Early Chemotherapy Intensification With Escalated BEACOPP in Patients With Advanced-Stage Hodgkin Lymphoma With a Positive Interim Positron Emission Tomography/Computed Tomography Scan After Two ABVD Cycles: Long-Term Results of the GITIL/FIL HD 0607 Trial

A Gallamini, C Tarella, S Viviani, A Rossi, C Patti, A Mulé, M Picardi, A Romano, M Cantonetti, G La Nasa, L Trentin, S Bolis, D Rapezzi, R Battistini, D Gottardi, P Gavarotti, P Corradini, M Cimminiello, C Schiavotto, G ParvisR Zanotti, G Gini, AJM Ferreri, P Viero, M Miglino, A Billio, A Avigdor, A Biggi, F Fallanca, U Ficola, M Gregianin, A Chiaravalloti, G Prosperini, F Bergesio, S Chauvie, C Pavoni, AM Gianni, A Rambaldi

Research output: Contribution to journalArticle

Abstract

Purpose - To investigate the progression-free survival (PFS) of patients with advanced Hodgkin lymphoma (HL) after a risk-adapted treatment strategy that was based on a positive positron emission tomography scan performed after two doxorubicin, vinblastine, vincristine, and dacarbazine (ABVD) cycles (PET2). Patients and Methods Patients with advanced-stage (IIB to IVB) HL were consecutively enrolled. After two ABVD cycles, PET2 was performed and centrally reviewed according to the Deauville five-point scale. Patients with a positive PET2 were randomly assigned to four cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) followed by four cycles of standard BEACOPP with or without rituximab. Patients with a negative PET2 continued ABVD, and those with a large nodal mass at diagnosis (≥ 5 cm) in complete remission with a negative PET at the end of chemotherapy were randomly assigned to radiotherapy or no further treatment. The primary end point was 3-year PFS. Results Of 782 enrolled patients, 150 (19%) had a positive and 630 (81%) a negative PET2. The 3-year PFS of all patients was 82%. The 3-year PFS of those with a positive and negative PET2 was 60% and 87%, respectively ( P <.001). The 3-year PFS of patients with a positive PET2 assigned to BEACOPP with or without rituximab was 63% versus 57% ( P = .53). In 296 patients with both interim and post-ABVD-negative PET who had a large nodal mass at diagnosis, radiotherapy was randomly added after chemotherapy without a significant PFS improvement (97% v 93%, respectively; P = .29). The 3-year overall survival of all 782 patients was 97% (99% and 89% for PET2 negative and positive, respectively). Conclusion The PET-driven switch from ABVD to escalated BEACOPP is feasible and effective in high-risk patients with advanced-stage HL.
Original languageEnglish
Pages (from-to)454-462
Number of pages9
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology
Volume36
Issue number5
DOIs
Publication statusPublished - 2018

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Hodgkin Disease
Drug Therapy
Disease-Free Survival
Vincristine
Doxorubicin
Positron Emission Tomography Computed Tomography
Radiotherapy
Procarbazine
Dacarbazine
Vinblastine
Bleomycin
Etoposide
Prednisone
Positron-Emission Tomography
Cyclophosphamide
Survival

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Early Chemotherapy Intensification With Escalated BEACOPP in Patients With Advanced-Stage Hodgkin Lymphoma With a Positive Interim Positron Emission Tomography/Computed Tomography Scan After Two ABVD Cycles: Long-Term Results of the GITIL/FIL HD 0607 Trial. / Gallamini, A; Tarella, C; Viviani, S; Rossi, A; Patti, C; Mulé, A; Picardi, M; Romano, A; Cantonetti, M; La Nasa, G; Trentin, L; Bolis, S; Rapezzi, D; Battistini, R; Gottardi, D; Gavarotti, P; Corradini, P; Cimminiello, M; Schiavotto, C; Parvis, G; Zanotti, R; Gini, G; Ferreri, AJM; Viero, P; Miglino, M; Billio, A; Avigdor, A; Biggi, A; Fallanca, F; Ficola, U; Gregianin, M; Chiaravalloti, A; Prosperini, G; Bergesio, F; Chauvie, S; Pavoni, C; Gianni, AM; Rambaldi, A.

In: Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Vol. 36, No. 5, 2018, p. 454-462.

