Results from a study of 98 children and adolescents with high-risk
Hodgkins lymphoma show that early intensification with BEACOPP
chemotherapy followed by less intense response-based therapy for rapidly
responding patients was associated with high rates of event-free and overall
Researchers said these results demonstrate that early dose
intensification with escalated-dose
BEACOPP chemotherapy is not only feasible but highly
From October 1999 to May 2001, patients aged younger than 21 years who
had been diagnosed with advanced
Hodgkins lymphoma were assigned to four courses of
induction chemotherapy with escalated-dose BEACOPP administered every 21 days.
Patients who responded slowly to treatment were assigned another four more
courses of escalated-dose BEACOPP followed by 21 Gy of radiotherapy. Patients
with residual disease identified on imaging studies were assigned to an
additional 35 Gy.
Most patients (57%) had stage IV disease and the majority presented with
high-risk features including B-symptoms (70%), hilar adenopathy (73%), nodal
aggregate greater than 10 cm (61%) and three or more nodal regions involved
(74%). Sixty-four patients had bulk disease at diagnosis.
Median follow-up among patients with no reported event was 6.3 years and
91% of patients were followed for a minimum of 3 years. Five-year event-free
survival was 94% ± 2.4%. Five-year OS was 97% ± 1.9%.
Neutropenia (83%), anemia (79%) and thrombocytopenia (62%) were the most
common grade-3/grade-4 toxicities. Stomatitis, dysphagia, esophagitis and
odynophagia were the most common non-hematologic toxicities reported.
We certainly know the BEACOPP regimen is effective. What were
trying to do now is avoid using so much of the alkylator, and find children who
may not need so much doxorubicin which affects for the heart. We know BEACOPP
works, we know its a maximal therapy. For the vast majority of patients,
we can probably come up with less therapy and something that works faster.
These results present a wonderful outcome that is not compared anywhere else
and our hope is that we can continue to tailor therapy so that we can get these
sorts of outcomes across the board by knowing exactly who needs the extra
Cindy Schwartz, MD
Hasbro Children's Hospital in Providence, RI