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Ann Oncol. 2012 May;23(5):1254-1259. doi: 10.1093/annonc/mdr385. Epub 2019 Dec 4.

Two escalated followed by six standard BEACOPP in advanced-stage high-risk classical Hodgkin lymphoma: high cure rates but increased risk of aseptic osteonecrosis.

Author information

1
Department of Oncology, Division of Surgery and Cancer Medicine. Electronic address: AFF@ous-hf.no.
2
Department of Oncology, Division of Surgery and Cancer Medicine.
3
Department of Radiology.
4
Department of Pathology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.

Abstract

BACKGROUND:

From 1999, Norwegian guidelines recommend two escalated (esc) BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisolone) followed by six standard (s) BEACOPP for patients with advanced-stage classical Hodgkin lymphoma (HL) with an international prognostic score (IPS) ≥4. We evaluated retrospectively the experience with this recommendation at the Norwegian Radium Hospital, also including all IPS 3 patients treated with the same regimen.

PATIENTS AND METHODS:

Forty-seven patients were treated between June 1999 and December 2008. IPS was 3 in 10 patients and ≥4 in 37.

RESULTS:

Thirty-five patients received eight cycles of BEACOPP, 12 patients received one to six cycles only, mainly due to toxicity. Sixty percent of patients had dose reductions. With median follow-up of survivors of 89 months, 5-year progression-free and overall survival are 84% [95% confidence interval (CI) 73% to 95%] and 91% (95% CI 82% to 100%), respectively. Toxicity was considerable with grade 3 or more infections/febrile neutropenia in 66% of patients, including one death and three cases of Pneumocystis jiroveci pneumonia. Of note, 10 patients (21%) experienced symptomatic aseptic osteonecrosis, of whom 3 have had hip replacement surgery after treatment.

CONCLUSION:

Two escBEACOPP plus six sBEACOPP is efficacious in advanced-stage high-risk HL. We document a high incidence of aseptic bone necrosis, possibly related to prednisolone.

KEYWORDS:

Hodgkin lymphoma; chemotherapy; osteonecrosis; steroids

PMID:
32018585
DOI:
10.1093/annonc/mdr385
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