Classical Hodgkin lymphoma
Section editor | |
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Tarsheen Sethi, MD, MSCI Yale University New Haven, CT, USA |
Are you looking for a regimen but can't find it here? It is possible that we've moved it to the historical regimens page. For placebo or observational studies in this condition, please visit this page. If you still can't find it, please let us know so we can add it.
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Note: certain regimens can be found on dedicated pages:
Last updated on 2024-12-02: 84 regimens on this page
137 variants on this page
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Guidelines
Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.
ASBMT
ESMO
- 2018: Eichenauer et al. Hodgkin lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up PubMed
- 2014: Eichenauer et al. Hodgkin's lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up PubMed
- 2011: Eichenauer et al. Hodgkin's lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up PubMed
- 2010: Engert et al. Hodgkin's lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up PubMed
- 2009: Engert et al. Hodgkin's lymphoma: ESMO clinical recommendations for diagnosis, treatment and follow-up PubMed
- 2008: Engert & Dreyling. Hodgkin's lymphoma: ESMO clinical recommendations for diagnosis, treatment and follow-up PubMed
- 2001: ESMO minimum clinical recommendations for diagnosis, treatment and follow-up of Hodgkin's disease PubMed
NCCN
- NCCN Guidelines - Hodgkin Lymphoma
- 2017: Hoppe et al. Hodgkin Lymphoma Version 1.2017, NCCN Clinical Practice Guidelines in Oncology PubMed
- 2015: Hoppe et al. Hodgkin lymphoma, version 2.2015 PubMed
- 2012: Hoppe et al. Hodgkin lymphoma, version 2.2012 featured updates to the NCCN guidelines. PubMed
- 2011: Hoppe et al. Hodgkin lymphoma. PubMed
- 2008: Hoppe et al. Hodgkin disease/lymphoma. PubMed
- 2006: Hoppe et al. Hodgkin disease/lymphoma. Clinical practice guidelines in oncology. PubMed
SITC
Untreated, early-stage favorable (ESF)
Note: the definition of early stage favorable varies across organizations, e.g., EORTC, GHSG, NCIC, and NCCN; see original definitions used in the trials for details.
ABVD
ABVD: Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine
Example orders
Regimen variant #1, 2 cycles
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Engert et al. 2007 (GHSG HD7) | 1993-1998 | Phase 3 (E-esc) | No chemotherapy | Superior FFTF |
Engert et al. 2010 (GHSG HD10) | 1998-2003 | Phase 3 (E-de-esc) | ABVD x 4 | Did not meet primary endpoint of FFTF |
Behringer et al. 2014 (GHSG HD13) | 2003-2009 | Phase 3 (C) | 1. ABV | Superior FFTF |
2. AV | Superior FFTF | |||
3. AVD | Might have superior FFTF | |||
Fuchs et al. 2019 (GHSG HD16) | 2009-2015 | Non-randomized part of phase 3 RCT |
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 2 cycles
Regimen variant #2, 2 cycles with response adaptation
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Raemaekers et al. 2014 (EORTC/LYSA/FIL H10 F) | 2006-2009 | Phase 3 (E-switch-ooc) | See link | See link |
Straus et al. 2018 (CALGB 50604) | 2010-2013 | Non-randomized |
Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 2 cycles
Subsequent treatment
- EORTC/LYSA/FIL H10 F, negative interim PET-CT (1 or 2 points on the 5-point Deauville scale): ABVD continuation x 2 (4 total) versus ABVD continuation x 1 (3 total) followed by INRT consolidation
- EORTC/LYSA/FIL H10 F, positive interim PET-CT: eBEACOPP salvage, then INRT consolidation
- CALGB 50604, negative interim PET-CT (1 to 3 points on the 5-point Deauville scale): ABVD continuation x 2 (4 total)
- CALGB 50604, positive interim PET-CT: eBEACOPP salvage x 2, then IFRT x 3060 cGy consolidation
Regimen variant #3, 3 cycles with response adaptation
Study | Dates of enrollment | Evidence |
---|---|---|
Radford et al. 2015 (UK NCRI RAPID) | 2003-2010 | Non-randomized part of phase 3 RCT |
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 3 cycles
Subsequent treatment
- UK NCRI RAPID, negative interim PET-CT (1 or 2 points on the 5-point Deauville scale): IFRT consolidation versus no further treatment
- UK NCRI RAPID, positive interim PET-CT: A fourth cycle of ABVD continuation, then IFRT consolidation
Regimen variant #4, 4 cycles
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Bonadonna et al. 2004 | 1990-1996 | Non-randomized part of phase 3 RCT | ||
Meyer et al. 2005 (NCIC-CTG/ECOG HD.6 F) | 1994-2002 | Phase 3 (E-switch-ooc) | STNI | Seems to have superior OS1 (primary endpoint) OS144: 94% vs 87% (HR 0.50, 95% CI 0.25-0.99) |
Engert et al. 2010 (GHSG HD10) | 1998-2003 | Phase 3 (C) | ABVD x 2 | Did not meet primary endpoint of FFTF |
1Reported efficacy for NCIC-CTG/ECOG HD.6 F is based on the 2011 update.
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 4 cycles
References
- Bonadonna G, Bonfante V, Viviani S, Di Russo A, Villani F, Valagussa P. ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin's disease: long-term results. J Clin Oncol. 2004 Jul 15;22(14):2835-41. Epub 2004 Jun 15. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- NCIC-CTG/ECOG HD.6 F: Meyer RM, Gospodarowicz MK, Connors JM, Pearcey RG, Bezjak A, Wells WA, Burns BF, Winter JN, Horning SJ, Dar AR, Djurfeldt MS, Ding K, Shepherd LE; National Cancer Institute of Canada Clinical Trials Group; ECOG. Randomized comparison of ABVD chemotherapy with a strategy that includes radiation therapy in patients with limited-stage Hodgkin's lymphoma: National Cancer Institute of Canada Clinical Trials Group and the Eastern Cooperative Oncology Group. J Clin Oncol. 2005 Jul 20;23(21):4634-42. Epub 2005 Apr 18. link to original article does not contain dosing details in manuscript PubMed NCT00002561
- Update: Meyer RM, Gospodarowicz MK, Connors JM, Pearcey RG, Wells WA, Winter JN, Horning SJ, Dar AR, Shustik C, Stewart DA, Crump M, Djurfeldt MS, Chen BE, Shepherd LE; NCIC Clinical Trials Group; ECOG. ABVD alone versus radiation-based therapy in limited-stage Hodgkin's lymphoma. N Engl J Med. 2012 Feb 2;366(5):399-408. Epub 2011 Dec 11. link to original article link to PMC article dosing details in abstract have been reviewed by our editors PubMed
- GHSG HD7: Engert A, Franklin J, Eich HT, Brillant C, Sehlen S, Cartoni C, Herrmann R, Pfreundschuh M, Sieber M, Tesch H, Franke A, Koch P, de Wit M, Paulus U, Hasenclever D, Loeffler M, Müller RP, Müller-Hermelink HK, Dühmke E, Diehl V. Two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine plus extended-field radiotherapy is superior to radiotherapy alone in early favorable Hodgkin's lymphoma: final results of the GHSG HD7 trial. J Clin Oncol. 2007 Aug 10;25(23):3495-502. Epub 2007 Jul 2. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- Pooled update: Sasse S, Bröckelmann PJ, Goergen H, Plütschow A, Müller H, Kreissl S, Buerkle C, Borchmann S, Fuchs M, Borchmann P, Diehl V, Engert A. Long-term follow-up of contemporary treatment in early-stage Hodgkin lymphoma: updated analyses of the German Hodgkin Study Group HD7, HD8, HD10, and HD11 trials. J Clin Oncol. 2017 Jun 20;35(18):1999-2007. Epub 2017 Apr 18. link to original article PubMed
- GHSG HD10: Engert A, Plütschow A, Eich HT, Lohri A, Dörken B, Borchmann P, Berger B, Greil R, Willborn KC, Wilhelm M, Debus J, Eble MJ, Sökler M, Ho A, Rank A, Ganser A, Trümper L, Bokemeyer C, Kirchner H, Schubert J, Král Z, Fuchs M, Müller-Hermelink HK, Müller RP, Diehl V. Reduced treatment intensity in patients with early-stage Hodgkin's lymphoma. N Engl J Med. 2010 Aug 12;363(7):640-52. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00265018
- Pooled subgroup analysis: Böll B, Görgen H, Fuchs M, Pluetschow A, Eich HT, Bargetzi MJ, Weidmann E, Junghanß C, Greil R, Scherpe A, Schmalz O, Eichenauer DA, von Tresckow B, Rothe A, Diehl V, Engert A, Borchmann P. ABVD in older patients with early-stage Hodgkin lymphoma treated within the German Hodgkin Study Group HD10 and HD11 trials. J Clin Oncol. 2013 Apr 20;31(12):1522-9. Epub 2013 Mar 18. link to original article PubMed
- Pooled subgroup analysis: Böll B, Goergen H, Behringer K, Bröckelmann PJ, Hitz F, Kerkhoff A, Greil R, von Tresckow B, Eichenauer DA, Bürkle C, Borchmann S, Fuchs M, Diehl V, Engert A, Borchmann P. Bleomycin in older early-stage favorable Hodgkin lymphoma patients: analysis of the German Hodgkin Study Group (GHSG) HD10 and HD13 trials. Blood. 2016 May 5;127(18):2189-92. Epub 2016 Feb 1. link to original article PubMed
- Pooled update: Sasse S, Bröckelmann PJ, Goergen H, Plütschow A, Müller H, Kreissl S, Buerkle C, Borchmann S, Fuchs M, Borchmann P, Diehl V, Engert A. Long-term follow-up of contemporary treatment in early-stage Hodgkin lymphoma: updated analyses of the German Hodgkin Study Group HD7, HD8, HD10, and HD11 trials. J Clin Oncol. 2017 Jun 20;35(18):1999-2007. Epub 2017 Apr 18. link to original article PubMed
- EORTC/LYSA/FIL H10: Raemaekers JM, André MP, Federico M, Girinsky T, Oumedaly R, Brusamolino E, Brice P, Fermé C, van der Maazen R, Gotti M, Bouabdallah R, Sebban CJ, Lievens Y, Re A, Stamatoullas A, Morschhauser F, Lugtenburg PJ, Abruzzese E, Olivier P, Casasnovas RO, van Imhoff G, Raveloarivahy T, Bellei M, van der Borght T, Bardet S, Versari A, Hutchings M, Meignan M, Fortpied C. Omitting radiotherapy in early positron emission tomography-negative stage I/II Hodgkin lymphoma is associated with an increased risk of early relapse: Clinical results of the preplanned interim analysis of the randomized EORTC/LYSA/FIL H10 trial. J Clin Oncol. 2014 Apr 20;32(12):1188-94. Epub 2014 Mar 17. link to original article does not contain dosing details in manuscript PubMed NCT00433433
- Update: André MPE, Girinsky T, Federico M, Reman O, Fortpied C, Gotti M, Casasnovas O, Brice P, van der Maazen R, Re A, Edeline V, Fermé C, van Imhoff G, Merli F, Bouabdallah R, Sebban C, Specht L, Stamatoullas A, Delarue R, Fiaccadori V, Bellei M, Raveloarivahy T, Versari A, Hutchings M, Meignan M, Raemaekers J. Early positron emission tomography response-adapted treatment in stage I and II Hodgkin lymphoma: final results of the randomized EORTC/LYSA/FIL H10 trial. J Clin Oncol. 2017 Jun 1;35(16):1786-1794. Epub 2017 Mar 14. link to original article PubMed
- Update: Federico M, Fortpied C, Stepanishyna Y, Gotti M, van der Maazen R, Cristinelli C, Re A, Plattel W, Lazarovici J, Merli F, Specht L, Schiano de Colella JM, Hutchings M, Versari A, Edeline V, Stamatoulas A, Girinsky T, Ricardi U, Aleman B, Meulemans B, Tonino S, Raemaekers J, André M. Long-Term Follow-Up of the Response-Adapted Intergroup EORTC/LYSA/FIL H10 Trial for Localized Hodgkin Lymphoma. J Clin Oncol. 2024 Jan 1;42(1):19-25. Epub 2023 Nov 15. link to original article link to PMC article PubMed
- GHSG HD13: Behringer K, Goergen H, Hitz F, Zijlstra JM, Greil R, Markova J, Sasse S, Fuchs M, Topp MS, Soekler M, Mathas S, Meissner J, Wilhelm M, Koch P, Lindemann HW, Schalk E, Semrau R, Kriz J, Vieler T, Bentz M, Lange E, Mahlberg R, Hassler A, Vogelhuber M, Hahn D, Mezger J, Krause SW, Skoetz N, Böll B, von Tresckow B, Diehl V, Hallek M, Borchmann P, Stein H, Eich H, Engert A; German Hodgkin Study Group; Swiss Group for Clinical Cancer Research; Arbeitsgemeinschaft Medikamentöse Tumortherapie. Omission of dacarbazine or bleomycin, or both, from the ABVD regimen in treatment of early-stage favourable Hodgkin's lymphoma (GHSG HD13): an open-label, randomised, non-inferiority trial. Lancet. 2015 Apr 11;385(9976):1418-27. Epub 2014 Dec 22. Erratum in: Lancet. 2015 Apr 11;385(9976):1396. link to original article does not contain dosing details in manuscript PubMed ISRCTN63474366
- Pooled subgroup analysis: Böll B, Goergen H, Behringer K, Bröckelmann PJ, Hitz F, Kerkhoff A, Greil R, von Tresckow B, Eichenauer DA, Bürkle C, Borchmann S, Fuchs M, Diehl V, Engert A, Borchmann P. Bleomycin in older early-stage favorable Hodgkin lymphoma patients: analysis of the German Hodgkin Study Group (GHSG) HD10 and HD13 trials. Blood. 2016 May 5;127(18):2189-92. Epub 2016 Feb 1. link to original article PubMed
- Retrospective: Stamatoullas A, Brice P, Bouabdallah R, Mareschal S, Camus V, Rahal I, Franchi P, Lanic H, Tilly H. Outcome of patients older than 60 years with classical Hodgkin lymphoma treated with front line ABVD chemotherapy: frequent pulmonary events suggest limiting the use of bleomycin in the elderly. Br J Haematol. 2015 Jul;170(2):179-84. Epub 2015 Apr 19. link to original article PubMed
- UK NCRI RAPID: Radford J, Illidge T, Counsell N, Hancock B, Pettengell R, Johnson P, Wimperis J, Culligan D, Popova B, Smith P, McMillan A, Brownell A, Kruger A, Lister A, Hoskin P, O'Doherty M, Barrington S. Results of a trial of PET-directed therapy for early-stage Hodgkin's lymphoma. N Engl J Med. 2015 Apr 23;372(17):1598-607. link to original article does not contain dosing details in manuscript PubMed NCT00943423
- CALGB 50604: Straus DJ, Jung SH, Pitcher B, Kostakoglu L, Grecula JC, Hsi ED, Schöder H, Popplewell LL, Chang JE, Moskowitz CH, Wagner-Johnston N, Leonard JP, Friedberg JW, Kahl BS, Cheson BD, Bartlett NL. CALGB 50604: risk-adapted treatment of nonbulky early-stage Hodgkin lymphoma based on interim PET. Blood. 2018 Sep 6;132(10):1013-1021. Epub 2018 Jul 26. link to original article dosing details in abstract have been reviewed by our editors link to PMC article PubMed NCT01132807
- GHSG HD16: Fuchs M, Goergen H, Kobe C, Kuhnert G, Lohri A, Greil R, Sasse S, Topp MS, Schäfer E, Hertenstein B, Soekler M, Vogelhuber M, Zijlstra JM, Keller UB, Krause SW, Wilhelm M, Maschmeyer G, Thiemer J, Dührsen U, Meissner J, Viardot A, Eich H, Baues C, Diehl V, Rosenwald A, von Tresckow B, Dietlein M, Borchmann P, Engert A. Positron Emission Tomography-Guided Treatment in Early-Stage Favorable Hodgkin Lymphoma: Final Results of the International, Randomized Phase III HD16 Trial by the German Hodgkin Study Group. J Clin Oncol. 2019 Nov 1;37(31):2835-2845. Epub 2019 Sep 10. link to original article PubMed NCT00736320
AVD
AVD: Adriamycin (Doxorubicin), Vinblastine, Dacarbazine
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Behringer et al. 2014 (GHSG HD13) | 2003-2009 | Phase 3 (E-de-esc) | 1. ABV | Not reported |
2. ABVD | Might have inferior FFTF (primary endpoint) | |||
3. AV | Not reported |
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 2 cycles
Subsequent treatment
- IFRT x 3000 cGy consolidation
References
- GHSG HD13: Behringer K, Goergen H, Hitz F, Zijlstra JM, Greil R, Markova J, Sasse S, Fuchs M, Topp MS, Soekler M, Mathas S, Meissner J, Wilhelm M, Koch P, Lindemann HW, Schalk E, Semrau R, Kriz J, Vieler T, Bentz M, Lange E, Mahlberg R, Hassler A, Vogelhuber M, Hahn D, Mezger J, Krause SW, Skoetz N, Böll B, von Tresckow B, Diehl V, Hallek M, Borchmann P, Stein H, Eich H, Engert A; German Hodgkin Study Group; Swiss Group for Clinical Cancer Research; Arbeitsgemeinschaft Medikamentöse Tumortherapie. Omission of dacarbazine or bleomycin, or both, from the ABVD regimen in treatment of early-stage favourable Hodgkin's lymphoma (GHSG HD13): an open-label, randomised, non-inferiority trial. Lancet. 2015 Apr 11;385(9976):1418-27. Epub 2014 Dec 22. Erratum in: Lancet. 2015 Apr 11;385(9976):1396. link to original article does not contain dosing details in manuscript PubMed ISRCTN63474366
- Pooled subgroup analysis: Böll B, Goergen H, Behringer K, Bröckelmann PJ, Hitz F, Kerkhoff A, Greil R, von Tresckow B, Eichenauer DA, Bürkle C, Borchmann S, Fuchs M, Diehl V, Engert A, Borchmann P. Bleomycin in older early-stage favorable Hodgkin lymphoma patients: analysis of the German Hodgkin Study Group (GHSG) HD10 and HD13 trials. Blood. 2016 May 5;127(18):2189-92. Epub 2016 Feb 1. link to original article PubMed
MOPP-ABV
MOPP-ABV: Mustargen (Mechlorethamine), Oncovin (Vincristine), Procarbazine, Prednisone, Adriamycin (Doxorubicin), Bleomycin, Vinblastine
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Fermé et al. 2007 (EORTC-GELA H8-F) | 1993-1999 | Phase 3 (E-switch-ooc) | See link | See link |
Chemotherapy
- Mechlorethamine (Mustargen) 6 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 1
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
- Doxorubicin (Adriamycin) 35 mg/m2 IV once on day 8
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Vinblastine (Velban) 6 mg/m2 IV once on day 8
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
28-day cycle for 3 cycles
Subsequent treatment
- IFRT consolidation, 3 to 4 weeks later
References
- EORTC-GELA H8-F: Fermé C, Eghbali H, Meerwaldt JH, Rieux C, Bosq J, Berger F, Girinsky T, Brice P, van't Veer MB, Walewski JA, Lederlin P, Tirelli U, Carde P, Van den Neste E, Gyan E, Monconduit M, Diviné M, Raemaekers JM, Salles G, Noordijk EM, Creemers GJ, Gabarre J, Hagenbeek A, Reman O, Blanc M, Thomas J, Vié B, Kluin-Nelemans JC, Viseu F, Baars JW, Poortmans P, Lugtenburg PJ, Carrie C, Jaubert J, Henry-Amar M; EORTC; GELA. Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease. N Engl J Med. 2007 Nov 8;357(19):1916-27. link to original article dosing details in supplement have been reviewed by our editors PubMed NCT00379041
Radiation therapy
RT: Radiation Therapy
Regimen variant #1, 3500 cGy of subtotal nodal irradiation (STNI)
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Meyer et al. 2005 (NCIC-CTG/ECOG HD.6 F) | 1994-2002 | Phase 3 (C) | ABVD | Seems to have inferior OS1 |
1Reported efficacy for NCIC-CTG/ECOG HD.6 F is based on the 2011 update.
