Hodgkin lymphoma, a form of lymphoma characterized by the presence of Reed-Sternberg cells (a type of B cell), is estimated to represent 11.5% of all types of lymphoma diagnosed this year, including approximately 8,500 new cases in the United States alone.[1, 2]

According to the National Cancer Institute, the two major types of Hodgkin lymphoma are classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Symptoms include the painless enlargement of lymph nodes, spleen, or other immune tissue. Other symptoms include fever, weight loss, fatigue, or night sweats. Also called Hodgkin disease.

Hodgkin lymphoma is a type of cancer that is one of the most curable. Previous research of the HD8 trial by the German Hodgkin Study Group demonstrated that the standard treatment for early, unfavorable Hodgkin lymphoma is combination chemotherapy along with involved field radiation therapy (IF-RT) ? four cycles of ABVD chemotherapy (adriamycin, bleomycin, vinblastine, and dacarbazine) followed by IF-RT, a treatment in which radiation is delivered only to areas of the body affected by the lymphoma. Results from this study have shown that overall survival and freedom from treatment failure (time from random assignment to the occurrence of a Hodgkin lymphoma-specific event) at five years in patients treated with this particular regimen reached 91% and 83%, respectively.

In order to further improve the overall survival and freedom from treatment failure results, researchers from the German Hodgkin Study Group initiated a new study (HD14 trial) to determine whether an escalated dose of the BEACOPP chemotherapy regimen (cyclophosphamide, doxorubicin, etopodise, procarbazine, prednisone, bleomycin, and vincristine) added to standard ABVB chemotherapy would improve freedom from treatment failure in patients with early, unfavorable Hodgkin lymphoma.

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Axplora

The data of this research was presented during the 52nd Annual Meeting of the American Society of Hematology in Orlando, Florida (December 4 ? 7, 2010).

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In this study [3], a total of 1,655 patients with early, unfavorable stages of Hodgkin lymphoma were randomized to one of two treatment arms. In the control arm, 818 patients received four cycles of ABVD chemotherapy. In the experimental arm, 805 patients received two cycles of an escalated dose of BEACOPP chemotherapy followed by two cycles of ABVD chemotherapy. Following the chemotherapy regimens, all patients received 30 Gy IF-RT.

After a median follow-up of 42.4 months (about 3.5 years), the estimated four-year freedom from treatment failure rate was significantly higher in the BEACOPP arm as compared with the control arm (94.7% and 89.3%, respectively). The overall response rate to treatment was 95% in each arm of the study. No significant difference in overall survival has been seen yet.

“Results from this study demonstrate that an early intensification treatment approach with an escalated regimen of BEACOPP chemotherapy results in better overall tumor control in patients with early, unfavorable Hodgkin lymphoma,” said lead study author Andreas Engert, MD, Chairman, German Hodgkin Study Group, University Hospital Cologne in Germany. “The treatment regimen of two cycles of escalated BEACOPP followed by AVBD chemotherapy and involved-field radiation has become the new standard of care in a follow-up study we are currently conducting, and this approach continues to improve tumor control rates in these patients.”

For more information:
[1] The Leukemia & Lymphoma Society. Hodgkin Lymphoma. Accessed December 6, 2010.
[2] National Cancer Institute. Hodgkin Lymphoma . Accessed December 6, 2010.
[3] Dose-Escalation With BEACOPP Escalated Is Superior to ABVD in the Combined-Modality Treatment of Early Unfavorable Hodgkin Lymphoma: Final Analysis of the German Hodgkin Study Group (GHSG) HD14 Trial [ Abstract 765]

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