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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.
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.
At 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.
The 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.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
823 randomised.
95 per cent confidence interval 81.4 to 89.1 · 81.6 to 89.8
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Progression-free survival at 5 yearsprimary | Scan-driven switch to ABVD | 410 | 85.7% | 1.084 (0.737 to 1.596) | 0.65 | link |
| Six cycles of escalated BEACOPP | 413 | 86.2% | ||||
| Grade 3 to 4 anaemia | Scan-driven switch to ABVD | 407 | 28% | - | - | - |
| Six cycles of escalated BEACOPP | 413 | 69% |
Shares RATHL, Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Non-inferiority trial and the tag lymphoma-evidence.
Shares GHSG HD21, Deauville five-point scale, GHSG HD18, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens) and the tag lymphoma-evidence.
Shares Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Non-inferiority trial, Procarbazine and the tag lymphoma-evidence.
Shares GHSG HD21, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Dacarbazine, Bleomycin and the tag lymphoma-evidence.
Shares Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Dacarbazine, Bleomycin and the tag lymphoma-evidence.
Shares Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Dacarbazine, Bleomycin and the tag lymphoma-evidence.
Shares Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Dacarbazine, Bleomycin and the tag lymphoma-evidence.
Shares Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Dacarbazine, Bleomycin and the tag lymphoma-evidence.