Regimen variant #2, 3600 cGy of STNI + 400 cGy boost
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Fermé et al. 2007 (EORTC-GELA H8-F) | 1993-1999 | Phase 3 (C) | MOPP-ABV, then IFRT | Inferior OS |
Regimen variant #3, 4000 to 4400 cGy of subtotal lymphoid irradiation (STLI)
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Horning et al. 1988 | Not reported | Phase 3 (C) | IFRT, then VBM | Might have inferior FFP |
References
- Horning SJ, Hoppe RT, Hancock SL, Rosenberg SA; EORTC Lymphoma Cooperative Group. Vinblastine, bleomycin, and methotrexate: an effective adjuvant in favorable Hodgkin's disease. J Clin Oncol. 1988 Dec;6(12):1822-31. link to original article PubMed
- EORTC H6U: Carde P, Hagenbeek A, Hayat M, Monconduit M, Thomas J, Burgers MJ, Noordijk EM, Tanguy A, Meerwaldt JH, Le Fur R, Somers R, Kluin-Nelemans HC, Busson A, Breed WP, Bron D, Holdrinet A, Rutten EH, Michiels JJ, Regnier R, Debusscher L, Musella R, Fargeot P, Thyss A, Cattan A, Rigal-Huguet F, Roth S, Caillou B, Dupouy N, Henry-Amar M; EORTC Lymphoma Cooperative Group. Clinical staging versus laparotomy and combined modality with MOPP versus ABVD in early-stage Hodgkin's disease: the H6 twin randomized trials from the European Organisation for Research and Treatment of Cancer Lymphoma Cooperative Group. J Clin Oncol. 1993 Nov;11(11):2258-72. link to original article PubMed
- NCIC-CTG/ECOG HD.6 F: Meyer RM, Gospodarowicz MK, Connors JM, Pearcey RG, Bezjak A, Wells WA, Burns BF, Winter JN, Horning SJ, Dar AR, Djurfeldt MS, Ding K, Shepherd LE; National Cancer Institute of Canada Clinical Trials Group; ECOG. Randomized comparison of ABVD chemotherapy with a strategy that includes radiation therapy in patients with limited-stage Hodgkin's lymphoma: National Cancer Institute of Canada Clinical Trials Group and the Eastern Cooperative Oncology Group. J Clin Oncol. 2005 Jul 20;23(21):4634-42. Epub 2005 Apr 18. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00002561
- Update: Meyer RM, Gospodarowicz MK, Connors JM, Pearcey RG, Wells WA, Winter JN, Horning SJ, Dar AR, Shustik C, Stewart DA, Crump M, Djurfeldt MS, Chen BE, Shepherd LE; NCIC Clinical Trials Group; ECOG. ABVD alone versus radiation-based therapy in limited-stage Hodgkin's lymphoma. N Engl J Med. 2012 Feb 2;366(5):399-408. Epub 2011 Dec 11. link to original article link to PMC article dosing details in abstract have been reviewed by our editors PubMed
- EORTC-GELA H8-F: Fermé C, Eghbali H, Meerwaldt JH, Rieux C, Bosq J, Berger F, Girinsky T, Brice P, van't Veer MB, Walewski JA, Lederlin P, Tirelli U, Carde P, Van den Neste E, Gyan E, Monconduit M, Diviné M, Raemaekers JM, Salles G, Noordijk EM, Creemers GJ, Gabarre J, Hagenbeek A, Reman O, Blanc M, Thomas J, Vié B, Kluin-Nelemans JC, Viseu F, Baars JW, Poortmans P, Lugtenburg PJ, Carrie C, Jaubert J, Henry-Amar M; EORTC; GELA. Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease. N Engl J Med. 2007 Nov 8;357(19):1916-27. link to original article dosing details in supplement have been reviewed by our editors PubMed NCT00379041
Stanford V
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Advani et al. 2013 (G4) | 1995-2001 | Non-randomized |
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per week on weeks 1, 3, 5, 7
- Vinblastine (Velban) 6 mg/m2 IV once per week on weeks 1, 3, 5, 7
- Mechlorethamine (Mustargen) 6 mg/m2 IV once per week on weeks 1 & 5
- Etoposide (Vepesid) 60 mg/m2 IV twice per week (presumably on subsequent days) on weeks 3 & 7
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once per week on weeks 2, 4, 6, 8
- Bleomycin (Blenoxane) 5 units/m2 IV once per week on weeks 2, 4, 6, 8
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO every other day for 6 weeks, then tapered by 10 mg per day over the next 2 weeks
8-week course
Subsequent treatment
- IFRT consolidation, 1 to 3 weeks later
References
- G4: Advani RH, Hoppe RT, Baer D, Mason J, Warnke R, Allen J, Daadi S, Rosenberg SA, Horning SJ. Efficacy of abbreviated Stanford V chemotherapy and involved-field radiotherapy in early-stage Hodgkin lymphoma: mature results of the G4 trial. Ann Oncol. 2013 Apr;24(4):1044-8. Epub 2012 Nov 7. link to original article contains limited protocol link to PMC article PubMed
Untreated, early-stage unfavorable (ESU)
Note: the definition of early stage unfavorable varies across organizations, e.g., EORTC, GHSG, NCIC, and NCCN; see original definitions used in the trials for details.
ABVD
ABVD: Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine
Example orders
Regimen variant #1, 2 cycles
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Meyer et al. 2005 (NCIC-CTG/ECOG HD.6 U) | 1994-2002 | Phase 3 (C) | See link | See link |
Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 2 cycles
Subsequent treatment
- NCIC-CTG/ECOG HD.6 U: STNI consolidation
Regimen variant #2, 2 cycles with response adaptation
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Raemaekers et al. 2014 (EORTC/LYSA/FIL H10 U) | 2006-2009 | Phase 3 (E-switch-ooc) | See link | See link |
Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 2 cycles
Subsequent treatment
Regimen variant #3, 4 cycles
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Meyer et al. 2005 (NCIC-CTG/ECOG HD.6 U) | 1994-2002 | Phase 3 (E-switch-ooc) | ABVD x 2, then STNI | Seems to have superior OS1 (primary endpoint) OS144: 94% vs 87% (HR 0.50, 95% CI 0.25-0.99) |
Eich et al. 2010 (GHSG HD11) | 1998-2003 | Phase 3 (C) | BEACOPP | Did not meet primary endpoint of FFTF |
von Tresckow et al. 2012 (GHSG HD14) | 2003-2008 | Phase 3 (C) | eBEACOPP-ABVD | Inferior FFTF |
Fornecker et al. 2022 (BREACH) | 2015-03 to 2016-10 | Randomized Phase 2 (C) | BV-AVD | Inferior PET RR after 2 cycles |
1Reported efficacy for NCIC-CTG/ECOG HD.6 U is based on the 2011 update.
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 4 cycles
Regimen variant #4, 6 to 8 cycles
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Carde et al. 1993 (EORTC H6U) | 1982-1988 | Phase 3 (E-switch-ic) | MOPP | Superior FFP |
Straus et al. 2004 | 1990-2000 | Non-randomized part of phase 3 RCT | ||
Gordon et al. 2012 (ECOG E2496) | 1999-2006 | Phase 3 (C) | Stanford V | Did not meet primary endpoint of FFS |
Note: EORTC H6U included radiation delivered between cycles 3 & 4. Straus et al. 2004 enrolled patients with stages I, II, and IIIA nonbulky disease and did not distinguish between favorable or unfavorable subtypes. ECOG E2496 gives a range of cycles.
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 6 to 8 cycles
Subsequent treatment
- EORTC H6U & ECOG E2496: IFRT x 3600 cGy consolidation
- Straus et al. 2004: EFRT x 3600 cGy consolidation versus no further treatment
References
- EORTC H6U: Carde P, Hagenbeek A, Hayat M, Monconduit M, Thomas J, Burgers MJ, Noordijk EM, Tanguy A, Meerwaldt JH, Le Fur R, Somers R, Kluin-Nelemans HC, Busson A, Breed WP, Bron D, Holdrinet A, Rutten EH, Michiels JJ, Regnier R, Debusscher L, Musella R, Fargeot P, Thyss A, Cattan A, Rigal-Huguet F, Roth S, Caillou B, Dupouy N, Henry-Amar M; EORTC Lymphoma Cooperative Group. Clinical staging versus laparotomy and combined modality with MOPP versus ABVD in early-stage Hodgkin's disease: the H6 twin randomized trials from the European Organisation for Research and Treatment of Cancer Lymphoma Cooperative Group. J Clin Oncol. 1993 Nov;11(11):2258-72. link to original article PubMed
- Straus DJ, Portlock CS, Qin J, Myers J, Zelenetz AD, Moskowitz C, Noy A, Goy A, Yahalom J. Results of a prospective randomized clinical trial of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by radiation therapy (RT) versus ABVD alone for stages I, II, and IIIA nonbulky Hodgkin disease. Blood. 2004 Dec 1;104(12):3483-9. Epub 2004 Aug 17. link to original article PubMed
- NCIC-CTG/ECOG HD.6 U: Meyer RM, Gospodarowicz MK, Connors JM, Pearcey RG, Bezjak A, Wells WA, Burns BF, Winter JN, Horning SJ, Dar AR, Djurfeldt MS, Ding K, Shepherd LE; National Cancer Institute of Canada Clinical Trials Group; ECOG. Randomized comparison of ABVD chemotherapy with a strategy that includes radiation therapy in patients with limited-stage Hodgkin's lymphoma: National Cancer Institute of Canada Clinical Trials Group and the Eastern Cooperative Oncology Group. J Clin Oncol. 2005 Jul 20;23(21):4634-42. Epub 2005 Apr 18. link to original article does not contain dosing details in manuscript PubMed NCT00002561
- Update: Meyer RM, Gospodarowicz MK, Connors JM, Pearcey RG, Wells WA, Winter JN, Horning SJ, Dar AR, Shustik C, Stewart DA, Crump M, Djurfeldt MS, Chen BE, Shepherd LE; NCIC Clinical Trials Group; ECOG. ABVD alone versus radiation-based therapy in limited-stage Hodgkin's lymphoma. N Engl J Med. 2012 Feb 2;366(5):399-408. Epub 2011 Dec 11. link to original article link to PMC article dosing details in abstract have been reviewed by our editors PubMed
- GHSG HD11: Eich HT, Diehl V, Görgen H, Pabst T, Markova J, Debus J, Ho A, Dörken B, Rank A, Grosu AL, Wiegel T, Karstens JH, Greil R, Willich N, Schmidberger H, Döhner H, Borchmann P, Müller-Hermelink HK, Müller RP, Engert A. Intensified chemotherapy and dose-reduced involved-field radiotherapy in patients with early unfavorable Hodgkin's lymphoma: final analysis of the German Hodgkin Study Group HD11 trial. J Clin Oncol. 2010 Sep 20;28(27):4199-206. Epub 2010 Aug 16. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00264953
- Pooled subgroup analysis: Böll B, Görgen H, Fuchs M, Pluetschow A, Eich HT, Bargetzi MJ, Weidmann E, Junghanß C, Greil R, Scherpe A, Schmalz O, Eichenauer DA, von Tresckow B, Rothe A, Diehl V, Engert A, Borchmann P. ABVD in older patients with early-stage Hodgkin lymphoma treated within the German Hodgkin Study Group HD10 and HD11 trials. J Clin Oncol. 2013 Apr 20;31(12):1522-9. Epub 2013 Mar 18. link to original article PubMed
- Pooled update: Sasse S, Bröckelmann PJ, Goergen H, Plütschow A, Müller H, Kreissl S, Buerkle C, Borchmann S, Fuchs M, Borchmann P, Diehl V, Engert A. Long-term follow-up of contemporary treatment in early-stage Hodgkin lymphoma: updated analyses of the German Hodgkin Study Group HD7, HD8, HD10, and HD11 trials. J Clin Oncol. 2017 Jun 20;35(18):1999-2007. Epub 2017 Apr 18. link to original article PubMed
- GHSG HD14: von Tresckow B, Plütschow A, Fuchs M, Klimm B, Markova J, Lohri A, Kral Z, Greil R, Topp MS, Meissner J, Zijlstra JM, Soekler M, Stein H, Eich HT, Mueller RP, Diehl V, Borchmann P, Engert A. Dose-intensification in early unfavorable Hodgkin's lymphoma: final analysis of the German Hodgkin Study Group HD14 trial. J Clin Oncol. 2012 Mar 20;30(9):907-13. Epub 2012 Jan 23. link to original article dosing details in manuscript have been reviewed by our editors PubMed ISRCTN04761296
- ECOG E2496: Gordon LI, Hong F, Fisher RI, Bartlett NL, Connors JM, Gascoyne RD, Wagner H, Stiff PJ, Cheson BD, Gospodarowicz M, Advani R, Kahl BS, Friedberg JW, Blum KA, Habermann TM, Tuscano JM, Hoppe RT, Horning SJ. Randomized phase III trial of ABVD versus Stanford V with or without radiation therapy in locally extensive and advanced-stage Hodgkin lymphoma: An Intergroup study coordinated by the Eastern Cooperative Oncology Group (E2496). J Clin Oncol. 2013 Feb 20;31(6):684-91. Epub 2012 Nov 26. link to original article link to PMC article dosing details in supplement have been reviewed by our editors PubMed NCT00003389
- Subgroup analysis: Evens AM, Hong F, Gordon LI, Fisher RI, Bartlett NL, Connors JM, Gascoyne RD, Wagner H, Gospodarowicz M, Cheson BD, Stiff PJ, Advani R, Miller TP, Hoppe RT, Kahl BS, Horning SJ. The efficacy and tolerability of adriamycin, bleomycin, vinblastine, dacarbazine and Stanford V in older Hodgkin lymphoma patients: a comprehensive analysis from the North American intergroup trial E2496. Br J Haematol. 2013 Apr;161(1):76-86. Epub 2013 Jan 29. link to original article link to PMC article PubMed
- Subgroup analysis: Advani RH, Hong F, Fisher RI, Bartlett NL, Robinson KS, Gascoyne RD, Wagner H Jr, Stiff PJ, Cheson BD, Stewart DA, Gordon LI, Kahl BS, Friedberg JW, Blum KA, Habermann TM, Tuscano JM, Hoppe RT, Horning SJ. Randomized phase III trial comparing ABVD plus radiotherapy with the Stanford V regimen in patients with stages I or II locally extensive, bulky mediastinal Hodgkin lymphoma: a subset analysis of the North American Intergroup E2496 trial. J Clin Oncol. 2015 Jun 10;33(17):1936-42. Epub 2015 Apr 20. link to original article contains limited protocol link to PMC article PubMed
- EORTC/LYSA/FIL H10: Raemaekers JM, André MP, Federico M, Girinsky T, Oumedaly R, Brusamolino E, Brice P, Fermé C, van der Maazen R, Gotti M, Bouabdallah R, Sebban CJ, Lievens Y, Re A, Stamatoullas A, Morschhauser F, Lugtenburg PJ, Abruzzese E, Olivier P, Casasnovas RO, van Imhoff G, Raveloarivahy T, Bellei M, van der Borght T, Bardet S, Versari A, Hutchings M, Meignan M, Fortpied C. Omitting radiotherapy in early positron emission tomography-negative stage I/II Hodgkin lymphoma is associated with an increased risk of early relapse: Clinical results of the preplanned interim analysis of the randomized EORTC/LYSA/FIL H10 trial. J Clin Oncol. 2014 Apr 20;32(12):1188-94. Epub 2014 Mar 17. link to original article does not contain dosing details in manuscript PubMed NCT00433433
- Update: André MPE, Girinsky T, Federico M, Reman O, Fortpied C, Gotti M, Casasnovas O, Brice P, van der Maazen R, Re A, Edeline V, Fermé C, van Imhoff G, Merli F, Bouabdallah R, Sebban C, Specht L, Stamatoullas A, Delarue R, Fiaccadori V, Bellei M, Raveloarivahy T, Versari A, Hutchings M, Meignan M, Raemaekers J. Early positron emission tomography response-adapted treatment in stage I and II Hodgkin lymphoma: final results of the randomized EORTC/LYSA/FIL H10 trial. J Clin Oncol. 2017 Jun 1;35(16):1786-1794. Epub 2017 Mar 14. link to original article PubMed
- Update: Federico M, Fortpied C, Stepanishyna Y, Gotti M, van der Maazen R, Cristinelli C, Re A, Plattel W, Lazarovici J, Merli F, Specht L, Schiano de Colella JM, Hutchings M, Versari A, Edeline V, Stamatoulas A, Girinsky T, Ricardi U, Aleman B, Meulemans B, Tonino S, Raemaekers J, André M. Long-Term Follow-Up of the Response-Adapted Intergroup EORTC/LYSA/FIL H10 Trial for Localized Hodgkin Lymphoma. J Clin Oncol. 2024 Jan 1;42(1):19-25. Epub 2023 Nov 15. link to original article link to PMC article PubMed
- Retrospective: Stamatoullas A, Brice P, Bouabdallah R, Mareschal S, Camus V, Rahal I, Franchi P, Lanic H, Tilly H. Outcome of patients older than 60 years with classical Hodgkin lymphoma treated with front line ABVD chemotherapy: frequent pulmonary events suggest limiting the use of bleomycin in the elderly. Br J Haematol. 2015 Jul;170(2):179-84. Epub 2015 Apr 19. link to original article PubMed
- BREACH: Fornecker LM, Lazarovici J, Aurer I, Casasnovas RO, Gac AC, Bonnet C, Bouabdallah K, Feugier P, Specht L, Molina L, Touati M, Borel C, Stamatoullas A, Nicolas-Virelizier E, Pascal L, Lugtenburg P, Di Renzo N, Vander Borght T, Traverse-Glehen A, Dartigues P, Hutchings M, Versari A, Meignan M, Federico M, André M; LYSA-FIL-EORTC Intergroup. Brentuximab Vedotin Plus AVD for First-Line Treatment of Early-Stage Unfavorable Hodgkin Lymphoma (BREACH): A Multicenter, Open-Label, Randomized, Phase II Trial. J Clin Oncol. 2023 Jan 10;41(2):327-335. Epub 2022 Jul 22. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT02292979
A-AVD
A-AVD: Adcetris (Brentuximab vedotin), Adriamycin (Doxorubicin), Vinblastine, Dacarbazine
A+AVD: Adcetris (Brentuximab vedotin), Adriamycin (Doxorubicin), Vinblastine, Dacarbazine
BV + AVD: Brentuximab Vedotin, Adriamycin (Doxorubicin), Vinblastine, Dacarbazine
Regimen variant #1, uncapped BV
Study | Dates of enrollment | Evidence |
---|---|---|
Kumar et al. 2016 (MSK 13-034) | 2013-06 to 2015-02 | Phase 2 |
Antibody-drug conjugate therapy
- Brentuximab vedotin (Adcetris) 1.2 mg/kg IV once per day on days 1 & 15
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 4 cycles
Subsequent treatment
- MSK 13-034, patients with a negative repeat PET-CT: ISRT consolidation
Regimen variant #2, capped BV
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Fornecker et al. 2022 (BREACH) | 2015-03 to 2016-10 | Randomized Phase 2 (E-switch-ooc) | ABVD x 4 | Superior PET RR after 2 cycles (primary endpoint) |
Antibody-drug conjugate therapy
- Brentuximab vedotin (Adcetris) 1.2 mg/kg (maximum dose of 120 mg) IV once per day on days 1 & 15
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 4 cycles
Subsequent treatment
- IFRT x 3000 cGy consolidation
References
- MSK 13-034: Kumar A, Casulo C, Yahalom J, Schöder H, Barr PM, Caron P, Chiu A, Constine LS, Drullinsky P, Friedberg JW, Gerecitano JF, Hamilton A, Hamlin PA, Horwitz SM, Jacob AG, Matasar MJ, McArthur GN, McCall SJ, Moskowitz AJ, Noy A, Palomba ML, Portlock CS, Straus DJ, VanderEls N, Verwys SL, Yang J, Younes A, Zelenetz AD, Zhang Z, Moskowitz CH. Brentuximab vedotin and AVD followed by involved-site radiotherapy in early stage, unfavorable risk Hodgkin lymphoma. Blood. 2016 Sep 15;128(11):1458-64. Epub 2016 Jul 25. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT01868451
- BREACH: Fornecker LM, Lazarovici J, Aurer I, Casasnovas RO, Gac AC, Bonnet C, Bouabdallah K, Feugier P, Specht L, Molina L, Touati M, Borel C, Stamatoullas A, Nicolas-Virelizier E, Pascal L, Lugtenburg P, Di Renzo N, Vander Borght T, Traverse-Glehen A, Dartigues P, Hutchings M, Versari A, Meignan M, Federico M, André M; LYSA-FIL-EORTC Intergroup. Brentuximab Vedotin Plus AVD for First-Line Treatment of Early-Stage Unfavorable Hodgkin Lymphoma (BREACH): A Multicenter, Open-Label, Randomized, Phase II Trial. J Clin Oncol. 2023 Jan 10;41(2):327-335. Epub 2022 Jul 22. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT02292979
BEACOPP
BEACOPP: Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone
BEACOPPbaseline
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Eich et al. 2010 (GHSG HD11) | 1998-2003 | Phase 3 (E-esc) | ABVD | Did not meet primary endpoint of FFTF |
Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.
