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In early Hodgkin lymphoma, people whose scan was still positive after two rounds did much better on more intensive chemotherapy, and people whose scan was clear still needed their radiotherapy.
H10 tested both directions of scan-adapted treatment at once, in people with stage I and II Hodgkin lymphoma classified by the European Organisation for Research and Treatment of Cancer criteria as favourable or unfavourable. The standard arm was ABVD followed by involved-node radiotherapy irrespective of the scan. In the experimental arm, a negative scan after two cycles meant ABVD alone, tested for non-inferiority; a positive scan meant switching to two cycles of escalated BEACOPP with involved-node radiotherapy, tested for superiority.
Of 1,950 randomly assigned patients, 1,925 had an early scan and 361 (18.8 per cent) were positive. In those scan-positive patients, intensification worked: five-year progression-free survival rose from 77.4 per cent with ABVD and radiotherapy to 90.6 per cent with escalated BEACOPP and radiotherapy (hazard ratio 0.42, 95 per cent confidence interval 0.23 to 0.74, p = 0.002). In the scan-negative patients, non-inferiority of ABVD alone could not be demonstrated in either group: in the favourable group five-year progression-free survival was 99.0 per cent with combined treatment against 87.1 per cent without (hazard ratio 15.8, 3.8 to 66.1), and in the unfavourable group 92.1 against 89.6 per cent (hazard ratio 1.45, 0.8 to 2.5).
The 99.0 per cent figure in the favourable group is the most striking number in early Hodgkin lymphoma and sets the bar any radiotherapy-sparing strategy has to clear. Together with HD16 and RAPID it establishes that an interim scan identifies who needs more treatment far better than it identifies who needs less.
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.
1,925 analysed.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Progression-free survival at 5 years, scan-positive patientsprimary | Escalated BEACOPP with involved-node radiotherapy | - | 90.6% | 0.42 (0.23 to 0.74) | 0.002 | link |
| ABVD with involved-node radiotherapy | - | 77.4% | ||||
| Progression-free survival at 5 years, scan-negative favourable group | ABVD with involved-node radiotherapy | - | 99% | 15.8 (3.8 to 66.1) | - | - |
| ABVD alone | - | 87.1% | ||||
| Progression-free survival at 5 years, scan-negative unfavourable group | ABVD with involved-node radiotherapy | - | 92.1% | 1.45 (0.8 to 2.5) | - | - |
| ABVD alone | - | 89.6% |
Shares RATHL, Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Non-inferiority trial and the tag lymphoma-evidence.
Shares RATHL, Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Non-inferiority trial and the tag lymphoma-evidence.
Shares GHSG HD16, A radiotherapy-free cure for early Hodgkin lymphoma that actually holds, Deauville five-point scale, RADAR and the tag lymphoma-evidence.
Shares RATHL, Deauville five-point scale, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Non-inferiority trial 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 HD10, GHSG HD16, A radiotherapy-free cure for early Hodgkin lymphoma that actually holds, RADAR and the tag lymphoma-evidence.
Shares GHSG HD10, GHSG HD16, RADAR, Early-stage classical Hodgkin lymphoma (stage I to II) and the tag lymphoma-evidence.
Shares Non-inferiority trial, Survivorship and late effects are neglected, Prednisone, Vincristine and the tag lymphoma-evidence.