Hodgkin lymphoma is the most common malignancy of young adults.
Intensive chemotherapy with 8 or 6 cycles of eBEACOPP is very effective in patients with advanced-stage Hodgkin’s lymphoma (HL), albeit at the expense of severe toxicities.
Aiming at better tolerability, we investigated whether metabolic response determined by positron emission tomography after two cycles (PET-2) would allow us to select patients, who could be treated with reduced intensity (4 cycles) without loss of efficacy.
The GHSG HD18 trial was conducted in five European countries (Germany, Switzerland (SAKK), Austria (AGMT), Czech Republic, Netherlands).
Between 05/2008 and 07/2014, 2101 patients aged 18–60 years with newly diagnosed, advanced-stage HL were recruited, of whom 1005 were PET-2 negative.
Reduced therapy with 4 cycles of eBEACOPP was non-inferior to 6/8 cycles in terms of five-year progression-free survival (92·2% versus 90·8%, difference 1·4%, 95% CI -2·7–5·4).
We observed no treatment related mortality in the experimental group, fewer infections, less organ toxicities and a very low incidence of second acute myeloid leukemia.
Overall, this resulted in a significantly superior five-year overall survival (97·7% versus 95·4%, log-rank p=0·004) for the patient cohort with reduced treatment.
In conclusion, treatment with 4 cycles of eBEACOPP in patients with negative PET-2 is extremely effective, very safe, short (12 weeks), and affordable.
Results for efficacy and safety compare favorably with any other published treatment strategy.
We therefore recommend PET-2-guided eBEACOPP for patients with advanced-stage HL.