Chemotherapy
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Etoposide (Vepesid) 100 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 25 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 650 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
21-day cycle for 4 cycles
References
- GHSG HD11: Eich HT, Diehl V, Görgen H, Pabst T, Markova J, Debus J, Ho A, Dörken B, Rank A, Grosu AL, Wiegel T, Karstens JH, Greil R, Willich N, Schmidberger H, Döhner H, Borchmann P, Müller-Hermelink HK, Müller RP, Engert A. Intensified chemotherapy and dose-reduced involved-field radiotherapy in patients with early unfavorable Hodgkin's lymphoma: final analysis of the German Hodgkin Study Group HD11 trial. J Clin Oncol. 2010 Sep 20;28(27)99-206. Epub 2010 Aug 16. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00264953
- Pooled subgroup analysis: Böll B, Görgen H, Fuchs M, Pluetschow A, Eich HT, Bargetzi MJ, Weidmann E, Junghanß C, Greil R, Scherpe A, Schmalz O, Eichenauer DA, von Tresckow B, Rothe A, Diehl V, Engert A, Borchmann P. ABVD in older patients with early-stage Hodgkin lymphoma treated within the German Hodgkin Study Group HD10 and HD11 trials. J Clin Oncol. 2013 Apr 20;31(12):1522-9. Epub 2013 Mar 18. link to original article PubMed
- Pooled update: Sasse S, Bröckelmann PJ, Goergen H, Plütschow A, Müller H, Kreissl S, Buerkle C, Borchmann S, Fuchs M, Borchmann P, Diehl V, Engert A. Long-term follow-up of contemporary treatment in early-stage Hodgkin lymphoma: updated analyses of the German Hodgkin Study Group HD7, HD8, HD10, and HD11 trials. J Clin Oncol. 2017 Jun 20;35(18):1999-2007. Epub 2017 Apr 18. link to original article PubMed
eBEACOPP-ABVD
eBEACOPP-ABVD: escalated Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone, followed by Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
von Tresckow et al. 2012 (GHSG HD14) | 2003-2008 | Phase 3 (E-esc) | ABVD x 4 | Superior FFTF (primary endpoint) FFTF60: 94.8% vs 87.7% (HR 0.44, 95% CI 0.30-0.66) |
Borchmann et al. 2021 (GHSG HD17) | 2012-2017 | Non-randomized part of phase 3 RCT |
Chemotherapy, eBEACOPP portion (cycles 1 & 2)
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Etoposide (Vepesid) 200 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 35 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 1250 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
Glucocorticoid therapy, eBEACOPP portion (cycles 1 & 2)
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
Supportive therapy, eBEACOPP portion (cycles 1 & 2)
- Filgrastim (Neupogen) (dose not specified) SC once per day, starting on day 8, continues until ANC greater than 1000/μL for 3 consecutive days
Chemotherapy, ABVD portion (cycles 3 & 4)
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
21-day cycle for 2 cycles, then 28-day cycle for 2 cycles (eBEACOPP x 2; ABVD x 2)
Subsequent treatment
- GHSG HD14: IFRT x 3000 cGy consolidation
- GHSG HD17, PET4 positive: IFRT x 3000 cGy consolidation
- GHSG HD17, PET4 negative: IFRT x 3000 cGy consolidation versus no further treatment
References
- GHSG HD14: von Tresckow B, Plütschow A, Fuchs M, Klimm B, Markova J, Lohri A, Kral Z, Greil R, Topp MS, Meissner J, Zijlstra JM, Soekler M, Stein H, Eich HT, Mueller RP, Diehl V, Borchmann P, Engert A. Dose-intensification in early unfavorable Hodgkin's lymphoma: final analysis of the German Hodgkin Study Group HD14 trial. J Clin Oncol. 2012 Mar 20;30(9):907-13. Epub 2012 Jan 23. link to original article dosing details in manuscript have been reviewed by our editors PubMed ISRCTN04761296
- GHSG HD17: Borchmann P, Plütschow A, Kobe C, Greil R, Meissner J, Topp MS, Ostermann H, Dierlamm J, Mohm J, Thiemer J, Sökler M, Kerkhoff A, Ahlborn M, Halbsguth TV, Martin S, Keller U, Balabanov S, Pabst T, Vogelhuber M, Hüttmann A, Wilhelm M, Zijlstra JM, Moccia A, Kuhnert G, Bröckelmann PJ, von Tresckow B, Fuchs M, Klimm B, Rosenwald A, Eich H, Baues C, Marnitz S, Hallek M, Diehl V, Dietlein M, Engert A. PET-guided omission of radiotherapy in early-stage unfavourable Hodgkin lymphoma (GHSG HD17): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2021 Feb;22(2):223-234. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT01356680
EBVP
EBVP: Epirubicin, Bleomycin, Vinblastine, Prednisone
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Thomas et al. 2017 (EORTC-GELA H9-F) | 1998-2004 | Non-randomized part of phase 3 RCT |
Chemotherapy
- Epirubicin (Ellence) 70 mg/m2 IV once on day 1
- Bleomycin (Blenoxane) 10 units/m2 IM or IV once on day 1
- Vinblastine (Velban) 6 mg/m2 IV once on day 1
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 5
21-day cycle for 6 cycles
Subsequent treatment
- IFRT x 2000 cGy versus IFRT x 3600 cGy consolidation versus no further treatment
References
- EORTC-GELA H9-F: Thomas J, Fermé C, Noordijk EM, Morschhauser F, Girinsky T, Gaillard I, Lugtenburg PJ, André M, Lybeert MLM, Stamatoullas A, Beijert M, Hélias P, Eghbali H, Gabarre J, van der Maazen RWM, Jaubert J, Bouabdallah K, Boulat O, Roesink JM, Christian B, Ong F, Bordessoule D, Tertian G, Gonzalez H, Vranovsky A, Quittet P, Tirelli U, de Jong D, Audouin J, Aleman BMP, Henry-Amar M; EORTC; GELA. Comparison of 36 Gy, 20 Gy, or no radiation therapy after 6 cycles of EBVP chemotherapy and complete remission in early-stage Hodgkin lymphoma without risk factors: results of the EORTC-GELA H9-F intergroup randomized trial. Int J Radiat Oncol Biol Phys. 2018 Apr 1;100(5):1133-1145. Epub 2017 Oct 27. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00005584
MOPP-ABV
MOPP-ABV: Mustargen (Mechlorethamine), Oncovin (Vincristine), Procarbazine, Prednisone, Adriamycin (Doxorubicin), Bleomycin, Vinblastine
Regimen variant #1, 4 cycles
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Fermé et al. 2007 (EORTC-GELA H8-U) | 1993-1999 | Phase 3 (E-de-esc) | See link | See link |
Chemotherapy
- Mechlorethamine (Mustargen) 6 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 1
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
- Doxorubicin (Adriamycin) 35 mg/m2 IV once on day 8
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Vinblastine (Velban) 6 mg/m2 IV once on day 8
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
28-day cycle for 4 cycles
Regimen variant #2, 6 cycles
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Noordijk et al. 2006 (EORTC H7-U) | 1988-1993 | Phase 3 (C) | EBVP | Seems to have superior OS |
Fermé et al. 2007 (EORTC-GELA H8-U) | 1993-1999 | Phase 3 (C) | See link | See link |
Chemotherapy
- Mechlorethamine (Mustargen) 6 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 1
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
- Doxorubicin (Adriamycin) 35 mg/m2 IV once on day 8
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Vinblastine (Velban) 6 mg/m2 IV once on day 8
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
28-day cycle for 6 cycles
Subsequent treatment
- IFRT consolidation, in 3 to 4 weeks
References
- EORTC H7-U: Noordijk EM, Carde P, Dupouy N, Hagenbeek A, Krol AD, Kluin-Nelemans JC, Tirelli U, Monconduit M, Thomas J, Eghbali H, Aleman BM, Bosq J, Vovk M, Verschueren TA, Pény AM, Girinsky T, Raemaekers JM, Henry-Amar M. Combined-modality therapy for clinical stage I or II Hodgkin's lymphoma: long-term results of the European Organisation for Research and Treatment of Cancer H7 randomized controlled trials. J Clin Oncol. 2006 Jul 1;24(19):3128-35. Epub 2006 Jun 5. link to original article PubMed
- EORTC-GELA H8-U: Fermé C, Eghbali H, Meerwaldt JH, Rieux C, Bosq J, Berger F, Girinsky T, Brice P, van't Veer MB, Walewski JA, Lederlin P, Tirelli U, Carde P, Van den Neste E, Gyan E, Monconduit M, Diviné M, Raemaekers JM, Salles G, Noordijk EM, Creemers GJ, Gabarre J, Hagenbeek A, Reman O, Blanc M, Thomas J, Vié B, Kluin-Nelemans JC, Viseu F, Baars JW, Poortmans P, Lugtenburg PJ, Carrie C, Jaubert J, Henry-Amar M; EORTC; GELA. Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease. N Engl J Med. 2007 Nov 8;357(19):1916-27. link to original article dosing details in supplement have been reviewed by our editors PubMed NCT00379041
RABVD
RABVD: Rituximab, Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Kasamon et al. 2012 (J0615) | 2006 to not reported | Phase 2, fewer than 20 pts in subgroup |
Note: Patients were NOT required to have CD20+ disease.
Targeted therapy
- Rituximab (Rituxan) as follows:
- Pre-phase: 375 mg/m2 IV once one week prior to cycle 1 of ABVD
- Cycle 1: 375 mg/m2 IV once per day on days 1, 8, 15, 22
- Cycles 2, 4, 6: 375 mg/m2 IV once on day 1
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 6 to 8 cycles
References
- J0615: Kasamon YL, Jacene HA, Gocke CD, Swinnen LJ, Gladstone DE, Perkins B, Link BK, Popplewell LL, Habermann TM, Herman JM, Matsui WH, Jones RJ, Ambinder RF. Phase 2 study of rituximab-ABVD in classical Hodgkin lymphoma. Blood. 2012 May 3;119(18):4129-32. Epub 2012 Feb 16. link to original article contains partial protocol link to PMC article PubMed NCT00369681
Stanford V
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Gordon et al. 2012 (ECOG E2496) | 1999-2006 | Phase 3 (E-esc) | ABVD | Did not meet primary endpoint of FFS |
Note: In the Advani et al. 2015 subgroup analysis, the Stanford V regimen is described as "once per week for 12 weeks." However, the regimen has previously been described as being 4-week cycles for 3 cycles (same duration, but schedule is different). Until this discrepancy is resolved, we replicate the 4-week cycle version here:
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Mechlorethamine (Mustargen) 6 mg/m2 IV once on day 1
- Etoposide (Vepesid) 60 mg/m2 IV once per day on days 15 & 16
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once per day on days 8 & 22
- Bleomycin (Blenoxane) 5 units/m2 IV once per day on days 8 & 22
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO every other day (with taper in weeks 10 to 12)
28-day cycle for 3 cycles
Subsequent treatment
- IFRT x 3600 cGy consolidation
References
- ECOG E2496: Gordon LI, Hong F, Fisher RI, Bartlett NL, Connors JM, Gascoyne RD, Wagner H, Stiff PJ, Cheson BD, Gospodarowicz M, Advani R, Kahl BS, Friedberg JW, Blum KA, Habermann TM, Tuscano JM, Hoppe RT, Horning SJ. Randomized phase III trial of ABVD versus Stanford V with or without radiation therapy in locally extensive and advanced-stage Hodgkin lymphoma: An Intergroup study coordinated by the Eastern Cooperative Oncology Group (E2496). J Clin Oncol. 2013 Feb 20;31(6):684-91. Epub 2012 Nov 26. link to original article link to PMC article dosing details in supplement have been reviewed by our editors PubMed NCT00003389
- Subgroup analysis: Evens AM, Hong F, Gordon LI, Fisher RI, Bartlett NL, Connors JM, Gascoyne RD, Wagner H, Gospodarowicz M, Cheson BD, Stiff PJ, Advani R, Miller TP, Hoppe RT, Kahl BS, Horning SJ. The efficacy and tolerability of adriamycin, bleomycin, vinblastine, dacarbazine and Stanford V in older Hodgkin lymphoma patients: a comprehensive analysis from the North American intergroup trial E2496. Br J Haematol. 2013 Apr;161(1):76-86. Epub 2013 Jan 29. link to original article link to PMC article PubMed
- Subgroup analysis: Advani RH, Hong F, Fisher RI, Bartlett NL, Robinson KS, Gascoyne RD, Wagner H Jr, Stiff PJ, Cheson BD, Stewart DA, Gordon LI, Kahl BS, Friedberg JW, Blum KA, Habermann TM, Tuscano JM, Hoppe RT, Horning SJ. Randomized phase III trial comparing ABVD plus radiotherapy with the Stanford V regimen in patients with stages I or II locally extensive, bulky mediastinal Hodgkin lymphoma: a subset analysis of the North American Intergroup E2496 trial. J Clin Oncol. 2015 Jun 10;33(17):1936-42. Epub 2015 Apr 20. link to original article contains limited protocol link to PMC article PubMed
Untreated, advanced stage
Note: the definition of advanced stage varies across organizations, e.g., EORTC, GHSG, NCIC, and NCCN; see original definitions used in the trials for details.
ABVD
ABVD: Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine
Example orders
Regimen variant #1, 2 cycles with response adaptation
Study | Dates of enrollment | Evidence |
---|---|---|
Johnson et al. 2016 (RATHL) | 2008-2012 | Non-randomized part of phase 3 RCT |
Zinzani et al. 2016 (HD0801) | 2008-2013 | Non-randomized |
Gallamini et al. 2018 (GITIL/FIL HD 0607) | 2008-2014 | Non-randomized part of phase 3 RCT |
Press et al. 2016 (SWOG S0816) | 2009-2012 | Phase 2 |
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 2 cycles
Subsequent treatment
- HD0801, negative PET-CT by Juweid's criteria: ABVD continuation x 4 (6 total)
- HD0801, positive PET-CT by Juweid's criteria: IGEV salvage
- SWOG S0816 & GITIL/FIL HD 0607, negative PET-CT by Deauville score (1 to 3): ABVD continuation x 4 (6 total)
- SWOG S0816, positive PET-CT by Deauville score (4 or 5): eBEACOPP salvage
- RATHL, negative PET-CT by Deauville score (1 to 3): ABVD continuation x 4 (6 total) versus AVD de-intensification x 4
- RATHL, positive PET-CT by Deauville score (4 or 5): eBEACOPP or BEACOPP-14 salvage, specified in advance
- GITIL/FIL HD 0607, positive PET-CT by Deauville score (4 or 5): eBEACOPP versus R-BEACOPP salvage
Regimen variant #2, 3 cycles
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Santoro et al. 1987 | 1974-1982 | Phase 3 (E-switch-ic) | MOPP | Seems to have superior OS |
Note: Santoro et al. 1987 does not describe the dosages but refers to Bonadonna et al. 1982.
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 3 cycles
Regimen variant #3, 6 cycles with variant DTIC
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Bonadonna et al. 1975 | 1973-04 to 1974-01 | Phase 3 (E-switch-ic) | MOPP | Did not meet efficacy endpoints |
Note: This study clearly stated that chemotherapy was given on days 1 & 14, not days 1 & 15.
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 14
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 14
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 14
- Dacarbazine (DTIC) 150 mg/m2 IV once per day on days 1 to 5
28-day cycle for 6 cycles
Regimen variant #4, 6 cycles with lower-dose bleomycin
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Gobbi et al. 2005 (GITIL HD9601) | 1996-2000 | Phase 3 (C) | 1. MOPPEBVCAD | Did not meet primary endpoint of FFS |
2. Modified Stanford V | Superior FFS |
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 5 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 6 cycles
Subsequent treatment
- GITIL HD9601: conditioned Radiotherapy consolidation
Regimen variant #5, 6 cycles
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Federico et al. 2009 (GITIL/FIL HD2000) | 2000-2007 | Phase 3 (C) | 1. #eBEACOPP-BEACOPP; 4+2 | Did not meet primary endpoint of FFS1 |
2. COPPEBVCAD | Did not meet primary endpoint of FFS | |||
Johnson et al. 2016 (RATHL) | 2008-2012 | Non-randomized part of phase 3 RCT | ||
Zinzani et al. 2016 (HD0801) | 2008-2013 | Non-randomized | ||
Gallamini et al. 2018 (GITIL/FIL HD 0607) | 2008-2014 | Non-randomized part of phase 3 RCT | ||
Press et al. 2016 (SWOG S0816) | 2009-2012 | Phase 2 | ||
Connors et al. 2017 (ECHELON-1) | 2012-2016 | Phase 3 (C) | A-AVD | Inferior OS2 |
1Reported efficacy for GITIL/FIL HD2000 is based on the 2015 update.
2Reported efficacy for ECHELON-1 is based on the 2022 update.
Note: Zinzani et al. 2016 does not describe the details of radiotherapy. Note that ECHELON-1 specifies "up to" 6 cycles of therapy, but does not explain circumstance in which fewer than 6 would be given.
Preceding treatment
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 6 cycles (see note)
Subsequent treatment
- HD0801, with initial bulky disease: Observation versus Radiotherapy consolidation
Regimen variant #6, 8 cycles (ABVD8)
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Canellos et al. 1992 (CALGB 8251) | 1982 to not reported | Phase 3 (E-switch-ic) | 1. MOPP | Seems to have superior EFS1 |
2. MOPP/ABVD | Did not meet endpoint of OS1 | |||
Duggan et al. 2003 (CALGB-8952) | Not reported to 1995 | Phase 3 (C) | MOPP-ABV | Did not meet primary endpoint of CR rate |
Johnson et al. 2005 (UKLG LY09) | 1998-2001 | Phase 3 (C) | 1. ChlVPP/EVA 2. ChlVPP/PABlOE |
Did not meet primary endpoint of EFS |
Hoskin et al. 2009 (BNLI STANFORDV) | 1998-2006 | Phase 3 (C) | Stanford V | Did not meet primary endpoint of PFS |
Gordon et al. 2012 (ECOG E2496) | 1999-2006 | Phase 3 (C) | Stanford V | Did not meet primary endpoint of FFS |
Viviani et al. 2011 (GSM-HD) | 2000-2007 | Phase 3 (C) | BEACOPP4+4 | Seems to have inferior FFFP |
Carde et al. 2016 (EORTC 20012) | 2002-2010 | Phase 3 (C) | BEACOPP4+4 | Did not meet primary endpoint of EFS |
Mounier et al. 2014 (LYSA H34) | 2003-2008 | Phase 3 (C) | BEACOPP4+4 | Might have inferior EFS |
1Reported efficacy for CALGB 8251 is based on the 2009 update.
Note: Duggan et al. 2003 specified that chemotherapy was given until CR plus an additional two cycles, for a minimum of eight cycles and a maximum of 10 cycles. This was the upper bound of cycles in ECOG E2496
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 8 cycles
References
- Bonadonna G, Zucali R, Monfardini S, De Lena M, Uslenghi C. Combination chemotherapy of Hodgkin's disease with adriamycin, bleomycin, vinblastine, and imidazole carboxamide versus MOPP. Cancer. 1975 Jul;36(1):252-9. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- Santoro A, Bonadonna G, Valagussa P, Zucali R, Viviani S, Villani F, Pagnoni AM, Bonfante V, Musumeci R, Crippa F, Tesoro-Tess JD, Banfi A. Long-term results of combined chemotherapy-radiotherapy approach in Hodgkin's disease: superiority of ABVD plus radiotherapy versus MOPP plus radiotherapy. J Clin Oncol. 1987 Jan;5(1):27-37. link to original article does not contain dosing details in manuscript PubMed
- CALGB 8251: Canellos GP, Anderson JR, Propert KJ, Nissen N, Cooper MR, Henderson ES, Green MR, Gottlieb A, Peterson BA. Chemotherapy of advanced Hodgkin's disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med. 1992 Nov 19;327(21):1478-84. link to original article PubMed
- Update: Canellos GP, Niedzwiecki D. Long-term follow-up of Hodgkin's disease trial. N Engl J Med. 2002 May 2;346(18):1417-8. link to original article PubMed
- Update: Canellos GP, Niedzwiecki D, Johnson JL. Long-term follow-up of survival in Hodgkin's lymphoma. N Engl J Med. 2009 Dec 10;361(24):2390-1. link to original article PubMed
- CALGB-8952: Duggan DB, Petroni GR, Johnson JL, Glick JH, Fisher RI, Connors JM, Canellos GP, Peterson BA. Randomized comparison of ABVD and MOPP/ABV hybrid for the treatment of advanced Hodgkin's disease: report of an intergroup trial. J Clin Oncol. 2003 Feb 15;21(4):607-14. link to original article does not contain dosing details PubMed
- GITIL HD9601: Gobbi PG, Levis A, Chisesi T, Broglia C, Vitolo U, Stelitano C, Pavone V, Cavanna L, Santini G, Merli F, Liberati M, Baldini L, Deliliers GL, Angelucci E, Bordonaro R, Federico M; Intergruppo Italiano Linfomi. ABVD versus modified Stanford V versus MOPPEBVCAD with optional and limited radiotherapy in intermediate- and advanced-stage Hodgkin's lymphoma: final results of a multicenter randomized trial by the Intergruppo Italiano Linfomi. J Clin Oncol. 2005 Dec 20;23(36):9198-207. Epub 2005 Sep 19. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- Update: Chisesi T, Bellei M, Luminari S, Montanini A, Marcheselli L, Levis A, Gobbi P, Vitolo U, Stelitano C, Pavone V, Merli F, Liberati M, Baldini L, Bordonaro R, Pesce EA, Federico M. Long-term follow-up analysis of HD9601 trial comparing ABVD versus Stanford V versus MOPP/EBV/CAD in patients with newly diagnosed advanced-stage Hodgkin's lymphoma: a study from the Intergruppo Italiano Linfomi. J Clin Oncol. 2011 Nov 10;29(32):4227-33. Epub 2011 Oct 11. link to original article PubMed
- UKLG LY09: Johnson PW, Radford JA, Cullen MH, Sydes MR, Walewski J, Jack AS, MacLennan KA, Stenning SP, Clawson S, Smith P, Ryder D, Hancock BW; United Kingdom Lymphoma Group. Comparison of ABVD and alternating or hybrid multidrug regimens for the treatment of advanced Hodgkin's lymphoma: results of the United Kingdom Lymphoma Group LY09 Trial (ISRCTN97144519). J Clin Oncol. 2005 Dec 20;23(36):9208-18. Epub 2005 Nov 28. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00003421
- Subgroup analysis: Johnson PW, Sydes MR, Hancock BW, Cullen M, Radford JA, Stenning SP. Consolidation radiotherapy in patients with advanced Hodgkin's lymphoma: survival data from the UKLG LY09 randomized controlled trial (ISRCTN97144519). J Clin Oncol. 2010 Jul 10;28(20):3352-9. Epub 2010 May 24. link to original article PubMed
