remained positive then additional 4 cycles of EB were administered, otherwise, SB was given. 108 pts 44 F64 M age 18–63y (median 33) who had at least 1 year of follow up are reported. The CR rate was 97%. The 4-yr disease free (DFS) and overall survival (OS) is 84% and 90% respectively at a median follow up of 35-month (5-70). The 4-yr DFS and OS are similar for standard and high risk patients. The disease progressed in 3/10 pts with an interim positive PET versus 1/40 negative scans (p<0.03) and in 1/13 (8%) interim positive Ga⁶⁷scan versus 7/44 (16%) negative scan (NS). Negative predictive value of early normal PET and GA⁶⁷ scans are 98% and 84% respectively. Only one patient developed secondary leukemia following salvage therapy and high dose chemotherapy. One patient died during therapy from unrelated cause.

Conclusion: PET is a useful tool for early interim decision regarding dose of chemotherapy. Early PET allowed for chemotherapy reduction in 80% of high-risk pts. Only 14% of standard risk patients required dose intensification. Similar DFS and OS can be obtained regardless of IPS. 6 cycles of risk adapted BEACOPP are effective.