{"entity":{"id":"ahl2011","kind":"trial","name":"AHL2011","aka":["AHL2011","Positron emission tomography-adapted de-escalation to ABVD"],"tldr":"Starting with the most intensive Hodgkin chemotherapy and switching to the gentler standard once the scan cleared gave the same results with markedly less anaemia, low platelets and infection.","summary":"AHL2011 took the opposite route from HD18 to the same place. Everyone started with two cycles of escalated BEACOPP. In the standard arm, everyone completed six cycles regardless of the scan. In the scan-driven arm, a negative scan after two cycles meant switching to four cycles of ABVD; a positive scan meant continuing with escalated BEACOPP. 823 patients aged 16 to 60 with stage III, IV or IIB disease with a large mediastinal mass or extranodal involvement were randomised at 90 centres in Belgium and France. 346 of the 410 patients in the scan-driven arm (84 per cent) switched to ABVD.\n\nAt a median follow-up of 50.4 months, five-year progression-free survival by intention to treat was 86.2 per cent (95 per cent confidence interval 81.6 to 89.8) in the standard arm and 85.7 per cent (81.4 to 89.1) in the scan-driven arm (hazard ratio 1.084, 0.737 to 1.596, p = 0.65), which met the non-inferiority margin of 10 points.\n\nThe toxicity difference is where the trial earns its place. Grade 3 to 4 anaemia fell from 69 to 28 per cent, thrombocytopenia from 66 to 40 per cent, febrile neutropenia from 35 to 23 per cent and infections from 22 to 11 per cent. Serious treatment-related adverse events fell from 47 to 28 per cent, and six treatment-related deaths occurred in the standard arm.","status":"positive","asOf":"2026-10-01","links":[{"label":"ClinicalTrials.gov NCT01358747","url":"https://clinicaltrials.gov/study/NCT01358747"},{"label":"Lancet Oncology 2019","url":"https://doi.org/10.1016/S1470-2045(18)30784-8"}],"tags":["lymphoma-evidence"],"related":[],"cancers":["advanced-stage-classical-hodgkin-lymphoma","hodgkin-lymphoma"],"sections":["chemotherapy","imaging"],"technologies":["pet-ct","cytotoxic-chemotherapy"],"targets":[],"drugs":["bleomycin","etoposide","doxorubicin","cyclophosphamide","vincristine","procarbazine","prednisone","vinblastine","dacarbazine"],"companies":["lysa"],"institutions":[],"pathways":[],"terms":["deauville-score","abvd-beacopp","non-inferiority"],"trials":["hd18","hd21","rathl"],"people":[],"bottlenecks":["b-toxicity-qol","b-survivorship"],"keyPapers":["paper-ahl2011-pet-adapted-treatment-advanced-hodgkin-lancet-oncol-2019"],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT01358747","phase":"3","setting":"Aged 16 to 60 with newly diagnosed advanced Hodgkin lymphoma: six cycles of escalated BEACOPP against a switch to ABVD after a negative scan at two cycles","sponsor":"Centre Hospitalier Universitaire Dijon (LYSA)","result":"Five-year progression-free survival 85.7 against 86.2 per cent when a negative interim scan allowed a switch to ABVD, with grade 3 to 4 anaemia falling from 69 to 28 per cent.","started":"2011-05","yearReported":2019,"enrolled":823,"enrolledBasis":"randomised","enrolledNote":"The ClinicalTrials.gov record carries no enrolment count; 823 patients were randomised in the Lancet Oncology report, 413 to standard treatment and 410 to the scan-driven arm.","outcomes":[{"endpoint":"Progression-free survival at 5 years","primary":true,"unit":"%","arms":[{"name":"Scan-driven switch to ABVD","n":410,"value":85.7,"note":"95 per cent confidence interval 81.4 to 89.1"},{"name":"Six cycles of escalated BEACOPP","n":413,"value":86.2,"note":"81.6 to 89.8"}],"hr":1.084,"ci":[0.737,1.596],"p":"0.65","source":"https://doi.org/10.1016/S1470-2045(18)30784-8"},{"endpoint":"Grade 3 to 4 anaemia","unit":"%","arms":[{"name":"Scan-driven switch to ABVD","n":407,"value":28},{"name":"Six cycles of escalated BEACOPP","n":413,"value":69}]}],"replication":"Concordant with HD18, which reached the same conclusion by shortening escalated BEACOPP rather than switching regimen."},"route":"/trials/ahl2011/","neighbours":{"cancer":[{"id":"advanced-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Advanced-stage classical Hodgkin lymphoma (stage III to IV)","route":"/cancers/advanced-stage-classical-hodgkin-lymphoma/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"},{"id":"imaging","kind":"section","name":"Imaging","route":"/fronts/imaging/"}],"technology":[{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"},{"id":"pet-ct","kind":"technology","name":"PET/CT","route":"/technologies/pet-ct/"}],"drug":[{"id":"bleomycin","kind":"drug","name":"Bleomycin","route":"/drugs/bleomycin/"},{"id":"cyclophosphamide","kind":"drug","name":"Cyclophosphamide","route":"/drugs/cyclophosphamide/"},{"id":"dacarbazine","kind":"drug","name":"Dacarbazine","route":"/drugs/dacarbazine/"},{"id":"doxorubicin","kind":"drug","name":"Doxorubicin","route":"/drugs/doxorubicin/"},{"id":"etoposide","kind":"drug","name":"Etoposide","route":"/drugs/etoposide/"},{"id":"prednisone","kind":"drug","name":"Prednisone","route":"/drugs/prednisone/"},{"id":"procarbazine","kind":"drug","name":"Procarbazine","route":"/drugs/procarbazine/"},{"id":"vinblastine","kind":"drug","name":"Vinblastine","route":"/drugs/vinblastine/"},{"id":"vincristine","kind":"drug","name":"Vincristine","route":"/drugs/vincristine/"}],"company":[{"id":"lysa","kind":"company","name":"LYSA (The Lymphoma Study Association)","route":"/companies/lysa/"}],"term":[{"id":"abvd-beacopp","kind":"term","name":"ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)","route":"/terms/abvd-beacopp/"},{"id":"deauville-score","kind":"term","name":"Deauville five-point scale","route":"/terms/deauville-score/"},{"id":"non-inferiority","kind":"term","name":"Non-inferiority trial","route":"/terms/non-inferiority/"}],"trial":[{"id":"hd18","kind":"trial","name":"GHSG HD18","route":"/trials/hd18/"},{"id":"hd21","kind":"trial","name":"GHSG HD21","route":"/trials/hd21/"},{"id":"rathl","kind":"trial","name":"RATHL","route":"/trials/rathl/"}],"bottleneck":[{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"paper":[{"id":"paper-ahl2011-pet-adapted-treatment-advanced-hodgkin-lancet-oncol-2019","kind":"paper","name":"PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study","route":"/key-papers/paper-ahl2011-pet-adapted-treatment-advanced-hodgkin-lancet-oncol-2019/"}],"roadmap":[{"id":"lymphoma-roadmap","kind":"roadmap","name":"Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting","route":"/roadmaps/lymphoma-roadmap/"}]}}