- GITIL/FIL HD2000: Federico M, Luminari S, Iannitto E, Polimeno G, Marcheselli L, Montanini A, La Sala A, Merli F, Stelitano C, Pozzi S, Scalone R, Di Renzo N, Musto P, Baldini L, Cervetti G, Angrilli F, Mazza P, Brugiatelli M, Gobbi PG; Gruppo Italiano per lo Studio dei Linfomi. ABVD compared with BEACOPP compared with CEC for the initial treatment of patients with advanced Hodgkin's lymphoma: results from the HD2000 Gruppo Italiano per lo Studio dei Linfomi Trial. J Clin Oncol. 2009 Feb 10;27(5):805-11. Epub 2009 Jan 5. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00443677
- Update: Merli F, Luminari S, Gobbi PG, Cascavilla N, Mammi C, Ilariucci F, Stelitano C, Musso M, Baldini L, Galimberti S, Angrilli F, Polimeno G, Scalzulli PR, Ferrari A, Marcheselli L, Federico M. Long-term results of the HD2000 trial comparing ABVD versus BEACOPP versus COPP-EBV-CAD in untreated patients with advanced Hodgkin lymphoma: a study by Fondazione Italiana Linfomi. J Clin Oncol. 2016 Apr 10;34(11):1175-81. Epub 2015 Dec 28. link to original article PubMed
- BNLI STANFORDV: Hoskin PJ, Lowry L, Horwich A, Jack A, Mead B, Hancock BW, Smith P, Qian W, Patrick P, Popova B, Pettitt A, Cunningham D, Pettengell R, Sweetenham J, Linch D, Johnson PW. Randomized comparison of the Stanford V regimen and ABVD in the treatment of advanced Hodgkin's Lymphoma: United Kingdom National Cancer Research Institute Lymphoma Group Study ISRCTN 64141244. J Clin Oncol. 2009 Nov 10;27(32):5390-6. Epub 2009 Sep 8. link to original article PubMed NCT00041210
- GSM-HD: Viviani S, Zinzani PL, Rambaldi A, Brusamolino E, Levis A, Bonfante V, Vitolo U, Pulsoni A, Liberati AM, Specchia G, Valagussa P, Rossi A, Zaja F, Pogliani EM, Pregno P, Gotti M, Gallamini A, Rota Scalabrini D, Bonadonna G, Gianni AM; Michelangelo Foundation; Gruppo Italiano di Terapie Innovative nei Linfomi; Intergruppo Italiano Linfomi. ABVD versus BEACOPP for Hodgkin's lymphoma when high-dose salvage is planned. N Engl J Med. 2011 Jul 21;365(3):203-12. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT01251107
- ECOG E2496: Gordon LI, Hong F, Fisher RI, Bartlett NL, Connors JM, Gascoyne RD, Wagner H, Stiff PJ, Cheson BD, Gospodarowicz M, Advani R, Kahl BS, Friedberg JW, Blum KA, Habermann TM, Tuscano JM, Hoppe RT, Horning SJ. Randomized phase III trial of ABVD versus Stanford V with or without radiation therapy in locally extensive and advanced-stage Hodgkin lymphoma: An Intergroup study coordinated by the Eastern Cooperative Oncology Group (E2496). J Clin Oncol. 2013 Feb 20;31(6):684-91. Epub 2012 Nov 26. link to original article link to PMC article dosing details in supplement have been reviewed by our editors PubMed NCT00003389
- Subgroup analysis: Evens AM, Hong F, Gordon LI, Fisher RI, Bartlett NL, Connors JM, Gascoyne RD, Wagner H, Gospodarowicz M, Cheson BD, Stiff PJ, Advani R, Miller TP, Hoppe RT, Kahl BS, Horning SJ. The efficacy and tolerability of adriamycin, bleomycin, vinblastine, dacarbazine and Stanford V in older Hodgkin lymphoma patients: a comprehensive analysis from the North American intergroup trial E2496. Br J Haematol. 2013 Apr;161(1):76-86. Epub 2013 Jan 29. link to original article link to PMC article PubMed
- Subgroup analysis: Advani RH, Hong F, Fisher RI, Bartlett NL, Robinson KS, Gascoyne RD, Wagner H Jr, Stiff PJ, Cheson BD, Stewart DA, Gordon LI, Kahl BS, Friedberg JW, Blum KA, Habermann TM, Tuscano JM, Hoppe RT, Horning SJ. Randomized phase III trial comparing ABVD plus radiotherapy with the Stanford V regimen in patients with stages I or II locally extensive, bulky mediastinal Hodgkin lymphoma: a subset analysis of the North American Intergroup E2496 trial. J Clin Oncol. 2015 Jun 10;33(17):1936-42. Epub 2015 Apr 20. link to original article contains limited protocol link to PMC article PubMed
- LYSA H34: Mounier N, Brice P, Bologna S, Briere J, Gaillard I, Heczko M, Gabarre J, Casasnovas O, Jaubert J, Colin P, Delmer A, Devidas A, Bachy E, Nicolas-Virelizier E, Aoudjhane A, Humbrecht C, Andre M, Carde P; Lymphoma Study Association. ABVD (8 cycles) versus BEACOPP (4 escalated cycles ≥4 baseline): final results in stage III-IV low-risk Hodgkin lymphoma (IPS 0-2) of the LYSA H34 randomized trial. Ann Oncol. 2014 Aug;25(8):1622-8. Epub 2014 May 14. link to original article dosing details in manuscript have been reviewed by our editors PubMed RECF0219
- Retrospective: Stamatoullas A, Brice P, Bouabdallah R, Mareschal S, Camus V, Rahal I, Franchi P, Lanic H, Tilly H. Outcome of patients older than 60 years with classical Hodgkin lymphoma treated with front line ABVD chemotherapy: frequent pulmonary events suggest limiting the use of bleomycin in the elderly. Br J Haematol. 2015 Jul;170(2):179-84. Epub 2015 Apr 19. link to original article PubMed
- HD0801: Zinzani PL, Broccoli A, Gioia DM, Castagnoli A, Ciccone G, Evangelista A, Santoro A, Ricardi U, Bonfichi M, Brusamolino E, Rossi G, Anastasia A, Zaja F, Vitolo U, Pavone V, Pulsoni A, Rigacci L, Gaidano G, Stelitano C, Salvi F, Rusconi C, Tani M, Freilone R, Pregno P, Borsatti E, Sacchetti GM, Argnani L, Levis A. Interim positron emission tomography response-adapted therapy in advanced-stage Hodgkin lymphoma: final results of the phase II part of the HD0801 study. J Clin Oncol. 2016 Apr 20;34(12):1376-85. Epub 2016 Feb 16. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00784537
- SWOG S0816: Press OW, Li H, Schöder H, Straus DJ, Moskowitz CH, LeBlanc M, Rimsza LM, Bartlett NL, Evens AM, Mittra ES, LaCasce AS, Sweetenham JW, Barr PM, Fanale MA, Knopp MV, Noy A, Hsi ED, Cook JR, Lechowicz MJ, Gascoyne RD, Leonard JP, Kahl BS, Cheson BD, Fisher RI, Friedberg JW. US Intergroup trial of response-adapted therapy for stage III to IV Hodgkin lymphoma using early interim fluorodeoxyglucose-positron emission tomography imaging: Southwest Oncology Group S0816. J Clin Oncol. 2016 Jun 10;34(17):2020-7. Epub 2016 Apr 11. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT00822120
- Update: Stephens DM, Li H, Schöder H, Straus DJ, Moskowitz CH, LeBlanc M, Rimsza LM, Bartlett NL, Evens AM, LaCasce AS, Barr PM, Knopp MV, Hsi ED, Leonard JP, Kahl BS, Smith SM, Friedberg JW. Five-year follow-up of SWOG S0816: limitations and values of a PET-adapted approach with stage III/IV Hodgkin lymphoma. Blood. 2019 Oct 10;134(15):1238-1246. link to original article link to PMC article PubMed
- EORTC 20012: Carde P, Karrasch M, Fortpied C, Brice P, Khaled H, Casasnovas O, Caillot D, Gaillard I, Bologna S, Ferme C, Lugtenburg PJ, Morschhauser F, Aurer I, Coiffier B, Meyer R, Seftel M, Wolf M, Glimelius B, Sureda A, Mounier N. Eight cycles of ABVD versus four cycles of BEACOPPescalated plus four cycles of BEACOPPbaseline in stage III to IV, International Prognostic Score ≥ 3, high-risk Hodgkin lymphoma: First results of the phase III EORTC 20012 Intergroup trial. J Clin Oncol. 2016 Jun 10;34(17):2028-36. Epub 2016 Apr 25. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00049595
- RATHL: Johnson P, Federico M, Kirkwood A, Fosså A, Berkahn L, Carella A, d'Amore F, Enblad G, Franceschetto A, Fulham M, Luminari S, O'Doherty M, Patrick P, Roberts T, Sidra G, Stevens L, Smith P, Trotman J, Viney Z, Radford J, Barrington S. Adapted treatment guided by interim PET-CT scan in advanced Hodgkin's lymphoma. N Engl J Med. 2016 Jun 23;374(25):2419-29. link to original article link to protocol dosing details in supplement have been reviewed by our editors link to PMC article PubMed NCT00678327
- Update: Luminari S, Fossa A, Trotman J, Molin D, d'Amore F, Enblad G, Berkahn L, Barrington SF, Radford J, Federico M, Kirkwood AA, Johnson PWM. Long-Term Follow-Up of the Response-Adjusted Therapy for Advanced Hodgkin Lymphoma Trial. J Clin Oncol. 2024 Jan 1;42(1):13-18. Epub 2023 Oct 26. link to original article link to PMC article PubMed
- ECHELON-1: Connors JM, Jurczak W, Straus DJ, Ansell SM, Kim WS, Gallamini A, Younes A, Alekseev S, Illés Á, Picardi M, Lech-Maranda E, Oki Y, Feldman T, Smolewski P, Savage KJ, Bartlett NL, Walewski J, Chen R, Ramchandren R, Zinzani PL, Cunningham D, Rosta A, Josephson NC, Song E, Sachs J, Liu R, Jolin HA, Huebner D, Radford J; ECHELON-1 Study Group. Brentuximab vedotin with chemotherapy for stage III or IV Hodgkin's lymphoma. N Engl J Med. 2018 Jan 25;378(4):331-344. Epub 2017 Dec 10. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT01712490
- Subgroup analysis: Ramchandren R, Advani RH, Ansell SM, Bartlett NL, Chen R, Connors JM, Feldman T, Forero-Torres A, Friedberg JW, Gopal AK, Gordon LI, Kuruvilla J, Savage KJ, Younes A, Engley G, Manley TJ, Fenton K, Straus DJ. Brentuximab vedotin plus chemotherapy in North American subjects with newly diagnosed stage III or IV Hodgkin lymphoma. Clin Cancer Res. 2019 Mar 15;25(6):1718-1726. Epub 2019 Jan 7. link to original article PubMed
- Update: Straus DJ, Długosz-Danecka M, Alekseev S, Illés Á, Picardi M, Lech-Maranda E, Feldman T, Smolewski P, Savage KJ, Bartlett NL, Walewski J, Ramchandren R, Zinzani PL, Hutchings M, Connors JM, Radford J, Munoz J, Kim WS, Advani R, Ansell SM, Younes A, Miao H, Liu R, Fenton K, Forero-Torres A, Gallamini A. Brentuximab vedotin with chemotherapy for stage III/IV classical Hodgkin lymphoma: 3-year update of the ECHELON-1 study. Blood. 2020 Mar 5;135(10):735-742. link to original article PubMed
- Update: Straus DJ, Długosz-Danecka M, Connors JM, Alekseev S, Illés Á, Picardi M, Lech-Maranda E, Feldman T, Smolewski P, Savage KJ, Bartlett NL, Walewski J, Ramchandren R, Zinzani PL, Hutchings M, Munoz J, Lee HJ, Kim WS, Advani R, Ansell SM, Younes A, Gallamini A, Liu R, Little M, Fenton K, Fanale M, Radford J. Brentuximab vedotin with chemotherapy for stage III or IV classical Hodgkin lymphoma (ECHELON-1): 5-year update of an international, open-label, randomised, phase 3 trial. Lancet Haematol. 2021 Jun;8(6):e410-e421. link to original article PubMed
- Update: Ansell SM, Radford J, Connors JM, Długosz-Danecka M, Kim WS, Gallamini A, Ramchandren R, Friedberg JW, Advani R, Hutchings M, Evens AM, Smolewski P, Savage KJ, Bartlett NL, Eom HS, Abramson JS, Dong C, Campana F, Fenton K, Puhlmann M, Straus DJ; ECHELON-1 Study Group. Overall Survival with Brentuximab Vedotin in Stage III or IV Hodgkin's Lymphoma. N Engl J Med. 2022 Jul 28;387(4):310-320. Epub 2022 Jul 13. link to original article PubMed
- GITIL/FIL HD 0607: Gallamini A, Tarella C, Viviani S, Rossi A, Patti C, Mulé A, Picardi M, Romano A, Cantonetti M, La Nasa G, Trentin L, Bolis S, Rapezzi D, Battistini R, Gottardi D, Gavarotti P, Corradini P, Cimminiello M, Schiavotto C, Parvis G, Zanotti R, Gini G, Ferreri AJM, Viero P, Miglino M, Billio A, Avigdor A, Biggi A, Fallanca F, Ficola U, Gregianin M, Chiaravalloti A, Prosperini G, Bergesio F, Chauvie S, Pavoni C, Gianni AM, Rambaldi A. Early chemotherapy intensification with escalated BEACOPP in patients with advanced-stage Hodgkin lymphoma with a positive interim positron emission tomography/computed tomography scan after two ABVD cycles: long-term results of the GITIL/FIL HD 0607 trial. J Clin Oncol. 2018 Feb 10;36(5):454-462. Epub 2018 Jan 23. link to original article does not contain dosing details in manuscript PubMed NCT00795613
- Update: Gallamini A, Rossi A, Patti C, Picardi M, Romano A, Cantonetti M, Oppi S, Viviani S, Bolis S, Trentin L, Gini G, Battistini R, Chauvie S, Sorasio R, Pavoni C, Zanotti R, Cimminiello M, Schiavotto C, Viero P, Mulé A, Fallanca F, Ficola U, Tarella C, Guerra L, Rambaldi A. Consolidation Radiotherapy Could Be Safely Omitted in Advanced Hodgkin Lymphoma With Large Nodal Mass in Complete Metabolic Response After ABVD: Final Analysis of the Randomized GITIL/FIL HD0607 Trial. J Clin Oncol. 2020 Nov 20;38(33):3905-3913. Epub 2020 Sep 18. Erratum in: J Clin Oncol. 2021 Jan 1;39(1):96. link to original article PubMed
ABVD, DD-DI
ABVD, DD-DI: Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine, Dose-Dense and Dose-Intense
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Russo et al. 2014 | 2004-06 to 2010-03 | Phase 2 |
Chemotherapy
- Doxorubicin (Adriamycin) as follows:
- Cycles 1 to 4: 35 mg/m2 IV once per day on days 1 & 11
- Cycles 5 & 6: 25 mg/m2 IV once per day on days 1 & 11
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 11
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 11
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 11
Supportive therapy
- Lenograstim (Granocyte) 263 mcg SC once per day on days 6 to 8, 17 to 19
21-day cycle for 6 cycles
References
- Russo F, Corazzelli G, Frigeri F, Capobianco G, Aloj L, Volzone F, De Chiara A, Bonelli A, Gatani T, Marcacci G, Donnarumma D, Becchimanzi C, de Lutio E, Ionna F, De Filippi R, Lastoria S, Pinto A. A phase II study of dose-dense and dose-intense ABVD (ABVD(DD-DI) ) without consolidation radiotherapy in patients with advanced Hodgkin lymphoma. Br J Haematol. 2014 Jul;166(1):118-29. Epub 2014 Mar 27. link to original article dosing details in manuscript have been reviewed by our editors PubMed
AVD
AVD: Adriamycin (Doxorubicin), Vinblastine, Dacarbazine
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Johnson et al. 2016 (RATHL) | 2008-2012 | Phase 3 (E-de-esc) | ABVD | Non-inferior PFS361 (primary endpoint) |
1Reported efficacy is based on the 2023 update.
Preceding treatment
- ABVD induction x 2
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 4 cycles
References
- RATHL: Johnson P, Federico M, Kirkwood A, Fosså A, Berkahn L, Carella A, d'Amore F, Enblad G, Franceschetto A, Fulham M, Luminari S, O'Doherty M, Patrick P, Roberts T, Sidra G, Stevens L, Smith P, Trotman J, Viney Z, Radford J, Barrington S. Adapted treatment guided by interim PET-CT scan in advanced Hodgkin's lymphoma. N Engl J Med. 2016 Jun 23;374(25):2419-29. link to original article link to protocol dosing details in supplement have been reviewed by our editors link to PMC article PubMed NCT00678327
- Update: Luminari S, Fossa A, Trotman J, Molin D, d'Amore F, Enblad G, Berkahn L, Barrington SF, Radford J, Federico M, Kirkwood AA, Johnson PWM. Long-Term Follow-Up of the Response-Adjusted Therapy for Advanced Hodgkin Lymphoma Trial. J Clin Oncol. 2024 Jan 1;42(1):13-18. Epub 2023 Oct 26. link to original article link to PMC article PubMed
A-AVD
A-AVD: Adcetris (Brentuximab vedotin), Adriamycin (Doxorubicin), Vinblastine, Dacarbazine
A+AVD: Adcetris (Brentuximab vedotin), Adriamycin (Doxorubicin), Vinblastine, Dacarbazine
B-AVD: Brentuximab vedotin, Adriamycin (Doxorubicin), Vinblastine, Dacarbazine
AVD-A: Adriamycin (Doxorubicin), Vinblastine, Dacarbazine, Adcetris (Brentuximab vedotin)
BV-AVD: Brentuximab, Vedotin, Adriamycin (Doxorubicin), Vinblastine, Dacarbazine
Regimen variant #1, uncapped brentuximab vedotin
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Younes et al. 2013 (SGN35-009) | 2010-2012 | Phase 1 | ||
Connors et al. 2017 (ECHELON-1) | 2012-2016 | Phase 3 (E-RT-switch-ooc) | ABVD | Seems to have superior mPFS (primary endpoint) mPFS24: 82.1% vs 77.2% (HR 0.77, 95% CI 0.60-0.98) Superior OS1 (secondary endpoint) OS72: 93.9% vs 89.4% (HR 0.59, 95% CI 0.40-0.88) |
1Reported efficacy for ECHELON-1 is based on the 2022 update.
Note: SGN35-009 was a phase I trial but had greater than 20 patients in the MTD expansion cohort.
Antibody-drug conjugate therapy
- Brentuximab vedotin (Adcetris) 1.2 mg/kg IV once per day on days 1 & 15, given fourth, within about 1 hour of AVD infusion completion
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for up to 6 cycles
Subsequent treatment
- SGN35-009: Consolidation radiotherapy was permitted at the investigator's discretion
Regimen variant #2, capped brentuximab vedotin
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Herrera et al. 2024 (SWOG S1826) | 2019-07-19 to 2022-10-05 | Phase 3 (C) | N-AVD | Inferior PFS |
Antibody-drug conjugate therapy
- Brentuximab vedotin (Adcetris) 1.2 mg/kg (maximum dose of 120 mg) IV once per day on days 1 & 15
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 6 cycles
References
- SGN35-009: Younes A, Connors JM, Park SI, Fanale M, O'Meara MM, Hunder NN, Huebner D, Ansell SM. Brentuximab vedotin combined with ABVD or AVD for patients with newly diagnosed Hodgkin's lymphoma: a phase 1, open-label, dose-escalation study. Lancet Oncol. 2013 Dec;14(13):1348-56. Epub 2013 Nov 15. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT01060904
- Update: Connors JM, Ansell SM, Fanale M, Park SI, Younes A. Five-year follow-up of brentuximab vedotin combined with ABVD or AVD for advanced-stage classical Hodgkin lymphoma. Blood. 2017 Sep 14;130(11):1375-1377. Epub 2017 Jul 21. link to original article link to PMC article PubMed
- ECHELON-1: Connors JM, Jurczak W, Straus DJ, Ansell SM, Kim WS, Gallamini A, Younes A, Alekseev S, Illés Á, Picardi M, Lech-Maranda E, Oki Y, Feldman T, Smolewski P, Savage KJ, Bartlett NL, Walewski J, Chen R, Ramchandren R, Zinzani PL, Cunningham D, Rosta A, Josephson NC, Song E, Sachs J, Liu R, Jolin HA, Huebner D, Radford J; ECHELON-1 Study Group. Brentuximab vedotin with chemotherapy for stage III or IV Hodgkin's lymphoma. N Engl J Med. 2018 Jan 25;378(4):331-344. Epub 2017 Dec 10. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT01712490
- Subgroup analysis: Ramchandren R, Advani RH, Ansell SM, Bartlett NL, Chen R, Connors JM, Feldman T, Forero-Torres A, Friedberg JW, Gopal AK, Gordon LI, Kuruvilla J, Savage KJ, Younes A, Engley G, Manley TJ, Fenton K, Straus DJ. Brentuximab vedotin plus chemotherapy in North American subjects with newly diagnosed stage III or IV Hodgkin lymphoma. Clin Cancer Res. 2019 Mar 15;25(6):1718-1726. Epub 2019 Jan 7. link to original article PubMed
- Update: Straus DJ, Długosz-Danecka M, Alekseev S, Illés Á, Picardi M, Lech-Maranda E, Feldman T, Smolewski P, Savage KJ, Bartlett NL, Walewski J, Ramchandren R, Zinzani PL, Hutchings M, Connors JM, Radford J, Munoz J, Kim WS, Advani R, Ansell SM, Younes A, Miao H, Liu R, Fenton K, Forero-Torres A, Gallamini A. Brentuximab vedotin with chemotherapy for stage III/IV classical Hodgkin lymphoma: 3-year update of the ECHELON-1 study. Blood. 2020 Mar 5;135(10):735-742. link to original article PubMed
- Update: Straus DJ, Długosz-Danecka M, Connors JM, Alekseev S, Illés Á, Picardi M, Lech-Maranda E, Feldman T, Smolewski P, Savage KJ, Bartlett NL, Walewski J, Ramchandren R, Zinzani PL, Hutchings M, Munoz J, Lee HJ, Kim WS, Advani R, Ansell SM, Younes A, Gallamini A, Liu R, Little M, Fenton K, Fanale M, Radford J. Brentuximab vedotin with chemotherapy for stage III or IV classical Hodgkin lymphoma (ECHELON-1): 5-year update of an international, open-label, randomised, phase 3 trial. Lancet Haematol. 2021 Jun;8(6):e410-e421. link to original article PubMed
- Update: Ansell SM, Radford J, Connors JM, Długosz-Danecka M, Kim WS, Gallamini A, Ramchandren R, Friedberg JW, Advani R, Hutchings M, Evens AM, Smolewski P, Savage KJ, Bartlett NL, Eom HS, Abramson JS, Dong C, Campana F, Fenton K, Puhlmann M, Straus DJ; ECHELON-1 Study Group. Overall Survival with Brentuximab Vedotin in Stage III or IV Hodgkin's Lymphoma. N Engl J Med. 2022 Jul 28;387(4):310-320. Epub 2022 Jul 13. link to original article PubMed
- SWOG S1826: Herrera AF, LeBlanc M, Castellino SM, Li H, Rutherford SC, Evens AM, Davison K, Punnett A, Parsons SK, Ahmed S, Casulo C, Bartlett NL, Tuscano JM, Mei MG, Hess BT, Jacobs R, Saeed H, Torka P, Hu B, Moskowitz C, Kaur S, Goyal G, Forlenza C, Doan A, Lamble A, Kumar P, Chowdhury S, Brinker B, Sharma N, Singh A, Blum KA, Perry AM, Kovach A, Hodgson D, Constine LS, Shields LK, Prica A, Dillon H, Little RF, Shipp MA, Crump M, Kahl B, Leonard JP, Smith SM, Song JY, Kelly KM, Friedberg JW. Nivolumab+AVD in Advanced-Stage Classic Hodgkin's Lymphoma. N Engl J Med. 2024 Oct 17;391(15):1379-1389. link to original article link to PMC article dosing details in manuscript have been reviewed by our editors PubMed NCT03907488
BEACOPP
BEACOPP: Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone
bBEACOPP: baseline Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Diehl et al. 1997 | 1991-1993 | Non-randomized | ORR: 93% | |
Diehl et al. 1998 (GHSG HD9) | 1993-1998 | Phase 3 (E-switch-ic) | 1. Escalated dose BEACOPP | Inferior FFTF |
2. COPP/ABVD | Seems to have superior OS |
Note: this is technically "BEACOPP II." The original "BEACOPP I" is detailed in Diehl et al. 1997 but is of historical interest, only.