Research output: Contribution to journalArticle

Gallamini, A, Tarella, C, Viviani, S, Rossi, A, Patti, C, Mulé, A, Picardi, M, Romano, A, Cantonetti, M, La Nasa, G, Trentin, L, Bolis, S, Rapezzi, D, Battistini, R, Gottardi, D, Gavarotti, P, Corradini, P, Cimminiello, M, Schiavotto, C, Parvis, G, Zanotti, R, Gini, G, Ferreri, AJM, Viero, P, Miglino, M, Billio, A, Avigdor, A, Biggi, A, Fallanca, F, Ficola, U, Gregianin, M, Chiaravalloti, A, Prosperini, G, Bergesio, F, Chauvie, S, Pavoni, C, Gianni, AM & Rambaldi, A 2018, 'Early Chemotherapy Intensification With Escalated BEACOPP in Patients With Advanced-Stage Hodgkin Lymphoma With a Positive Interim Positron Emission Tomography/Computed Tomography Scan After Two ABVD Cycles: Long-Term Results of the GITIL/FIL HD 0607 Trial', Journal of clinical oncology : official journal of the American Society of Clinical Oncology, vol. 36, no. 5, pp. 454-462. https://doi.org/10.1200/JCO.2017.75.2543
Gallamini, A ; Tarella, C ; Viviani, S ; Rossi, A ; Patti, C ; Mulé, A ; Picardi, M ; Romano, A ; Cantonetti, M ; La Nasa, G ; Trentin, L ; Bolis, S ; Rapezzi, D ; Battistini, R ; Gottardi, D ; Gavarotti, P ; Corradini, P ; Cimminiello, M ; Schiavotto, C ; Parvis, G ; Zanotti, R ; Gini, G ; Ferreri, AJM ; Viero, P ; Miglino, M ; Billio, A ; Avigdor, A ; Biggi, A ; Fallanca, F ; Ficola, U ; Gregianin, M ; Chiaravalloti, A ; Prosperini, G ; Bergesio, F ; Chauvie, S ; Pavoni, C ; Gianni, AM ; Rambaldi, A. / Early Chemotherapy Intensification With Escalated BEACOPP in Patients With Advanced-Stage Hodgkin Lymphoma With a Positive Interim Positron Emission Tomography/Computed Tomography Scan After Two ABVD Cycles: Long-Term Results of the GITIL/FIL HD 0607 Trial. In: Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2018 ; Vol. 36, No. 5. pp. 454-462.
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title = "Early Chemotherapy Intensification With Escalated BEACOPP in Patients With Advanced-Stage Hodgkin Lymphoma With a Positive Interim Positron Emission Tomography/Computed Tomography Scan After Two ABVD Cycles: Long-Term Results of the GITIL/FIL HD 0607 Trial",
abstract = "Purpose - To investigate the progression-free survival (PFS) of patients with advanced Hodgkin lymphoma (HL) after a risk-adapted treatment strategy that was based on a positive positron emission tomography scan performed after two doxorubicin, vinblastine, vincristine, and dacarbazine (ABVD) cycles (PET2). Patients and Methods Patients with advanced-stage (IIB to IVB) HL were consecutively enrolled. After two ABVD cycles, PET2 was performed and centrally reviewed according to the Deauville five-point scale. Patients with a positive PET2 were randomly assigned to four cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) followed by four cycles of standard BEACOPP with or without rituximab. Patients with a negative PET2 continued ABVD, and those with a large nodal mass at diagnosis (≥ 5 cm) in complete remission with a negative PET at the end of chemotherapy were randomly assigned to radiotherapy or no further treatment. The primary end point was 3-year PFS. Results Of 782 enrolled patients, 150 (19{\%}) had a positive and 630 (81{\%}) a negative PET2. The 3-year PFS of all patients was 82{\%}. The 3-year PFS of those with a positive and negative PET2 was 60{\%} and 87{\%}, respectively ( P <.001). The 3-year PFS of patients with a positive PET2 assigned to BEACOPP with or without rituximab was 63{\%} versus 57{\%} ( P = .53). In 296 patients with both interim and post-ABVD-negative PET who had a large nodal mass at diagnosis, radiotherapy was randomly added after chemotherapy without a significant PFS improvement (97{\%} v 93{\%}, respectively; P = .29). The 3-year overall survival of all 782 patients was 97{\%} (99{\%} and 89{\%} for PET2 negative and positive, respectively). Conclusion The PET-driven switch from ABVD to escalated BEACOPP is feasible and effective in high-risk patients with advanced-stage HL.",
author = "A Gallamini and C Tarella and S Viviani and A Rossi and C Patti and A Mul{\'e} and M Picardi and A Romano and M Cantonetti and {La Nasa}, G and L Trentin and S Bolis and D Rapezzi and R Battistini and D Gottardi and P Gavarotti and P Corradini and M Cimminiello and C Schiavotto and G Parvis and R Zanotti and G Gini and AJM Ferreri and P Viero and M Miglino and A Billio and A Avigdor and A Biggi and F Fallanca and U Ficola and M Gregianin and A Chiaravalloti and G Prosperini and F Bergesio and S Chauvie and C Pavoni and AM Gianni and A Rambaldi",
year = "2018",
doi = "10.1200/JCO.2017.75.2543",
language = "English",
volume = "36",
pages = "454--462",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "5",