Chemotherapy
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Etoposide (Vepesid) 100 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 25 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 650 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
21-day cycle for 8 cycles
References
- Diehl V, Sieber M, Rüffer U, Lathan B, Hasenclever D, Pfreundschuh M, Loeffler M, Lieberz D, Koch P, Adler M, Tesch H; German Hodgkin's Lymphoma Study Group. BEACOPP: an intensified chemotherapy regimen in advanced Hodgkin's disease. Ann Oncol. 1997 Feb;8(2):143-8. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- GHSG HD9: Diehl V, Franklin J, Hasenclever D, Tesch H, Pfreundschuh M, Lathan B, Paulus U, Sieber M, Rueffer JU, Sextro M, Engert A, Wolf J, Hermann R, Holmer L, Stappert-Jahn U, Winnerlein-Trump E, Wulf G, Krause S, Glunz A, von Kalle K, Bischoff H, Haedicke C, Duehmke E, Georgii A, Loeffler M. BEACOPP, a new dose-escalated and accelerated regimen, is at least as effective as COPP/ABVD in patients with advanced-stage Hodgkin's lymphoma: interim report from a trial of the German Hodgkin's Lymphoma Study Group. J Clin Oncol. 1998 Dec;16(12):3810-21. link to original articledosing details in manuscript have been reviewed by our editors PubMed
- Update: Diehl V, Franklin J, Pfreundschuh M, Lathan B, Paulus U, Hasenclever D, Tesch H, Herrmann R, Dörken B, Müller-Hermelink HK, Dühmke E, Loeffler M; German Hodgkin's Lymphoma Study Group. Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin's disease. N Engl J Med. 2003 Jun 12;348(24):2386-95. Erratum in: N Engl J Med. 2005 Aug 18;353(7):744. link to original article dosing details in abstract have been reviewed by our editors PubMed
- Update: Engert A, Diehl V, Franklin J, Lohri A, Dörken B, Ludwig WD, Koch P, Hänel M, Pfreundschuh M, Wilhelm M, Trümper L, Aulitzky WE, Bentz M, Rummel M, Sezer O, Müller-Hermelink HK, Hasenclever D, Löffler M. Escalated-dose BEACOPP in the treatment of patients with advanced-stage Hodgkin's lymphoma: 10 years of follow-up of the GHSG HD9 study. J Clin Oncol. 2009 Sep 20;27(27):4548-54. Epub 2009 Aug 24. link to original article PubMed
- Pooled update: von Tresckow B, Kreissl S, Dipl-Math HG, Bröckelmann PJ, Pabst T, Fridrik M, Rummel M, Jung W, Thiemer J, Sasse S, Bürkle C, Baues C, Diehl V, Engert A, Borchmann P; German Hodgkin Study Group. Intensive treatment strategies in advanced-stage Hodgkin's lymphoma (HD9 and HD12): analysis of long-term survival in two randomised trials. Lancet Haematol. 2018 Oct 01;5(10):e462-73. link to original article PubMed
BEACOPP-14
BEACOPP-14: Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone, 14-day course
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Sieber et al. 2003 | 1997-2000 | Phase 2 | ||
Engert et al. 2012 (GHSG HD15) | 2003-2008 | Phase 3 (E-esc) | 1. Escalated BEACOPP x 8 | Not reported |
2. Escalated BEACOPP x 6 | Non-inferior FFTF (primary endpoint) |
Chemotherapy
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Etoposide (Vepesid) 100 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 25 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 650 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
Glucocorticoid therapy
- Prednisone (Sterapred) 80 mg/m2 PO once per day on days 1 to 7
Supportive therapy
- Filgrastim (Neupogen) by the following weight-based criteria:
- Less than 75 kg: 300 mcg SC once per day on days 8 to 13
- 75 kg or more: 480 mcg SC once per day on days 8 to 13
14-day cycle for 8 cycles
References
- Sieber M, Bredenfeld H, Josting A, Reineke T, Rueffer U, Koch T, Naumann R, Boissevain F, Koch P, Worst P, Soekler M, Eich H, Müller-Hermelink HK, Franklin J, Paulus U, Wolf J, Engert A, Diehl V; German Hodgkin's Lymphoma Study Group. 14-day variant of the bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone regimen in advanced-stage Hodgkin's lymphoma: results of a pilot study of the German Hodgkin's Lymphoma Study Group. J Clin Oncol. 2003 May 1;21(9):1734-9. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- GHSG HD15: Engert A, Haverkamp H, Kobe C, Markova J, Renner C, Ho A, Zijlstra J, Král Z, Fuchs M, Hallek M, Kanz L, Döhner H, Dörken B, Engel N, Topp M, Klutmann S, Amthauer H, Bockisch A, Kluge R, Kratochwil C, Schober O, Greil R, Andreesen R, Kneba M, Pfreundschuh M, Stein H, Eich HT, Müller RP, Dietlein M, Borchmann P, Diehl V; German Hodgkin Study Group; Swiss Group for Clinical Cancer Research; Arbeitsgemeinschaft Medikamentöse Tumortherapie. Reduced-intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin's lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial. Lancet. 2012 May 12;379(9828):1791-9. Epub 2012 Apr 4. Erratum in: Lancet. 2012 May 12;379(9828):1790. link to original article PubMed ISRCTN32443041
eBEACOPP
eBEACOPP: escalated Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone
escBEACOPP: escalated Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone
BEACOPP(escalated): Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone, escalated dose
Regimen variant #1, 2 cycles with response adaptation
Study | Dates of enrollment | Evidence |
---|---|---|
Borchmann et al. 2017 (GHSG HD18) | 2008-2011 | Non-randomized part of phase 3 RCT |
Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.
Chemotherapy
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Etoposide (Vepesid) 200 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 35 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
21-day cycle for 2 cycles
Subsequent treatment
- GHSG HD18, PET-negative, prior to June 2011: eBEACOPP continuation x 4 (6 total) versus eBEACOPP continuation x 6 (8 total)
- GHSG HD18, PET-negative, after June 2011: eBEACOPP continuation x 2 (4 total) versus eBEACOPP continuation x 4 (6 total)
- GHSG HD18, PET-positive, prior to June 2011: eBEACOPP continuation x 6 (8 total) versus R-eBEACOPP intensification x 6
- GHSG HD18, PET-positive, after June 2011: eBEACOPP continuation x 4 (6 total)
Regimen variant #2, 4 cycles
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Borchmann et al. 2017 (GHSG HD18) | 2008-2011 | Phase 3 (C) | 1. eBEACOPP x 6 2. eBEACOPP x 8 |
Non-inferior PFS1 |
1Reported efficacy for GHSG HD18 is based on the 2017 update.
Chemotherapy
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Etoposide (Vepesid) 200 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 35 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
Supportive therapy
- Filgrastim (Neupogen) 300 mcg SC once per day, starting day 8, continues until ANC greater than 1000/μL for 3 consecutive days
21-day cycle for 4 cycles
Regimen variant #3, 6 cycles
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Engert et al. 2012 (GHSG HD15) | 2003-2008 | Phase 3 (E-de-esc) | 1. BEACOPP-14 | Non-inferior FFTF (primary endpoint) |
2. eBEACOPP x 8 | Seems to have superior OS (secondary endpoint) | |||
Borchmann et al. 2017 (GHSG HD18) | 2008-2011 | Phase 3 (C) | 1. eBEACOPP x 4 2. eBEACOPP x 8 |
Non-inferior PFS1 |
Casasnovas et al. 2019 (AHL2011) | 2011-2014 | Phase 3 (C) | PET-adapted therapy | Inconclusive whether non-inferior PFS |
Borchmann et al. 2024 (GHSG HD21) | 2016-07-22 to 2020-08-27 | Phase 3 (C) | BrECADD | Seems to have inferior PFS |
1Reported efficacy for GHSG HD18 is based on the 2017 update.
Chemotherapy
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Etoposide (Vepesid) 200 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 35 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 1250 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
21-day cycle for 6 cycles
Regimen variant #4, 8 cycles
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Diehl et al. 1998 (GHSG HD9) | 1993-1998 | Phase 3 (E-esc) | 1. BEACOPP | Superior FFTF |
2. COPP/ABVD | Seems to have superior OS | |||
Borchmann et al. 2011 (GHSG HD12) | 1999-2003 | Phase 3 (C) | BEACOPP4+4 | Non-inferior OS1 |
Engert et al. 2012 (GHSG HD15) | 2003-2008 | Phase 3 (C) | 1. BEACOPP-14 | Not reported |
2. eBEACOPP x 6 | Seems to have inferior OS | |||
Borchmann et al. 2017 (GHSG HD18) | 2008-2011 | Phase 3 (C) | 1. eBEACOPP x 4 2. eBEACOPP x 6 |
Non-inferior PFS2 |
1Reported efficacy for GHSG HD12 is based on the 2018 pooled update. 2Reported efficacy for GHSG HD18 is based on the 2017 update.
Chemotherapy
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Etoposide (Vepesid) 200 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 35 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
21-day cycle for 8 cycles
Subsequent treatment
- GHSG HD12, patients with initial bulky or residual disease: ISRT x 3000 cGy consolidation versus no further treatment
References
- GHSG HD9: Diehl V, Franklin J, Hasenclever D, Tesch H, Pfreundschuh M, Lathan B, Paulus U, Sieber M, Rueffer JU, Sextro M, Engert A, Wolf J, Hermann R, Holmer L, Stappert-Jahn U, Winnerlein-Trump E, Wulf G, Krause S, Glunz A, von Kalle K, Bischoff H, Haedicke C, Duehmke E, Georgii A, Loeffler M. BEACOPP, a new dose-escalated and accelerated regimen, is at least as effective as COPP/ABVD in patients with advanced-stage Hodgkin's lymphoma: interim report from a trial of the German Hodgkin's Lymphoma Study Group. J Clin Oncol. 1998 Dec;16(12):3810-21. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- Update: Diehl V, Franklin J, Pfreundschuh M, Lathan B, Paulus U, Hasenclever D, Tesch H, Herrmann R, Dörken B, Müller-Hermelink HK, Dühmke E, Loeffler M; German Hodgkin's Lymphoma Study Group. Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin's disease. N Engl J Med. 2003 Jun 12;348(24):2386-95. Erratum in: N Engl J Med. 2005 Aug 18;353(7):744. link to original article dosing details in abstract have been reviewed by our editors PubMed
- Update: Engert A, Diehl V, Franklin J, Lohri A, Dörken B, Ludwig WD, Koch P, Hänel M, Pfreundschuh M, Wilhelm M, Trümper L, Aulitzky WE, Bentz M, Rummel M, Sezer O, Müller-Hermelink HK, Hasenclever D, Löffler M. Escalated-dose BEACOPP in the treatment of patients with advanced-stage Hodgkin's lymphoma: 10 years of follow-up of the GHSG HD9 study. J Clin Oncol. 2009 Sep 20;27(27):4548-54. Epub 2009 Aug 24. link to original article PubMed
- Pooled update: von Tresckow B, Kreissl S, Dipl-Math HG, Bröckelmann PJ, Pabst T, Fridrik M, Rummel M, Jung W, Thiemer J, Sasse S, Bürkle C, Baues C, Diehl V, Engert A, Borchmann P; German Hodgkin Study Group. Intensive treatment strategies in advanced-stage Hodgkin's lymphoma (HD9 and HD12): analysis of long-term survival in two randomised trials. Lancet Haematol. 2018 Oct 01;5(10):e462-73. link to original article PubMed
- GHSG HD12: Borchmann P, Haverkamp H, Diehl V, Cerny T, Markova J, Ho AD, Eich HT, Mueller-Hermelink HK, Kanz L, Greil R, Rank A, Paulus U, Smardova L, Huber C, Dörken B, Nerl C, Krause SW, Mueller RP, Fuchs M, Engert A. Eight cycles of escalated-dose BEACOPP compared with four cycles of escalated-dose BEACOPP followed by four cycles of baseline-dose BEACOPP with or without radiotherapy in patients with advanced-stage Hodgkin's lymphoma: final analysis of the HD12 trial of the German Hodgkin Study Group. J Clin Oncol. 2011 Nov 10;29(32):4234-42. Epub 2011 Oct 11. link to original article does not contain dosing details in manuscript PubMed NCT00265031
- Pooled update: von Tresckow B, Kreissl S, Dipl-Math HG, Bröckelmann PJ, Pabst T, Fridrik M, Rummel M, Jung W, Thiemer J, Sasse S, Bürkle C, Baues C, Diehl V, Engert A, Borchmann P; German Hodgkin Study Group. Intensive treatment strategies in advanced-stage Hodgkin's lymphoma (HD9 and HD12): analysis of long-term survival in two randomised trials. Lancet Haematol. 2018 Oct 01;5(10):e462-73. link to original article PubMed
- GHSG HD15: Engert A, Haverkamp H, Kobe C, Markova J, Renner C, Ho A, Zijlstra J, Král Z, Fuchs M, Hallek M, Kanz L, Döhner H, Dörken B, Engel N, Topp M, Klutmann S, Amthauer H, Bockisch A, Kluge R, Kratochwil C, Schober O, Greil R, Andreesen R, Kneba M, Pfreundschuh M, Stein H, Eich HT, Müller RP, Dietlein M, Borchmann P, Diehl V; German Hodgkin Study Group; Swiss Group for Clinical Cancer Research; Arbeitsgemeinschaft Medikamentöse Tumortherapie. Reduced-intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin's lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial. Lancet. 2012 May 12;379(9828):1791-9. Epub 2012 Apr 4. Erratum in: Lancet. 2012 May 12;379(9828):1790. link to original article PubMed ISRCTN32443041
- GHSG HD18: Borchmann P, Haverkamp H, Lohri A, Mey U, Kreissl S, Greil R, Markova J, Feuring-Buske M, Meissner J, Dührsen U, Ostermann H, Keller U, Maschmeyer G, Kuhnert G, Dietlein M, Kobe C, Eich H, Baues C, Stein H, Fuchs M, Diehl V, Engert A. Progression-free survival of early interim PET-positive patients with advanced stage Hodgkin's lymphoma treated with BEACOPP(escalated) alone or in combination with rituximab (HD18): an open-label, international, randomised phase 3 study by the German Hodgkin Study Group. Lancet Oncol. 2017 Apr;18(4):454-463. Epub 2017 Feb 22. link to original article contains partial dosing details in supplement PubMed NCT00515554
- Update: Borchmann P, Goergen H, Kobe C, Lohri A, Greil R, Eichenauer DA, Zijlstra JM, Markova J, Meissner J, Feuring-Buske M, Hüttmann A, Dierlamm J, Soekler M, Beck HJ, Willenbacher W, Ludwig WD, Pabst T, Topp MS, Hitz F, Bentz M, Keller UB, Kühnhardt D, Ostermann H, Schmitz N, Hertenstein B, Aulitzky W, Maschmeyer G, Vieler T, Eich H, Baues C, Stein H, Fuchs M, Kuhnert G, Diehl V, Dietlein M, Engert A. PET-guided treatment in patients with advanced-stage Hodgkin's lymphoma (HD18): final results of an open-label, international, randomised phase 3 trial by the German Hodgkin Study Group. Lancet. 2017 Dec 23;390(10114):2790-2802. Epub 2017 Oct 20. link to original article PubMed
- Update: Kreissl S, Goergen H, Buehnen I, Kobe C, Moccia A, Greil R, Eichenauer DA, Zijlstra JM, Markova J, Meissner J, Feuring-Buske M, Soekler M, Beck HJ, Willenbacher W, Ludwig WD, Pabst T, Topp MS, Hitz F, Bentz M, Keller UB, Kühnhardt D, Ostermann H, Hertenstein B, Aulitzky W, Maschmeyer G, Vieler T, Eich H, Baues C, Stein H, Fuchs M, Diehl V, Dietlein M, Engert A, Borchmann P; German Hodgkin Study Group. PET-guided eBEACOPP treatment of advanced-stage Hodgkin lymphoma (HD18): follow-up analysis of an international, open-label, randomised, phase 3 trial. Lancet Haematol. 2021 Jun;8(6):e398-e409. link to original article PubMed
- AHL2011: Casasnovas RO, Bouabdallah R, Brice P, Lazarovici J, Ghesquieres H, Stamatoullas A, Dupuis J, Gac AC, Gastinne T, Joly B, Bouabdallah K, Nicolas-Virelizier E, Feugier P, Morschhauser F, Delarue R, Farhat H, Quittet P, Berriolo-Riedinger A, Tempescul A, Edeline V, Maisonneuve H, Fornecker LM, Lamy T, Delmer A, Dartigues P, Martin L, André M, Mounier N, Traverse-Glehen A, Meignan M. PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study. Lancet Oncol. 2019 Feb;20(2):202-215. Epub 2019 Jan 15. link to original article dosing details in abstract have been reviewed by our editors PubMed NCT01358747
- GHSG HD21: Borchmann P, Ferdinandus J, Schneider G, Moccia A, Greil R, Hertzberg M, Schaub V, Hüttmann A, Keil F, Dierlamm J, Hänel M, Novak U, Meissner J, Zimmermann A, Mathas S, Zijlstra JM, Fosså A, Viardot A, Hertenstein B, Martin S, Giri P, Scholl S, Topp MS, Jung W, Vucinic V, Beck HJ, Kerkhoff A, Unger B, Rank A, Schroers R, Zum Büschenfelde CM, de Wit M, Trautmann-Grill K, Kamper P, Molin D, Kreissl S, Kaul H, von Tresckow B, Borchmann S, Behringer K, Fuchs M, Rosenwald A, Klapper W, Eich HT, Baues C, Zomas A, Hallek M, Dietlein M, Kobe C, Diehl V; German Hodgkin Study Group; Swiss Group for Clinical Cancer Research; Arbeitsgemeinschaft Medikamentöse Tumortherapie; Nordic Lymphoma Group; Australasian Leukaemia and Lymphoma Group. Assessing the efficacy and tolerability of PET-guided BrECADD versus eBEACOPP in advanced-stage, classical Hodgkin lymphoma (HD21): a randomised, multicentre, parallel, open-label, phase 3 trial. Lancet. 2024 Jul 27;404(10450):341-352. Epub 2024 Jul 3. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT02661503
eBEACOPP-BEACOPP
eBEACOPP-BEACOPP: escalated Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone followed by Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone
BEACOPP4+4
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Borchmann et al. 2011 (GHSG HD12) | 1999-2003 | Phase 3 (E-de-esc) | eBEACOPP x 8 | Non-inferior OS1 (secondary endpoint) |
Viviani et al. 2011 (GSM-HD) | 2000-2007 | Phase 3 (E-esc) | ABVD x 8 | Seems to have superior FFFP (primary endpoint) |
Carde et al. 2016 (EORTC 20012) | 2002-2010 | Phase 3 (E-esc) | ABVD x 8 | Did not meet primary endpoint of EFS |
Mounier et al. 2014 (LYSA H34) | 2003-2008 | Phase 3 (E-esc) | ABVD x 8 | Might have superior EFS (primary endpoint) |
1Reported efficacy for GHSG HD12 is based on the 2018 pooled update.
Chemotherapy, eBEACOPP portion (cycles 1 to 4)
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Etoposide (Vepesid) 200 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 35 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
Chemotherapy, BEACOPP portion (cycles 5 to 8)
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Etoposide (Vepesid) 100 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 25 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 650 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
Glucocorticoid therapy, both portions (cycles 1 to 8)
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
Supportive therapy, both portions (cycles 1 to 8)
- Filgrastim (Neupogen) 300 mcg SC once per day, starting day 8, continues until ANC greater than 1000/μL for 3 consecutive days (GSM-HD) or until day 14 (LYSA H34)
21-day cycle for 8 cycles
Subsequent treatment
- GHSG HD12, patients with initial bulky or residual disease: ISRT x 3000 cGy consolidation versus no further treatment
References
- GITIL/FIL HD2000: Federico M, Luminari S, Iannitto E, Polimeno G, Marcheselli L, Montanini A, La Sala A, Merli F, Stelitano C, Pozzi S, Scalone R, Di Renzo N, Musto P, Baldini L, Cervetti G, Angrilli F, Mazza P, Brugiatelli M, Gobbi PG; HD2000 Gruppo Italiano per lo Studio dei Linfomi Trial. ABVD compared with BEACOPP compared with CEC for the initial treatment of patients with advanced Hodgkin's lymphoma: results from the HD2000 Gruppo Italiano per lo Studio dei Linfomi Trial. J Clin Oncol. 2009 Feb 10;27(5):805-11. Epub 2009 Jan 5. link to original article PubMed NCT00443677
- Update: Merli F, Luminari S, Gobbi PG, Cascavilla N, Mammi C, Ilariucci F, Stelitano C, Musso M, Baldini L, Galimberti S, Angrilli F, Polimeno G, Scalzulli PR, Ferrari A, Marcheselli L, Federico M. Long-term results of the HD2000 trial comparing ABVD versus BEACOPP versus COPP-EBV-CAD in untreated patients with advanced Hodgkin lymphoma: a study by Fondazione Italiana Linfomi. J Clin Oncol. 2016 Apr 10;34(11):1175-81. Epub 2015 Dec 28. link to original article PubMed
- GSM-HD: Viviani S, Zinzani PL, Rambaldi A, Brusamolino E, Levis A, Bonfante V, Vitolo U, Pulsoni A, Liberati AM, Specchia G, Valagussa P, Rossi A, Zaja F, Pogliani EM, Pregno P, Gotti M, Gallamini A, Rota Scalabrini D, Bonadonna G, Gianni AM; Michelangelo Foundation; Gruppo Italiano di Terapie Innovative nei Linfomi; Intergruppo Italiano Linfomi. ABVD versus BEACOPP for Hodgkin's lymphoma when high-dose salvage is planned. N Engl J Med. 2011 Jul 21;365(3):203-12. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT01251107
- GHSG HD12: Borchmann P, Haverkamp H, Diehl V, Cerny T, Markova J, Ho AD, Eich HT, Mueller-Hermelink HK, Kanz L, Greil R, Rank A, Paulus U, Smardova L, Huber C, Dörken B, Nerl C, Krause SW, Mueller RP, Fuchs M, Engert A. Eight cycles of escalated-dose BEACOPP compared with four cycles of escalated-dose BEACOPP followed by four cycles of baseline-dose BEACOPP with or without radiotherapy in patients with advanced-stage Hodgkin's lymphoma: final analysis of the HD12 trial of the German Hodgkin Study Group. J Clin Oncol. 2011 Nov 10;29(32):4234-42. Epub 2011 Oct 11. link to original article does not contain dosing details in manuscript PubMed NCT00265031
- Pooled update: von Tresckow B, Kreissl S, Dipl-Math HG, Bröckelmann PJ, Pabst T, Fridrik M, Rummel M, Jung W, Thiemer J, Sasse S, Bürkle C, Baues C, Diehl V, Engert A, Borchmann P; German Hodgkin Study Group. Intensive treatment strategies in advanced-stage Hodgkin's lymphoma (HD9 and HD12): analysis of long-term survival in two randomised trials. Lancet Haematol. 2018 Oct 01;5(10):e462-73. link to original article PubMed
- LYSA H34: Mounier N, Brice P, Bologna S, Briere J, Gaillard I, Heczko M, Gabarre J, Casasnovas O, Jaubert J, Colin P, Delmer A, Devidas A, Bachy E, Nicolas-Virelizier E, Aoudjhane A, Humbrecht C, Andre M, Carde P; Lymphoma Study Association. ABVD (8 cycles) versus BEACOPP (4 escalated cycles ≥4 baseline): final results in stage III-IV low-risk Hodgkin lymphoma (IPS 0-2) of the LYSA H34 randomized trial. Ann Oncol. 2014 Aug;25(8):1622-8. Epub 2014 May 14. link to original article dosing details in manuscript have been reviewed by our editors PubMed RECF0219
- EORTC 20012: Carde P, Karrasch M, Fortpied C, Brice P, Khaled H, Casasnovas O, Caillot D, Gaillard I, Bologna S, Ferme C, Lugtenburg PJ, Morschhauser F, Aurer I, Coiffier B, Meyer R, Seftel M, Wolf M, Glimelius B, Sureda A, Mounier N. Eight cycles of ABVD versus four cycles of BEACOPPescalated plus four cycles of BEACOPPbaseline in stage III to IV, International Prognostic Score ≥ 3, high-risk Hodgkin lymphoma: First results of the phase III EORTC 20012 Intergroup trial. J Clin Oncol. 2016 Jun 10;34(17):2028-36. Epub 2016 Apr 25. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00049595
BrECADD
BrECADD: Brentuximab vedotin, Etoposide, Cyclophosphamide, Adriamycin (Doxorubicin), Dacarbazine, Dexamethasone
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Borchmann et al. 2024 (GHSG HD21) | 2016-07-22 to 2020-08-27 | Phase 3 (E-switch-ooc) | eBEACOPP x 6 | Seems to have superior PFS (primary endpoint) PFS48: 94.3% vs 90.9% (HR 0.66, 95% CI 0.49-0.97) |
Antibody-drug conjugate therapy
- Brentuximab vedotin (Adcetris) 1.8 mg/kg (maximum dose of 180 mg) IV once on day 0
Chemotherapy
- Etoposide (Vepesid) 150 mg/m2 IV once per day on days 1 to 3
- Cyclophosphamide (Cytoxan) 1250 mg/m2 IV once on day 1
- Doxorubicin (Adriamycin) 40 mg/m2 IV once on day 1
- Dacarbazine (DTIC) 250 mg/m2 IV once per day on days 2 & 3
Glucocorticoid therapy
- Dexamethasone (Decadron) 40 mg/m2 PO once per day on days 1 to 4
21-day cycle for 6 cycles
References
- GHSG HD21: Borchmann P, Ferdinandus J, Schneider G, Moccia A, Greil R, Hertzberg M, Schaub V, Hüttmann A, Keil F, Dierlamm J, Hänel M, Novak U, Meissner J, Zimmermann A, Mathas S, Zijlstra JM, Fosså A, Viardot A, Hertenstein B, Martin S, Giri P, Scholl S, Topp MS, Jung W, Vucinic V, Beck HJ, Kerkhoff A, Unger B, Rank A, Schroers R, Zum Büschenfelde CM, de Wit M, Trautmann-Grill K, Kamper P, Molin D, Kreissl S, Kaul H, von Tresckow B, Borchmann S, Behringer K, Fuchs M, Rosenwald A, Klapper W, Eich HT, Baues C, Zomas A, Hallek M, Dietlein M, Kobe C, Diehl V; German Hodgkin Study Group; Swiss Group for Clinical Cancer Research; Arbeitsgemeinschaft Medikamentöse Tumortherapie; Nordic Lymphoma Group; Australasian Leukaemia and Lymphoma Group. Assessing the efficacy and tolerability of PET-guided BrECADD versus eBEACOPP in advanced-stage, classical Hodgkin lymphoma (HD21): a randomised, multicentre, parallel, open-label, phase 3 trial. Lancet. 2024 Jul 27;404(10450):341-352. Epub 2024 Jul 3. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT02661503
C-MOPP/ABV
C-MOPP/ABV: CyclophosphaMide, Oncovin (Vincristine), Procarbazine, Prednisone, Adriamycin (Doxorubicin), Bleomycin, Vinblastine
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Montoto et al. 2000 | 1992-06 to 1998-04 | Phase 2 |
Chemotherapy
- Cyclophosphamide (Cytoxan) 650 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 3 mg) IV once on day 1
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
- Doxorubicin (Adriamycin) 35 mg/m2 IV once on day 8
- Bleomycin (Blenoxane) 10 mg/m2 IV once on day 8
- Vinblastine (Velban) 6 mg/m2 IV once on day 8
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
28-day cycle for 8 cycles
Subsequent treatment
- 2500 to 4000 cGy of radiation therapy consolidation given over extended fields (mantle or inverted "Y" type) to patients with bulky disease or ones with residual disease after completion of chemotherapy
References
- Montoto S, Camós M, López-Guillermo A, Bosch F, Cervantes F, Blandé J, Esteve J, Cobo F, Nomdedeu B, Campo E, Montserrat E. Hybrid chemotherapy consisting of cyclophosphamide, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (C-MOPP/ABV) as first-line treatment for patients with advanced Hodgkin disease. Cancer. 2000 May 1;88(9):2142-8. link to original article dosing details in abstract have been reviewed by our editors PubMed
MOPP
MOPP: Mechlorethamine, Oncovin (Vincristine), Procarbazine, Prednisone
Regimen variant #1, 8 cycles, prednisone 25 mg/m2
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Somers et al. 1994 | 1981-1986 | Phase 3 (C) | MOPP/ABVD | Seems to have inferior FFS |
Chemotherapy
- Mechlorethamine (Mustargen) 6 mg/m2 IV once per day on days 1 & 8
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once per day on days 1 & 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 14
Glucocorticoid therapy
- Prednisone (Sterapred) 25 mg/m2 PO once per day on days 1 to 14
28-day cycle for 8 cycles
Regimen variant #2, capped vincristine
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Canellos et al. 1992 (CALGB 8251) | 1982 to not reported | Phase 3 (C) | 1. ABVD | Seems to have inferior EFS1 |
2. MOPP/ABVD | Seems to have inferior EFS1 |
1Reported efficacy is based on the 2009 update.
Chemotherapy
- Mechlorethamine (Mustargen) 6 mg/m2 IV once per day on days 1 & 8
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once per day on days 1 & 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 14
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
28-day cycle for 6 to 8 cycles
Regimen variant #3, uncapped vincristine
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Devita et al. 1970 | 1964-1967 | Phase 2 | ||
Stutzman & Glidewell 1973 | 1967-1969 | Phase 3 (E-switch-ic) | 1. ALB 2. SEQ |
Superior ORR |
Cooper et al. 1980 | 1972-1975 | Phase 3 (C) | 1. COPP | Did not meet endpoint of OS |
2. CVPP | Seems to have inferior CR rate | |||
3. MVPP | Did not meet endpoint of OS | |||
Bonadonna et al. 1975 | 1973-04 to 1974-01 | Phase 3 (C) | ABVD | Did not meet efficacy endpoints |
Santoro et al. 1982 | 1974-1980 | Phase 3 (C) | MOPP/ABVD | Inferior PFS |
Santoro et al. 1987 | 1974-1982 | Phase 3 (C) | ABVD | Seems to have inferior OS |
Longo et al. 1991a | 1978-1988 | Phase 3 (C) | MOPP/CABS | Did not meet endpoint of OS |
Chemotherapy
- Mechlorethamine (Mustargen) 6 mg/m2 IV once per day on days 1 & 8
- Vincristine (Oncovin) 1.4 mg/m2 IV once per day on days 1 & 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 14
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
28-day cycle for 6 to 8 cycles
Regimen variant #4, BNLI variant
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Jelliffe 1976 | 1970-1975 | Phase 3 (C) | TNI | Inferior DFS |
Hancock 1986 | 1979 to not reported | Phase 3 (C) | LOPP | Did not meet primary endpoint of OS |
Chemotherapy
- Mechlorethamine (Mustargen) 6 mg/m2 (maximum dose of 15 mg) IV once per day on days 1 & 8
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once per day on days 1 & 8
- Procarbazine (Matulane) 100 mg/m2 (maximum dose of 200 mg) PO once per day on days 1 to 10
Glucocorticoid therapy
- Prednisone (Sterapred) 25 mg/m2 (maximum dose of 60 mg) PO once per day on days 1 to 14
28-day cycle for at least 6 cycles
References
- Devita VT Jr, Serpick AA, Carbone PP. Combination chemotherapy in the treatment of advanced Hodgkin's disease. Ann Intern Med. 1970 Dec;73(6):881-95. link to original article dosing details in abstract have been reviewed by our editors PubMed content property of HemOnc.org
- Stutzman L, Glidewell O; Acute Leukemia Group B. Multiple chemotherapeutic agents for Hodgkin disease: comparison of three routines: a cooperative study by Acute Leukemia Group B. JAMA. 1973 Sep 3;225(10):1202-11. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- Bonadonna G, Zucali R, Monfardini S, De Lena M, Uslenghi C. Combination chemotherapy of Hodgkin's disease with adriamycin, bleomycin, vinblastine, and imidazole carboxamide versus MOPP. Cancer. 1975 Jul;36(1):252-9. link to original article does not contain dosing details in manuscript; refers to Devita et al. 1970 PubMed
- Jelliffe AM; British National Lymphoma Investigation. Initial treatment of stage IIIA Hodgkin's disease: comparison of radiotherapy with combined chemotherapy. Lancet. 1976 Nov 6;2(7993):991-5. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- Cooper MR, Pajak TF, Nissen NI, Stutzman L, Brunner K, Cuttner J, Falkson G, Grunwald H, Bank A, Leone L, Seligman BR, Silver RT, Weiss RB, Haurani F, Blom J, Spurr CL, Glidewell OJ, Gottlieb AJ, Holland JF. A new effective four-drug combination of CCNU (1-[2-chloroethyl]-3-cyclohexyl-1-nitrosourea) (NSC-79038), vinblastine, prednisone, and procarbazine for the treatment of advanced Hodgkin's disease. Cancer. 1980 Aug 15;46(4):654-62. link to original article PubMed
- Santoro A, Bonadonna G, Bonfante V, Valagussa P. Alternating drug combinations in the treatment of advanced Hodgkin's disease. N Engl J Med. 1982 Apr 1;306(13):770-5. link to original article PubMed
- Update: Bonadonna G, Valagussa P, Santoro A. Alternating non-cross-resistant combination chemotherapy or MOPP in stage IV Hodgkin's disease: a report of 8-year results. Ann Intern Med. 1986 Jun;104(6):739-46. link to original article PubMed
- Hancock BW; British National Lymphoma Investigation. Randomised study of MOPP (mustine, Oncovin, procarbazine, prednisone) against LOPP (Leukeran substituted for mustine) in advanced Hodgkin's disease. Radiother Oncol. 1986 Nov;7(3):215-21. link to original article PubMed
- Update: Hancock BW, Vaughan Hudson G, Vaughan Hudson B, Haybittle JL, Bennett MH, MacLennan KA, Jelliffe AM; BNLI. British National Lymphoma Investigation randomised study of MOPP (mustine, Oncovin, procarbazine, prednisolone) against LOPP (Leukeran substituted for mustine) in advanced Hodgkin's disease--long term results. Br J Cancer. 1991 Apr;63(4):579-82. link to original article link to PMC article PubMed
- Santoro A, Bonadonna G, Valagussa P, Zucali R, Viviani S, Villani F, Pagnoni AM, Bonfante V, Musumeci R, Crippa F, Tesoro-Tess JD, Banfi A. Long-term results of combined chemotherapy-radiotherapy approach in Hodgkin's disease: superiority of ABVD plus radiotherapy versus MOPP plus radiotherapy. J Clin Oncol. 1987 Jan;5(1):27-37. link to original article PubMed
- Longo DL, Duffey PL, DeVita VT Jr, Wiernik PH, Hubbard SM, Phares JC, Bastian AW, Jaffe ES, Young RC. Treatment of advanced-stage Hodgkin's disease: alternating noncrossresistant MOPP/CABS is not superior to MOPP. J Clin Oncol. 1991 Aug;9(8):1409-20. link to original article PubMed
- CALGB 8251: Canellos GP, Anderson JR, Propert KJ, Nissen N, Cooper MR, Henderson ES, Green MR, Gottlieb A, Peterson BA. Chemotherapy of advanced Hodgkin's disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med. 1992 Nov 19;327(21):1478-84. link to original article does not contain dosing details PubMed
- Update: Canellos GP, Niedzwiecki D. Long-term follow-up of Hodgkin's disease trial. N Engl J Med. 2002 May 2;346(18):1417-8. link to original article PubMed
- Update: Canellos GP, Niedzwiecki D, Johnson JL. Long-term follow-up of survival in Hodgkin's lymphoma. N Engl J Med. 2009 Dec 10;361(24):2390-1. link to original article PubMed
- Somers R, Carde P, Henry-Amar M, Tarayre M, Thomas J, Hagenbeek A, Monconduit M, de Pauw BE, Breed WP, Verdonck L, Burgers JMV, Eghbali H, Zittoun R; EORTC Lymphoma Cooperative Group. A randomized study in stage IIIB and IV Hodgkin's disease comparing eight courses of MOPP versus an alteration of MOPP with ABVD: a European Organisation for Research and Treatment of Cancer Lymphoma Cooperative Group and Groupe Pierre-et-Marie-Curie controlled clinical trial. J Clin Oncol. 1994 Feb;12(2):279-87. link to original article dosing details in manuscript have been reviewed by our editors PubMed
MOPP-ABV
MOPP-ABV: Mustargen (Mechlorethamine), Oncovin (Vincristine), Procarbazine, Prednisone, Adriamycin (Doxorubicin), Bleomycin, Vinblastine
MOPP-ABV hybrid
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Klimo & Connors 1985 | 1980-1984 | Phase 2 | ||
Connor et al. 1997 (NCIC-CTG HD4) | 1984-1989 | Phase 3 (E-de-esc) | MOPP/ABVD | Did not meet primary endpoint of FFS24 |
Glick et al. 1998 (ECOG E4486) | 1987-1989 | Phase 3 (E-switch-ic) | MOPP x 6, then ABVD x 3 | Seems to have superior OS |
Duggan et al. 2003 (CALGB-8952) | Not reported to 1995 | Phase 3 (E-esc) | ABVD | Did not meet primary endpoint of CR rate |
Aleman et al. 2003 (EORTC 20884) | 1989-2000 | Non-randomized part of phase 3 RCT |
Chemotherapy
- Mechlorethamine (Mustargen) 6 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 1
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
- Doxorubicin (Adriamycin) 35 mg/m2 IV once on day 8
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Vinblastine (Velban) 6 mg/m2 IV once on day 8
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
28-day cycle for 6 to 8 cycles
Subsequent treatment
- EORTC 20884, CR: IFRT x 2400 cGy consolidation versus no further treatment
- EORTC 20884, PR: IFRT x 3000 cGy consolidation versus no further treatment
References
- Klimo P, Connors JM. MOPP/ABV hybrid program: combination chemotherapy based on early introduction of seven effective drugs for advanced Hodgkin's disease. J Clin Oncol. 1985 Sep;3(9):1174-82. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- NCIC-CTG HD4: Connors JM, Klimo P, Adams G, Burns BF, Cooper I, Meyer RM, O'Reilly SE, Pater J, Quirt I, Sadura A, Shustik C, Skillings J, Sutcliffe S, Verma S, Yoshida S, Zee B. Treatment of advanced Hodgkin's disease with chemotherapy--comparison of MOPP/ABV hybrid regimen with alternating courses of MOPP and ABVD: a report from the National Cancer Institute of Canada clinical trials group. J Clin Oncol. 1997 Apr;15(4):1638-45. Erratum in: J Clin Oncol 1997 Jul;15(7):2762. link to original article PubMed
- ECOG E4486: Glick JH, Young ML, Harrington D, Schilsky RL, Beck T, Neiman R, Fisher RI, Peterson BA, Oken MM. MOPP/ABV hybrid chemotherapy for advanced Hodgkin's disease significantly improves failure-free and overall survival: the 8-year results of the intergroup trial. J Clin Oncol. 1998 Jan;16(1):19-26. link to original article PubMed
- CALGB-8952: Duggan DB, Petroni GR, Johnson JL, Glick JH, Fisher RI, Connors JM, Canellos GP, Peterson BA. Randomized comparison of ABVD and MOPP/ABV hybrid for the treatment of advanced Hodgkin's disease: report of an intergroup trial. J Clin Oncol. 2003 Feb 15;21(4):607-14. link to original article does not contain dosing details PubMed
- EORTC 20884: Aleman BM, Raemaekers JM, Tirelli U, Bortolus R, van 't Veer MB, Lybeert ML, Keuning JJ, Carde P, Girinsky T, van der Maazen RW, Tomsic R, Vovk M, van Hoof A, Demeestere G, Lugtenburg PJ, Thomas J, Schroyens W, De Boeck K, Baars JW, Kluin-Nelemans JC, Carrie C, Aoudjhane M, Bron D, Eghbali H, Smit WG, Meerwaldt JH, Hagenbeek A, Pinna A, Henry-Amar M; EORTC Lymphoma Group. Involved-field radiotherapy for advanced Hodgkin's lymphoma. N Engl J Med. 2003 Jun 12;348(24):2396-406. link to original article dosing details in manuscript have been reviewed by our editors PubMed
N-AVD
N-AVD: Nivolumab, Adriamycin (Doxorubicin), Vinblastine, Dacarbazine
Regimen variant #1, adult dosing
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Herrera et al. 2024 (SWOG S1826) | 2019-07-19 to 2022-10-05 | Phase 3 (E-switch-ooc) | BV-AVD | Superior PFS (primary endpoint) PFS24: 92% vs 83% (HR 0.45, 95% CI 0.30-0.65) |
Immunotherapy
- Nivolumab (Opdivo) 240 mg IV once per day on days 1 & 15
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 6 cycles
Regimen variant #2, pediatric dosing
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Herrera et al. 2024 (SWOG S1826) | 2019-07-19 to 2022-10-05 | Phase 3 (E-switch-ooc) | BV-AVD | Superior PFS (primary endpoint) PFS24: 92% vs 83% (HR 0.45, 95% CI 0.30-0.65) |
Immunotherapy
- Nivolumab (Opdivo) 3 mg/kg (maximum dose of 240 mg) IV once per day on days 1 & 15
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 6 cycles
References
- SWOG S1826: Herrera AF, LeBlanc M, Castellino SM, Li H, Rutherford SC, Evens AM, Davison K, Punnett A, Parsons SK, Ahmed S, Casulo C, Bartlett NL, Tuscano JM, Mei MG, Hess BT, Jacobs R, Saeed H, Torka P, Hu B, Moskowitz C, Kaur S, Goyal G, Forlenza C, Doan A, Lamble A, Kumar P, Chowdhury S, Brinker B, Sharma N, Singh A, Blum KA, Perry AM, Kovach A, Hodgson D, Constine LS, Shields LK, Prica A, Dillon H, Little RF, Shipp MA, Crump M, Kahl B, Leonard JP, Smith SM, Song JY, Kelly KM, Friedberg JW. Nivolumab+AVD in Advanced-Stage Classic Hodgkin's Lymphoma. N Engl J Med. 2024 Oct 17;391(15):1379-1389. link to original article link to PMC article dosing details in manuscript have been reviewed by our editors PubMed NCT03907488
RABVD
RABVD: Rituximab, Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine
Regimen variant #1
Study | Dates of enrollment | Evidence |
---|---|---|
Younes et al. 2012 (MDACC ID00-218) | 2001-2007 | Phase 2 |
Targeted therapy
- Rituximab (Rituxan) as follows:
- Cycle 1: 375 mg/m2 IV once per day on days 1, 8, 15, 22
- Cycle 2: 375 mg/m2 IV once per day on days 1 & 8
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 6 cycles
Regimen variant #2
Study | Dates of enrollment | Evidence |
---|---|---|
Kasamon et al. 2012 (J0615) | 2006 to not reported | Phase 2 |
Targeted therapy
- Rituximab (Rituxan) as follows:
- Pre-phase: 375 mg/m2 IV once one week prior to cycle 1 of ABVD
- Cycle 1: 375 mg/m2 IV once per day on days 1, 8, 15, 22
- Cycles 2, 4, 6: 375 mg/m2 IV once on day 1
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day cycle for 6 to 8 cycles
References
- MDACC ID00-218: Younes A, Oki Y, McLaughlin P, Copeland AR, Goy A, Pro B, Feng L, Yuan Y, Chuang HH, Macapinlac HA, Hagemeister F, Romaguera J, Samaniego F, Fanale MA, Dabaja BS, Rodriguez MA, Dang N, Kwak LW, Neelapu SS, Fayad LE. Phase 2 study of rituximab plus ABVD in patients with newly diagnosed classical Hodgkin lymphoma. Blood. 2012 May 3;119(18):4123-8. Epub 2012 Feb 27. link to original article dosing details in abstract have been reviewed by our editors link to PMC article PubMed NCT00504504
- J0615: Kasamon YL, Jacene HA, Gocke CD, Swinnen LJ, Gladstone DE, Perkins B, Link BK, Popplewell LL, Habermann TM, Herman JM, Matsui WH, Jones RJ, Ambinder RF. Phase 2 study of rituximab-ABVD in classical Hodgkin lymphoma. Blood. 2012 May 3;119(18):4129-32. Epub 2012 Feb 16. link to original article contains partial protocol link to PMC article PubMed NCT00369681
Stanford V
Regimen variant #1, younger patients
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Bartlett et al. 1995 | 1989 to not reported | Non-randomized | ||
Horning et al. 2000 (ECOG E1492) | 1992-1995 | Phase 2 | ||
Hoskin et al. 2009 (BNLI STANFORDV) | 1998-2006 | Phase 3 (E-esc) | ABVD | Did not meet primary endpoint of PFS |
Gordon et al. 2012 (ECOG E2496) | 1999-2006 | Phase 3 (E-esc) | ABVD | Did not meet primary endpoint of FFS |
Eligibility criteria
- 50 years old or younger
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Mechlorethamine (Mustargen) 6 mg/m2 IV once on day 1
- Etoposide (Vepesid) 60 mg/m2 IV once per day on days 15 & 16
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once per day on days 8 & 22
- Bleomycin (Blenoxane) 5 units/m2 IV once per day on days 8 & 22
Glucocorticoid therapy
- Prednisone (Sterapred) as follows:
- Cycles 1 & 2: 40 mg/m2 PO every other day
- Cycle 3: 40 mg/m2 PO once per day on days 1, 3, 5, 7, then 30 mg/m2 PO once per day on days 9, 11, 13, then 20 mg/m2 PO once per day on days 15, 17, 19, 21, then 10 mg/m2 PO once per day on days 23, 25, 27
Supportive therapy
- If dose reduction or delay occurred at any time during chemotherapy, Filgrastim (Neupogen) 5 mcg/kg SC once per day x 5 days (starting 48 hours after myelosuppressive chemotherapy) should be given after all subsequent day 1 and 15 doses of chemotherapy. It was not precisely specified when to discontinue filgrastim.
- Ranitidine (Zantac) 150 mg PO twice per day throughout the course of treatment
- Trimethoprim-Sulfamethoxazole (Bactrim DS) 160/800 mg PO twice per day throughout the course of treatment
- Acyclovir (Zovirax) 200 mg PO three times per day throughout the course of treatment
- Ketoconazole (Nizoral) 200 mg PO once per day throughout the course of treatment; note: this may be optional--Horning SJ et al. J Clin Oncol (2000) listed this as a prophylactic medication, but Horning SJ et al. J Clin Oncol (2002) did not list this when prophylactic medications were specifically listed.
28-day cycle for 3 cycles
Subsequent treatment
- IFRT x 3600 cGy consolidation, started 2 to 4 weeks after chemotherapy is complete and is given to sites of disease greater than or equal to 5 cm and/or to macroscopic nodules in the spleen.