}

TY - JOUR

T1 - Early Chemotherapy Intensification With Escalated BEACOPP in Patients With Advanced-Stage Hodgkin Lymphoma With a Positive Interim Positron Emission Tomography/Computed Tomography Scan After Two ABVD Cycles: Long-Term Results of the GITIL/FIL HD 0607 Trial

AU - Gallamini, A

AU - Tarella, C

AU - Viviani, S

AU - Rossi, A

AU - Patti, C

AU - Mulé, A

AU - Picardi, M

AU - Romano, A

AU - Cantonetti, M

AU - La Nasa, G

AU - Trentin, L

AU - Bolis, S

AU - Rapezzi, D

AU - Battistini, R

AU - Gottardi, D

AU - Gavarotti, P

AU - Corradini, P

AU - Cimminiello, M

AU - Schiavotto, C

AU - Parvis, G

AU - Zanotti, R

AU - Gini, G

AU - Ferreri, AJM

AU - Viero, P

AU - Miglino, M

AU - Billio, A

AU - Avigdor, A

AU - Biggi, A

AU - Fallanca, F

AU - Ficola, U

AU - Gregianin, M

AU - Chiaravalloti, A

AU - Prosperini, G

AU - Bergesio, F

AU - Chauvie, S

AU - Pavoni, C

AU - Gianni, AM

AU - Rambaldi, A

PY - 2018

Y1 - 2018

N2 - Purpose - To investigate the progression-free survival (PFS) of patients with advanced Hodgkin lymphoma (HL) after a risk-adapted treatment strategy that was based on a positive positron emission tomography scan performed after two doxorubicin, vinblastine, vincristine, and dacarbazine (ABVD) cycles (PET2). Patients and Methods Patients with advanced-stage (IIB to IVB) HL were consecutively enrolled. After two ABVD cycles, PET2 was performed and centrally reviewed according to the Deauville five-point scale. Patients with a positive PET2 were randomly assigned to four cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) followed by four cycles of standard BEACOPP with or without rituximab. Patients with a negative PET2 continued ABVD, and those with a large nodal mass at diagnosis (≥ 5 cm) in complete remission with a negative PET at the end of chemotherapy were randomly assigned to radiotherapy or no further treatment. The primary end point was 3-year PFS. Results Of 782 enrolled patients, 150 (19%) had a positive and 630 (81%) a negative PET2. The 3-year PFS of all patients was 82%. The 3-year PFS of those with a positive and negative PET2 was 60% and 87%, respectively ( P <.001). The 3-year PFS of patients with a positive PET2 assigned to BEACOPP with or without rituximab was 63% versus 57% ( P = .53). In 296 patients with both interim and post-ABVD-negative PET who had a large nodal mass at diagnosis, radiotherapy was randomly added after chemotherapy without a significant PFS improvement (97% v 93%, respectively; P = .29). The 3-year overall survival of all 782 patients was 97% (99% and 89% for PET2 negative and positive, respectively). Conclusion The PET-driven switch from ABVD to escalated BEACOPP is feasible and effective in high-risk patients with advanced-stage HL.

AB - Purpose - To investigate the progression-free survival (PFS) of patients with advanced Hodgkin lymphoma (HL) after a risk-adapted treatment strategy that was based on a positive positron emission tomography scan performed after two doxorubicin, vinblastine, vincristine, and dacarbazine (ABVD) cycles (PET2). Patients and Methods Patients with advanced-stage (IIB to IVB) HL were consecutively enrolled. After two ABVD cycles, PET2 was performed and centrally reviewed according to the Deauville five-point scale. Patients with a positive PET2 were randomly assigned to four cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) followed by four cycles of standard BEACOPP with or without rituximab. Patients with a negative PET2 continued ABVD, and those with a large nodal mass at diagnosis (≥ 5 cm) in complete remission with a negative PET at the end of chemotherapy were randomly assigned to radiotherapy or no further treatment. The primary end point was 3-year PFS. Results Of 782 enrolled patients, 150 (19%) had a positive and 630 (81%) a negative PET2. The 3-year PFS of all patients was 82%. The 3-year PFS of those with a positive and negative PET2 was 60% and 87%, respectively ( P <.001). The 3-year PFS of patients with a positive PET2 assigned to BEACOPP with or without rituximab was 63% versus 57% ( P = .53). In 296 patients with both interim and post-ABVD-negative PET who had a large nodal mass at diagnosis, radiotherapy was randomly added after chemotherapy without a significant PFS improvement (97% v 93%, respectively; P = .29). The 3-year overall survival of all 782 patients was 97% (99% and 89% for PET2 negative and positive, respectively). Conclusion The PET-driven switch from ABVD to escalated BEACOPP is feasible and effective in high-risk patients with advanced-stage HL.

U2 - 10.1200/JCO.2017.75.2543

DO - 10.1200/JCO.2017.75.2543

M3 - Article

VL - 36

SP - 454

EP - 462

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 5

ER -