Dose and schedule modifications
- Doses of doxorubicin, vinblastine, mechlorethamine, and etoposide were reduced to 65% of the original dose if the ANC on the day of treatment was 500 to 1000/μL. If ANC was less than 500/μL on the day of treatment, therapy was delayed for 1 week, and therapy resumed the following week at the dose indicated by the ANC. As noted above, filgrastim was incorporated into all subsequent treatments if there were any dose reductions or delays.
Regimen variant #2, older patients
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Bartlett et al. 1995 | 1989 to not reported | Non-randomized | ||
Horning et al. 2000 (ECOG E1492) | 1992-1995 | Phase 2 | ||
Hoskin et al. 2009 (BNLI STANFORDV) | 1998-2006 | Phase 3 (E-esc) | ABVD | Did not meet primary endpoint of PFS |
Eligibility criteria
- Older than 50 years old
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) as follows:
- Cycles 1 & 2: 6 mg/m2 IV once per day on days 1 & 15
- Cycle 3: 4 mg/m2 IV once per day on days 1 & 15
- Mechlorethamine (Mustargen) 6 mg/m2 IV once on day 1
- Etoposide (Vepesid) 60 mg/m2 IV once per day on days 15 & 16
- Vincristine (Oncovin) as follows:
- Cycles 1 & 2: 1.4 mg/m2 (maximum dose of 2 mg) IV once per day on days 8 & 22
- Cycle 3: 1 mg/m2 (maximum dose of 2 mg) IV once per day on days 8 & 22
- Bleomycin (Blenoxane) 5 units/m2 IV once per day on days 8 & 22
Glucocorticoid therapy
- Prednisone (Sterapred) as follows:
- Cycles 1 & 2: 40 mg/m2 PO every other day
- Cycle 3: 40 mg/m2 PO once per day on days 1, 3, 5, 7, then 30 mg/m2 PO once per day on days 9, 11, 13, then 20 mg/m2 PO once per day on days 15, 17, 19, 21, then 10 mg/m2 PO once per day on days 23, 25, 27
Supportive therapy
- If dose reduction or delay occurred at any time during chemotherapy, Filgrastim (Neupogen) 5 mcg/kg SC once per day x 5 days (starting 48 hours after myelosuppressive chemotherapy) should be given after all subsequent day 1 and 15 doses of chemotherapy. It was not precisely specified when to discontinue filgrastim.
- Ranitidine (Zantac) 150 mg PO twice per day throughout the course of treatment
- Trimethoprim-Sulfamethoxazole (Bactrim DS) 160/800 mg PO twice per day throughout the course of treatment
- Acyclovir (Zovirax) 200 mg PO three times per day throughout the course of treatment
- Ketoconazole (Nizoral) 200 mg PO once per day throughout the course of treatment; note: this may be optional--Horning SJ et al. J Clin Oncol (2000) listed this as a prophylactic medication, but Horning SJ et al. J Clin Oncol (2002) did not list this when prophylactic medications were specifically listed.
28-day cycle for 3 cycles
Subsequent treatment
- IFRT x 3600 cGy consolidation, started 2 to 4 weeks after chemotherapy is complete and is given to sites of disease greater than or equal to 5 cm and/or to macroscopic nodules in the spleen.
Dose and schedule modifications
- Doses of doxorubicin, vinblastine, mechlorethamine, and etoposide were reduced to 65% of the original dose if the ANC on the day of treatment was 500 to 1000/μL. If ANC was less than 500/μL on the day of treatment, therapy was delayed for 1 week, and therapy resumed the following week at the dose indicated by the ANC. As noted above, filgrastim was incorporated into all subsequent treatments if there were any dose reductions or delays.
References
- Bartlett NL, Rosenberg SA, Hoppe RT, Hancock SL, Horning SJ. Brief chemotherapy, Stanford V, and adjuvant radiotherapy for bulky or advanced-stage Hodgkin's disease: a preliminary report. J Clin Oncol. 1995 May;13(5):1080-8. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- Update: Horning SJ, Hoppe RT, Breslin S, Bartlett NL, Brown BW, Rosenberg SA. Stanford V and radiotherapy for locally extensive and advanced Hodgkin's disease: mature results of a prospective clinical trial. J Clin Oncol. 2002 Feb 1;20(3):630-7. link to original article PubMed
- ECOG E1492: Horning SJ, Williams J, Bartlett NL, Bennett JM, Hoppe RT, Neuberg D, Cassileth P. Assessment of the Stanford V regimen and consolidative radiotherapy for bulky and advanced Hodgkin's disease: Eastern Cooperative Oncology Group pilot study E1492. J Clin Oncol. 2000 Mar;18(5):972-80. link to original article dosing details in abstract have been reviewed by our editors PubMed
- GITIL HD9601: Gobbi PG, Levis A, Chisesi T, Broglia C, Vitolo U, Stelitano C, Pavone V, Cavanna L, Santini G, Merli F, Liberati M, Baldini L, Deliliers GL, Angelucci E, Bordonaro R, Federico M; Intergruppo Italiano Linfomi. ABVD versus modified Stanford V versus MOPPEBVCAD with optional and limited radiotherapy in intermediate- and advanced-stage Hodgkin's lymphoma: final results of a multicenter randomized trial by the Intergruppo Italiano Linfomi. J Clin Oncol. 2005 Dec 20;23(36):9198-207. Epub 2005 Sep 19. link to original article PubMed
- Update: Chisesi T, Bellei M, Luminari S, Montanini A, Marcheselli L, Levis A, Gobbi P, Vitolo U, Stelitano C, Pavone V, Merli F, Liberati M, Baldini L, Bordonaro R, Pesce EA, Federico M. Long-term follow-up analysis of HD9601 trial comparing ABVD versus Stanford V versus MOPP/EBV/CAD in patients with newly diagnosed advanced-stage Hodgkin's lymphoma: a study from the Intergruppo Italiano Linfomi. J Clin Oncol. 2011 Nov 10;29(32):4227-33. Epub 2011 Oct 11. link to original article PubMed
- BNLI STANFORDV: Hoskin PJ, Lowry L, Horwich A, Jack A, Mead B, Hancock BW, Smith P, Qian W, Patrick P, Popova B, Pettitt A, Cunningham D, Pettengell R, Sweetenham J, Linch D, Johnson PW. Randomized comparison of the Stanford V regimen and ABVD in the treatment of advanced Hodgkin's Lymphoma: United Kingdom National Cancer Research Institute Lymphoma Group Study ISRCTN 64141244. J Clin Oncol. 2009 Nov 10;27(32):5390-6. Epub 2009 Sep 8. link to original article PubMed NCT00041210
- Retrospective: Edwards-Bennett SM, Jacks LM, Moskowitz CH, Wu EJ, Zhang Z, Noy A, Portlock CS, Straus DJ, Zelenetz AD, Yahalom J. Stanford V program for locally extensive and advanced Hodgkin lymphoma: the Memorial Sloan-Kettering Cancer Center experience. Ann Oncol. 2010 Mar;21(3):574-81. link to original article PubMed
- ECOG E2496: Gordon LI, Hong F, Fisher RI, Bartlett NL, Connors JM, Gascoyne RD, Wagner H, Stiff PJ, Cheson BD, Gospodarowicz M, Advani R, Kahl BS, Friedberg JW, Blum KA, Habermann TM, Tuscano JM, Hoppe RT, Horning SJ. Randomized phase III trial of ABVD versus Stanford V with or without radiation therapy in locally extensive and advanced-stage Hodgkin lymphoma: An Intergroup study coordinated by the Eastern Cooperative Oncology Group (E2496). J Clin Oncol. 2013 Feb 20;31(6):684-91. Epub 2012 Nov 26. link to original article link to PMC article dosing details in supplement have been reviewed by our editors PubMed NCT00003389
- Subgroup analysis: Evens AM, Hong F, Gordon LI, Fisher RI, Bartlett NL, Connors JM, Gascoyne RD, Wagner H, Gospodarowicz M, Cheson BD, Stiff PJ, Advani R, Miller TP, Hoppe RT, Kahl BS, Horning SJ. The efficacy and tolerability of adriamycin, bleomycin, vinblastine, dacarbazine and Stanford V in older Hodgkin lymphoma patients: a comprehensive analysis from the North American intergroup trial E2496. Br J Haematol. 2013 Apr;161(1):76-86. Epub 2013 Jan 29. link to original article link to PMC article PubMed
- Subgroup analysis: Advani RH, Hong F, Fisher RI, Bartlett NL, Robinson KS, Gascoyne RD, Wagner H Jr, Stiff PJ, Cheson BD, Stewart DA, Gordon LI, Kahl BS, Friedberg JW, Blum KA, Habermann TM, Tuscano JM, Hoppe RT, Horning SJ. Randomized phase III trial comparing ABVD plus radiotherapy with the Stanford V regimen in patients with stages I or II locally extensive, bulky mediastinal Hodgkin lymphoma: a subset analysis of the North American Intergroup E2496 trial. J Clin Oncol. 2015 Jun 10;33(17):1936-42. Epub 2015 Apr 20. link to original article contains limited protocol link to PMC article PubMed
Untreated, elderly
BEACOPP
BEACOPP: Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Ballova et al. 2005 (GHSG HD9elderly) | 1993-1998 | Phase 3 (E-switch-ic) | COPP/ABVD | Did not meet efficacy endpoints |
Note: this is technically "BEACOPP II." The original "BEACOPP I" is detailed in Diehl et al. 1997 but is of historical interest, only.
Chemotherapy
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Etoposide (Vepesid) 100 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 25 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 650 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
21-day cycle for 8 cycles
References
- GHSG HD9elderly: Ballova V, Rüffer JU, Haverkamp H, Pfistner B, Müller-Hermelink HK, Dühmke E, Worst P, Wilhelmy M, Naumann R, Hentrich M, Eich HT, Josting A, Löffler M, Diehl V, Engert A. A prospectively randomized trial carried out by the German Hodgkin Study Group (GHSG) for elderly patients with advanced Hodgkin's disease comparing BEACOPP baseline and COPP-ABVD (study HD9elderly). Ann Oncol. 2005 Jan;16(1):124-31. link to original articledosing details in abstract have been reviewed by our editors PubMed
Brentuximab vedotin monotherapy
Regimen variant #1, standard-dose
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Forero-Torres et al. 2015 (SGN35-015mono) | 2012-10 to 2015-03 | Phase 2 | ORR: 92% |
Antibody-drug conjugate therapy
- Brentuximab vedotin (Adcetris) 1.8 mg/kg IV once on day 1
Supportive therapy
- "according to institutional standards"
21-day cycle for up to 16 cycles, with continuing treatment allowed for those deriving clinical benefit
Regimen variant #2, reduced-dose
Study | Dates of enrollment | Evidence |
---|---|---|
Forero-Torres et al. 2015 (SGN35-015mono) | 2012-10 to 2015-03 | Phase 2, fewer than 20 pts in this subgroup |
Note: This was the starting dose for severe renal impairment (eGFR less than 30 mL/min/1.73m2) and also the dose reduction for toxicities. While described as a planned starting dose, no patients in the study actually had severe renal impairment.
Antibody-drug conjugate therapy
- Brentuximab vedotin (Adcetris) 1.2 mg/kg IV once on day 1
Supportive therapy
- "according to institutional standards"
21-day cycle for up to 16 cycles, with continuing treatment allowed for those deriving clinical benefit
References
- SGN35-015mono: Forero-Torres A, Holkova B, Goldschmidt J, Chen R, Olsen G, Boccia RV, Bordoni RE, Friedberg JW, Sharman JP, Palanca-Wessels MC, Wang Y, Yasenchak CA. Phase 2 study of frontline brentuximab vedotin monotherapy in Hodgkin lymphoma patients aged 60 years and older. Blood. 2015 Dec 24;126(26):2798-804. Epub 2015 Sep 16. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT01716806
Brentuximab vedotin & Dacarbazine
Regimen variant #1, standard-dose
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Friedberg et al. 2017 (SGN35-015combo) | 2014-02 to 2015-09 | Phase 2 | ORR: 100% |
Antibody-drug conjugate therapy
- Brentuximab vedotin (Adcetris) 1.8 mg/kg IV once on day 1
Chemotherapy
- Dacarbazine (DTIC) as follows:
- Cycles 1 to 12: 375 mg/m2 IV once on day 1
21-day cycle for up to 16 cycles, with continuing treatment allowed for those deriving clinical benefit
Regimen variant #2, reduced-dose
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Friedberg et al. 2017 (SGN35-015combo) | 2014-02 to 2015-09 | Phase 2, fewer than 20 pts in this subgroup | ORR: 100% |
Note: This is the starting dose for severe renal impairment (eGFR less than 30 mL/min/1.73m2). Only 2 patients in the study had severe renal impairment.
Antibody-drug conjugate therapy
- Brentuximab vedotin (Adcetris) 1.2 mg/kg IV once on day 1
Chemotherapy
- Dacarbazine (DTIC) as follows:
- Cycles 1 to 12: 262 mg/m2 IV once on day 1
21-day cycle for up to 16 cycles, with continuing treatment allowed for those deriving clinical benefit
References
- SGN35-015combo: Friedberg JW, Forero-Torres A, Bordoni RE, Cline VJM, Patel Donnelly D, Flynn PJ, Olsen G, Chen R, Fong A, Wang Y, Yasenchak CA. Frontline brentuximab vedotin in combination with dacarbazine or bendamustine in patients aged ≥60 years with HL. Blood. 2017 Dec 28;130(26):2829-2837. Epub 2017 Oct 16. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT01716806
ChlVPP
ChlVPP: Chllorambucil, Vinblastine, Procarbazine, Prednisone
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Anderson 1995 | Not reported | Retrospective |
Chemotherapy
- Chlorambucil (Leukeran) 6 mg/m2 (maximum dose of 10 mg) PO once per day on days 1 to 14
- Vinblastine (Velban) 6 mg/m2 (maximum dose of 10 mg) IV once per day on days 1 & 8
- Procarbazine (Matulane) 100 mg/m2 (maximum dose of 150 mg) PO once per day on days 1 to 14
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg PO once per day on days 1 to 14
28-day cycle to complete remission plus 2 cycles; minimum of 6 cycles and maximum of 8 cycles
References
- Retrospective: Druker BJ, Rosenthal DS, Canellos GP. Chlorambucil, vinblastine, procarbazine, and prednisone. An effective but less toxic regimen than MOPP for advanced-stage Hodgkin's disease. Cancer. 1989 Mar 15;63(6):1060-4. link to original article PubMed
- Case series: Selby P, Patel P, Milan S, Meldrum M, Mansi J, Mbidde E, Brada M, Perren T, Forgeson G, Gore M, Smith I, McElwain T. ChlVPP combination chemotherapy for Hodgkin's disease: long-term results. Br J Cancer. 1990 Aug;62(2):279-85. link to original article link to PMC article PubMed
- Retrospective: Anderson JR; International ChlVPP Treatment Group. ChlVPP therapy for Hodgkin's disease: experience of 960 patients. Ann Oncol. 1995 Feb;6(2):167-72. link to original article dosing details in abstract have been reviewed by our editors PubMed
ChlVPP/EVA
ChlVPP/EVA: Chllorambucil, Vinblastine, Procarbazine, Prednisone, Etoposide, Vincristine, Adriamycin (Doxorubicin)
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Radford et al. 1995 | 1984-1992 | Phase 3 (E-esc) | MVPP | Superior PFS |
Radford et al. 2002 | 1992-1996 | Phase 3 (C) | VAPEC-B | Seems to have superior OS |
Chemotherapy
- Chlorambucil (Leukeran) 6 mg/m2 PO once per day on days 1 to 7
- Vinblastine (Velban) 6 mg/m2 IV once on day 8
- Procarbazine (Matulane) 90 mg/m2 PO once per day on days 1 to 7
- Etoposide (Vepesid) as follows:
- Cycle 1: 75 mg/m2 PO once per day on days 1 to 5
- Cycles 2 to 6: 100 mg/m2 PO once per day on days 1 to 5
- Vincristine (Oncovin) by the following age-based criteria:
- 60 to 70 years old: 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 1
- 70 years old or older: 50% of BSA IV once on day 1
- Doxorubicin (Adriamycin) 50 mg/m2 IV once on day 8
Glucocorticoid therapy
- Prednisolone (Millipred) 50 mg PO once per day on days 1 to 7
28-day cycle for 6 cycles
Dose and schedule modifications
- Etoposide is only increased in cycle 2 if oral mucositis no worse than CTCAE grade 1
References
- Radford JA, Crowther D, Rohatiner AZ, Ryder WD, Gupta RK, Oza A, Deakin DP, Arnott S, Wilkinson PM, James RD, Johnson RJ, Lister TA. Results of a randomized trial comparing MVPP chemotherapy with a hybrid regimen, ChlVPP/EVA, in the initial treatment of Hodgkin's disease. J Clin Oncol. 1995 Sep;13(9):2379-85. link to original article PubMed
- Radford JA, Rohatiner AZ, Ryder WD, Deakin DP, Barbui T, Lucie NP, Rossi A, Dunlop DJ, Cowan RA, Wilkinson PM, Gupta RK, James RD, Shamash J, Chang J, Crowther D, Lister TA. ChlVPP/EVA hybrid versus the weekly VAPEC-B regimen for previously untreated Hodgkin's disease. J Clin Oncol. 2002 Jul 1;20(13):2988-94. link to original article dosing details in manuscript have been reviewed by our editors PubMed
PVAG
PVAG: Prednisone, Vinblastine, Adriamycin (Doxorubicin), Gemcitabine
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Böll et al. 2011 (PVAG elderly) | 2004-03 to 2007-07 | Phase 2 |
Note: This trial was open to patients with early unfavorable disease, but 93% of patients on study had advanced disease.
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 5
Chemotherapy
- Vinblastine (Velban) 6 mg/m2 IV once on day 1
- Doxorubicin (Adriamycin) 50 mg/m2 IV once on day 1
- Gemcitabine (Gemzar) 1000 mg/m2 IV once on day 1
21-day cycle for 6 to 8 cycles
Subsequent treatment
- PVAG elderly, patients with PR at the end of treatment: 3000 cGy of radiotherapy consolidation
References
- PVAG elderly: Böll B, Bredenfeld H, Görgen H, Halbsguth T, Eich HT, Soekler M, Markova J, Keller U, Graeven U, Kremers S, Geissler M, Trenn G, Fuchs M, von Tresckow B, Eichenauer DA, Borchmann P, Engert A. Phase 2 study of PVAG (prednisone, vinblastine, doxorubicin, gemcitabine) in elderly patients with early unfavorable or advanced stage Hodgkin lymphoma. Blood. 2011 Dec 8;118(24):6292-8. Epub 2011 Sep 13. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00147875
VEPEMB
VEPEMB: Vinblastine, Endoxan (Cyclophosphamide), Procarbazine, Etoposide, Mitoxantrone, Bleomycin
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Levis et al. 2004 | 1995-2001 | Phase 2 | ||
Proctor et al. 2012 (SHIELD) | Not reported | Phase 2 | ||
Zallio et al. 2016 | 2002-2006 | Phase 3 (E-de-esc) | ABVD | Might have inferior PFS (primary endpoint) |
Note: this regimen includes prednisone, even though it is not spelled out in the acronym.
Chemotherapy
- Vinblastine (Velban) 6 mg/m2 (maximum dose of 10 mg) IV once on day 1
- Cyclophosphamide (Cytoxan) 500 mg/m2 IV once on day 1
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 5
- Etoposide (Vepesid) 60 mg/m2 PO once per day on days 15 to 19
- Mitoxantrone (Novantrone) 6 mg/m2 IV once on day 15
- Bleomycin (Blenoxane) 10 mg/m2 IV once on day 15
Glucocorticoid therapy
- Prednisone (Sterapred) 30 mg/m2 PO once per day on days 1 to 5
28-day cycle for 3 to 6 cycles
References
- Levis A, Anselmo AP, Ambrosetti A, Adamo F, Bertini M, Cavalieri E, Gavarotti P, Genua A, Liberati M, Pavone V, Pietrasanta D, Ricetti MM, Scalabrini DR, Salvi F, Vitolo U, Angelucci E, Boccadoro M, Gallo E, Mandelli F; Intergruppo Italiano Linfomi. VEPEMB in elderly Hodgkin's lymphoma patients: results from an Intergruppo Italiano Linfomi (IIL) study. Ann Oncol. 2004 Jan;15(1):123-8. link to original article PubMed
- SHIELD: Proctor SJ, Wilkinson J, Jones G, Watson GC, Lucraft HH, Mainou-Fowler T, Culligan D, Galloway MJ, Wood KM, McNally RJ, James PW, Goodlad JR. Evaluation of treatment outcome in 175 patients with Hodgkin lymphoma aged 60 years or over: the SHIELD study. Blood. 2012 Jun 21;119(25):6005-15. Epub 2012 May 10. link to original article PubMed
- Zallio F, Tamiazzo S, Monagheddu C, Merli F, Ilariucci F, Stelitano C, Liberati AM, Mannina D, Vitolo U, Angelucci E, Rota Scalabrini D, Vallisa D, Bellei M, Bari A, Ciccone G, Salvi F, Levis A. Reduced intensity VEPEMB regimen compared with standard ABVD in elderly Hodgkin lymphoma patients: results from a randomized trial on behalf of the Fondazione Italiana Linfomi (FIL). Br J Haematol. 2016 Mar;172(6):879-88. Epub 2016 Jan 13. link to original article dosing details in manuscript have been reviewed by our editors PubMed
Consolidation after upfront therapy
Radiation therapy
RT: Radiation Therapy
Regimen variant #1, 2000 cGy of involved field RT (IFRT)
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Engert et al. 2010 (GHSG HD10) | 1998-2003 | Phase 3 (E-de-esc) | IFRT x 3000 cGy | Did not meet primary endpoint of FFTF |
Eich et al. 2010 (GHSG HD11) | 1998-2003 | Phase 3 (E-de-esc) | IFRT x 3000 cGy | Inconclusive whether non-inferior FFTF (primary endpoint) |
Note: This was an experimental arm that did not meet its primary endpoint; included here because it represents a de-escalation strategy.
Preceding treatment
Radiotherapy
- External beam radiotherapy 2000 cGy in 180 to 200 cGy fractions, five times per week
Regimen variant #3, 2400 cGy of IFRT
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Aleman et al. 2003 (EORTC 20884) | 1989-2000 | Phase 3 (E-esc) | Observation | Did not meet primary endpoint of RFS36 |
Note: This was an experimental arm that did not meet its primary endpoint; included here because other variants of this regimen have demonstrated comparative superiority.
Preceding treatment
- MOPP-ABV induction x 6 to 8, with CR
Radiotherapy
- External beam radiotherapy 2400 cGy
Regimen variant #4, 3000 cGy of IFRT
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Aleman et al. 2003 (EORTC 20884) | 1989-2000 | Phase 3 (E-esc) | Observation | Did not meet primary endpoint of RFS36 |
Engert et al. 2003 (GHSG HD8) | 1993-1998 | Phase 3 (E-de-esc) | EFRT x 3000 cGy + 1000 cGy boost | Equivalent FFTF |
Advani et al. 2013 (G4) | 1995-2001 | Non-randomized | ||
Engert et al. 2010 (GHSG HD10) | 1998-2003 | Phase 3 (C) | IFRT x 2000 cGy | Did not meet primary endpoint of FFTF |
Eich et al. 2010 (GHSG HD11) | 1998-2003 | Phase 3 (C) | IFRT x 2000 cGy | Inconclusive whether non-inferior FFTF (primary endpoint) |
von Tresckow et al. 2012 (GHSG HD14) | 2003-2008 | Non-randomized part of phase 3 RCT | ||
Behringer et al. 2014 (GHSG HD13) | 2003-2009 | Non-randomized part of phase 3 RCT | ||
Radford et al. 2015 (UK NCRI RAPID) | 2003-2010 | Phase 3 (C) | No further treatment | Inconclusive whether non-inferior PFS36 |
Borchmann et al. 2021 (GHSG HD17) | 2012-2017 | Phase 3 (C) | See link | See link |
Preceding treatment
- EORTC 20884: Induction MOPP-ABV x 6 to 8, with PR
- GHSG HD8: Induction COPP/ABVD x 4
- GHSG HD10: Induction ABVD x 2 versus ABVD x 4
- GHSG HD11: Induction ABVD x 4 versus BEACOPP x 4
- GHSG HD14: Induction ABVD x 4 versus eBEACOPP-ABVD; 2+2
- G4: Induction Stanford V x 8 wk
- GHSG HD13: Induction ABVD x 2
- UK NCRI RAPID: Induction ABVD x 3
- GHSG HD17: Induction eBEACOPP-ABVD; 2+2
Radiotherapy
- External beam radiotherapy 3000 cGy in 180 to 200 cGy fractions, five times per week
Regimen variant #5, 3000 cGy of involved site RT (ISRT)
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Borchmann et al. 2011 (GHSG HD12) | 1999-2003 | Phase 3 (E-esc) | Observation | Might have superior 5-year FFTF (primary endpoint) |
Kumar et al. 2016 (MSK 13-034) | 2013-06 to 2015-02 | Phase 2 |
Preceding treatment
- GHSG HD12: Induction eBEACOPP x 8 versus BEACOPP4+4
- MSK 13-034: Induction BV + AVD x 4
Radiotherapy
- External beam radiotherapy 3000 cGy
Regimen variant #6, 3000 cGy of involved node RT (INRT) + 600 cGy boost
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Raemaekers et al. 2014 (EORTC/LYSA/FIL H10) | 2006-2009 | Phase 3 (C) | See link | See link |
Preceding treatment
Radiotherapy
- External beam radiotherapy 3000 cGy (+ 600 cGy boost)
Regimen variant #7, 3000 cGy of extended-field RT (EFRT) + 1000 cGy boost
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Engert et al. 2003 (GHSG HD8) | 1993-1998 | Phase 3 (C) | IFRT x 3000 cGy + 1000 cGy boost | Equivalent FFTF |
Engert et al. 2007 (GHSG HD7) | 1993-1998 | Non-randomized part of phase 3 RCT |
Preceding treatment
- GHSG HD8: Induction COPP/ABVD x 4
- GHSG HD7: Induction ABVD x 2 versus no chemotherapy
Radiotherapy
- External beam radiotherapy 3000 cGy + 1000 cGy to the involved field
Regimen variant #8, 3500 cGy of subtotal nodal irradiation (STNI)
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Meyer et al. 2005 (NCIC-CTG/ECOG HD.6 U) | 1994-2002 | Phase 3 (C) | See link | See link |
Note: see link for use of STNI as definitive therapy.
Preceding treatment
- NCIC-CTG/ECOG HD.6 U: Induction ABVD x 2
Radiotherapy
- External beam radiotherapy 3500 cGy in 20 fractions
Regimen variant #9, 3600 cGy of IFRT
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Bonadonna et al. 2004 | 1990-1996 | Phase 3 (E-de-esc) | STNI x 3600 cGy | Inconclusive whether non-inferior |
Fermé et al. 2007 (EORTC-GELA H8-F) | 1993-1999 | Phase 3 (E-de-esc) | See link | See link |
Fermé et al. 2007 (EORTC-GELA H8-U) | 1993-1999 | Phase 3 (C) | See link | See link |
Gordon et al. 2012 (ECOG E2496) | 1999-2006 | Non-randomized part of phase 3 RCT |
Preceding treatment
Radiotherapy
- External beam radiotherapy 3600 cGy in 18 fractions of 200 cGy per fraction
Regimen variant #10, 3600 cGy of STNI
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Bonadonna et al. 2004 | 1990-1996 | Phase 3 (C) | IFRT x 3600 cGy | Inconclusive whether non-inferior |
Preceding treatment
- Induction ABVD x 4, with CR
Radiotherapy
- External beam radiotherapy 3600 cGy to involved sites, 3060 cGy to uninvolved sites
Regimen variant #11, 3600 cGy of STNI + 400 cGy boost
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Fermé et al. 2007 (EORTC-GELA H8-U) | 1993-1999 | Phase 3 (E-esc) | See link | See link |
Preceding treatment
- Induction MOPP-ABV x 4
Radiotherapy
- External beam radiotherapy 3600 cGy in 18 fractions of 200 cGy per fraction, with 400 cGy boost to involved fields
Regimen variant #12, 4000 cGy of IFRT
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Bonadonna et al. 2004 | 1990-1996 | Phase 3 (E-de-esc) | STNI x 4000 cGy | Inconclusive whether non-inferior |
Fermé et al. 2007 (EORTC-GELA H8-F) | 1993-1999 | Phase 3 (E-de-esc) | See link | See link |
Fermé et al. 2007 (EORTC-GELA H8-U) | 1993-1999 | Phase 3 (C) | See link | See link |
Preceding treatment
Radiotherapy
- External beam radiotherapy 4000 cGy in 20 fractions of 200 cGy per fraction
Regimen variant #13, 4000 cGy of STNI
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Bonadonna et al. 2004 | 1990-1996 | Phase 3 (C) | IFRT x 4000 cGy | Inconclusive whether non-inferior |
Preceding treatment
- Induction ABVD x 4, with CRu or PR
Radiotherapy
- External beam radiotherapy 4000 cGy to involved sites, 3060 cGy to uninvolved sites
References
- EORTC H6U: Carde P, Hagenbeek A, Hayat M, Monconduit M, Thomas J, Burgers MJ, Noordijk EM, Tanguy A, Meerwaldt JH, Le Fur R, Somers R, Kluin-Nelemans HC, Busson A, Breed WP, Bron D, Holdrinet A, Rutten EH, Michiels JJ, Regnier R, Debusscher L, Musella R, Fargeot P, Thyss A, Cattan A, Rigal-Huguet F, Roth S, Caillou B, Dupouy N, Henry-Amar M; EORTC Lymphoma Cooperative Group. Clinical staging versus laparotomy and combined modality with MOPP versus ABVD in early-stage Hodgkin's disease: the H6 twin randomized trials from the European Organisation for Research and Treatment of Cancer Lymphoma Cooperative Group. J Clin Oncol. 1993 Nov;11(11):2258-72. link to original article PubMed
- EORTC 20884: Aleman BM, Raemaekers JM, Tirelli U, Bortolus R, van 't Veer MB, Lybeert ML, Keuning JJ, Carde P, Girinsky T, van der Maazen RW, Tomsic R, Vovk M, van Hoof A, Demeestere G, Lugtenburg PJ, Thomas J, Schroyens W, De Boeck K, Baars JW, Kluin-Nelemans JC, Carrie C, Aoudjhane M, Bron D, Eghbali H, Smit WG, Meerwaldt JH, Hagenbeek A, Pinna A, Henry-Amar M; EORTC Lymphoma Group. Involved-field radiotherapy for advanced Hodgkin's lymphoma. N Engl J Med. 2003 Jun 12;348(24):2396-406. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- GHSG HD8: Engert A, Schiller P, Josting A, Herrmann R, Koch P, Sieber M, Boissevain F, De Wit M, Mezger J, Duhmke E, Willich N, Muller RP, Schmidt BF, Renner H, Muller-Hermelink HK, Pfistner B, Wolf J, Hasenclever D, Loffler M, Diehl V; German Hodgkin's Lymphoma Study Group. Involved-field radiotherapy is equally effective and less toxic compared with extended-field radiotherapy after four cycles of chemotherapy in patients with early-stage unfavorable Hodgkin's lymphoma: results of the HD8 trial of the German Hodgkin's Lymphoma Study Group. J Clin Oncol. 2003 Oct 1;21(19):3601-8. Epub 2003 Aug 11. link to original article dosing details in abstract have been reviewed by our editors PubMed
- Update: Sasse S, Klimm B, Görgen H, Fuchs M, Heyden-Honerkamp A, Lohri A, Koch O, Wilhelm M, Trenn G, Finke J, Müller RP, Diehl V, Eich HT, Borchmann P, Engert A; German Hodgkin Study Group (GHSG). Comparing long-term toxicity and efficacy of combined modality treatment including extended- or involved-field radiotherapy in early-stage Hodgkin's lymphoma. Ann Oncol. 2012 Nov;23(11):2953-9. Epub 2012 Jul 5. link to original article PubMed
- Pooled update: Sasse S, Bröckelmann PJ, Goergen H, Plütschow A, Müller H, Kreissl S, Buerkle C, Borchmann S, Fuchs M, Borchmann P, Diehl V, Engert A. Long-term follow-up of contemporary treatment in early-stage Hodgkin lymphoma: updated analyses of the German Hodgkin Study Group HD7, HD8, HD10, and HD11 trials. J Clin Oncol. 2017 Jun 20;35(18):1999-2007. Epub 2017 Apr 18. link to original article PubMed
- Bonadonna G, Bonfante V, Viviani S, Di Russo A, Villani F, Valagussa P. ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin's disease: long-term results. J Clin Oncol. 2004 Jul 15;22(14):2835-41. Epub 2004 Jun 15. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- NCIC-CTG/ECOG HD.6 U: Meyer RM, Gospodarowicz MK, Connors JM, Pearcey RG, Bezjak A, Wells WA, Burns BF, Winter JN, Horning SJ, Dar AR, Djurfeldt MS, Ding K, Shepherd LE; National Cancer Institute of Canada Clinical Trials Group; ECOG. Randomized comparison of ABVD chemotherapy with a strategy that includes radiation therapy in patients with limited-stage Hodgkin's lymphoma: National Cancer Institute of Canada Clinical Trials Group and the Eastern Cooperative Oncology Group. J Clin Oncol. 2005 Jul 20;23(21):4634-42. Epub 2005 Apr 18. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00002561
- Update: Meyer RM, Gospodarowicz MK, Connors JM, Pearcey RG, Wells WA, Winter JN, Horning SJ, Dar AR, Shustik C, Stewart DA, Crump M, Djurfeldt MS, Chen BE, Shepherd LE; NCIC Clinical Trials Group; ECOG. ABVD alone versus radiation-based therapy in limited-stage Hodgkin's lymphoma. N Engl J Med. 2012 Feb 2;366(5):399-408. Epub 2011 Dec 11. link to original article link to PMC article dosing details in abstract have been reviewed by our editors PubMed
- GHSG HD7: Engert A, Franklin J, Eich HT, Brillant C, Sehlen S, Cartoni C, Herrmann R, Pfreundschuh M, Sieber M, Tesch H, Franke A, Koch P, de Wit M, Paulus U, Hasenclever D, Loeffler M, Müller RP, Müller-Hermelink HK, Dühmke E, Diehl V. Two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine plus extended-field radiotherapy is superior to radiotherapy alone in early favorable Hodgkin's lymphoma: final results of the GHSG HD7 trial. J Clin Oncol. 2007 Aug 10;25(23):3495-502. Epub 2007 Jul 2. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- Pooled update: Sasse S, Bröckelmann PJ, Goergen H, Plütschow A, Müller H, Kreissl S, Buerkle C, Borchmann S, Fuchs M, Borchmann P, Diehl V, Engert A. Long-term follow-up of contemporary treatment in early-stage Hodgkin lymphoma: updated analyses of the German Hodgkin Study Group HD7, HD8, HD10, and HD11 trials. J Clin Oncol. 2017 Jun 20;35(18):1999-2007. Epub 2017 Apr 18. link to original article PubMed
- EORTC-GELA H8: Fermé C, Eghbali H, Meerwaldt JH, Rieux C, Bosq J, Berger F, Girinsky T, Brice P, van't Veer MB, Walewski JA, Lederlin P, Tirelli U, Carde P, Van den Neste E, Gyan E, Monconduit M, Diviné M, Raemaekers JM, Salles G, Noordijk EM, Creemers GJ, Gabarre J, Hagenbeek A, Reman O, Blanc M, Thomas J, Vié B, Kluin-Nelemans JC, Viseu F, Baars JW, Poortmans P, Lugtenburg PJ, Carrie C, Jaubert J, Henry-Amar M; EORTC; GELA. Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease. N Engl J Med. 2007 Nov 8;357(19):1916-27. link to original article dosing details in supplement have been reviewed by our editors PubMed NCT00379041
- GHSG HD10: Engert A, Plütschow A, Eich HT, Lohri A, Dörken B, Borchmann P, Berger B, Greil R, Willborn KC, Wilhelm M, Debus J, Eble MJ, Sökler M, Ho A, Rank A, Ganser A, Trümper L, Bokemeyer C, Kirchner H, Schubert J, Král Z, Fuchs M, Müller-Hermelink HK, Müller RP, Diehl V. Reduced treatment intensity in patients with early-stage Hodgkin's lymphoma. N Engl J Med. 2010 Aug 12;363(7):640-52. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00265018
- Pooled subgroup analysis: Böll B, Görgen H, Fuchs M, Pluetschow A, Eich HT, Bargetzi MJ, Weidmann E, Junghanß C, Greil R, Scherpe A, Schmalz O, Eichenauer DA, von Tresckow B, Rothe A, Diehl V, Engert A, Borchmann P. ABVD in older patients with early-stage Hodgkin lymphoma treated within the German Hodgkin Study Group HD10 and HD11 trials. J Clin Oncol. 2013 Apr 20;31(12):1522-9. Epub 2013 Mar 18. link to original article PubMed
- Pooled subgroup analysis: Böll B, Goergen H, Behringer K, Bröckelmann PJ, Hitz F, Kerkhoff A, Greil R, von Tresckow B, Eichenauer DA, Bürkle C, Borchmann S, Fuchs M, Diehl V, Engert A, Borchmann P. Bleomycin in older early-stage favorable Hodgkin lymphoma patients: analysis of the German Hodgkin Study Group (GHSG) HD10 and HD13 trials. Blood. 2016 May 5;127(18):2189-92. Epub 2016 Feb 1. link to original article PubMed
- Pooled update: Sasse S, Bröckelmann PJ, Goergen H, Plütschow A, Müller H, Kreissl S, Buerkle C, Borchmann S, Fuchs M, Borchmann P, Diehl V, Engert A. Long-term follow-up of contemporary treatment in early-stage Hodgkin lymphoma: updated analyses of the German Hodgkin Study Group HD7, HD8, HD10, and HD11 trials. J Clin Oncol. 2017 Jun 20;35(18):1999-2007. Epub 2017 Apr 18. link to original article PubMed
- GHSG HD11: Eich HT, Diehl V, Görgen H, Pabst T, Markova J, Debus J, Ho A, Dörken B, Rank A, Grosu AL, Wiegel T, Karstens JH, Greil R, Willich N, Schmidberger H, Döhner H, Borchmann P, Müller-Hermelink HK, Müller RP, Engert A. Intensified chemotherapy and dose-reduced involved-field radiotherapy in patients with early unfavorable Hodgkin's lymphoma: final analysis of the German Hodgkin Study Group HD11 trial. J Clin Oncol. 2010 Sep 20;28(27):4199-206. Epub 2010 Aug 16. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00264953
- Pooled subgroup analysis: Böll B, Görgen H, Fuchs M, Pluetschow A, Eich HT, Bargetzi MJ, Weidmann E, Junghanß C, Greil R, Scherpe A, Schmalz O, Eichenauer DA, von Tresckow B, Rothe A, Diehl V, Engert A, Borchmann P. ABVD in older patients with early-stage Hodgkin lymphoma treated within the German Hodgkin Study Group HD10 and HD11 trials. J Clin Oncol. 2013 Apr 20;31(12):1522-9. Epub 2013 Mar 18. link to original article PubMed
- Pooled update: Sasse S, Bröckelmann PJ, Goergen H, Plütschow A, Müller H, Kreissl S, Buerkle C, Borchmann S, Fuchs M, Borchmann P, Diehl V, Engert A. Long-term follow-up of contemporary treatment in early-stage Hodgkin lymphoma: updated analyses of the German Hodgkin Study Group HD7, HD8, HD10, and HD11 trials. J Clin Oncol. 2017 Jun 20;35(18):1999-2007. Epub 2017 Apr 18. link to original article PubMed
- GHSG HD12: Borchmann P, Haverkamp H, Diehl V, Cerny T, Markova J, Ho AD, Eich HT, Mueller-Hermelink HK, Kanz L, Greil R, Rank A, Paulus U, Smardova L, Huber C, Dörken B, Nerl C, Krause SW, Mueller RP, Fuchs M, Engert A. Eight cycles of escalated-dose BEACOPP compared with four cycles of escalated-dose BEACOPP followed by four cycles of baseline-dose BEACOPP with or without radiotherapy in patients with advanced-stage Hodgkin's lymphoma: final analysis of the HD12 trial of the German Hodgkin Study Group. J Clin Oncol. 2011 Nov 10;29(32):4234-42. Epub 2011 Oct 11. link to original article contains partial dosing details in manuscript PubMed NCT00265031
- Pooled update: von Tresckow B, Kreissl S, Dipl-Math HG, Bröckelmann PJ, Pabst T, Fridrik M, Rummel M, Jung W, Thiemer J, Sasse S, Bürkle C, Baues C, Diehl V, Engert A, Borchmann P; German Hodgkin Study Group. Intensive treatment strategies in advanced-stage Hodgkin's lymphoma (HD9 and HD12): analysis of long-term survival in two randomised trials. Lancet Haematol. 2018 Oct 01;5(10):e462-73. link to original article PubMed
- GHSG HD14: von Tresckow B, Plütschow A, Fuchs M, Klimm B, Markova J, Lohri A, Kral Z, Greil R, Topp MS, Meissner J, Zijlstra JM, Soekler M, Stein H, Eich HT, Mueller RP, Diehl V, Borchmann P, Engert A. Dose-intensification in early unfavorable Hodgkin's lymphoma: final analysis of the German Hodgkin Study Group HD14 trial. J Clin Oncol. 2012 Mar 20;30(9):907-13. Epub 2012 Jan 23. link to original article dosing details in manuscript have been reviewed by our editors PubMed ISRCTN04761296
- G4: Advani RH, Hoppe RT, Baer D, Mason J, Warnke R, Allen J, Daadi S, Rosenberg SA, Horning SJ. Efficacy of abbreviated Stanford V chemotherapy and involved-field radiotherapy in early-stage Hodgkin lymphoma: mature results of the G4 trial. Ann Oncol. 2013 Apr;24(4):1044-8. Epub 2012 Nov 7. link to original article contains limited protocol link to PMC article PubMed
- ECOG E2496: Gordon LI, Hong F, Fisher RI, Bartlett NL, Connors JM, Gascoyne RD, Wagner H, Stiff PJ, Cheson BD, Gospodarowicz M, Advani R, Kahl BS, Friedberg JW, Blum KA, Habermann TM, Tuscano JM, Hoppe RT, Horning SJ. Randomized phase III trial of ABVD versus Stanford V with or without radiation therapy in locally extensive and advanced-stage Hodgkin lymphoma: An Intergroup study coordinated by the Eastern Cooperative Oncology Group (E2496). J Clin Oncol. 2013 Feb 20;31(6):684-91. Epub 2012 Nov 26. link to original article link to PMC article PubMed NCT00003389
- Subgroup analysis: Evens AM, Hong F, Gordon LI, Fisher RI, Bartlett NL, Connors JM, Gascoyne RD, Wagner H, Gospodarowicz M, Cheson BD, Stiff PJ, Advani R, Miller TP, Hoppe RT, Kahl BS, Horning SJ. The efficacy and tolerability of adriamycin, bleomycin, vinblastine, dacarbazine and Stanford V in older Hodgkin lymphoma patients: a comprehensive analysis from the North American intergroup trial E2496. Br J Haematol. 2013 Apr;161(1):76-86. Epub 2013 Jan 29. link to original article link to PMC article PubMed
- Subgroup analysis: Advani RH, Hong F, Fisher RI, Bartlett NL, Robinson KS, Gascoyne RD, Wagner H Jr, Stiff PJ, Cheson BD, Stewart DA, Gordon LI, Kahl BS, Friedberg JW, Blum KA, Habermann TM, Tuscano JM, Hoppe RT, Horning SJ. Randomized phase III trial comparing ABVD plus radiotherapy with the Stanford V regimen in patients with stages I or II locally extensive, bulky mediastinal Hodgkin lymphoma: a subset analysis of the North American Intergroup E2496 trial. J Clin Oncol. 2015 Jun 10;33(17):1936-42. Epub 2015 Apr 20. link to original article contains limited protocol link to PMC article PubMed
- EORTC/LYSA/FIL H10: Raemaekers JM, André MP, Federico M, Girinsky T, Oumedaly R, Brusamolino E, Brice P, Fermé C, van der Maazen R, Gotti M, Bouabdallah R, Sebban CJ, Lievens Y, Re A, Stamatoullas A, Morschhauser F, Lugtenburg PJ, Abruzzese E, Olivier P, Casasnovas RO, van Imhoff G, Raveloarivahy T, Bellei M, van der Borght T, Bardet S, Versari A, Hutchings M, Meignan M, Fortpied C. Omitting radiotherapy in early positron emission tomography-negative stage I/II Hodgkin lymphoma is associated with an increased risk of early relapse: Clinical results of the preplanned interim analysis of the randomized EORTC/LYSA/FIL H10 trial. J Clin Oncol. 2014 Apr 20;32(12):1188-94. Epub 2014 Mar 17. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00433433
- Update: André MPE, Girinsky T, Federico M, Reman O, Fortpied C, Gotti M, Casasnovas O, Brice P, van der Maazen R, Re A, Edeline V, Fermé C, van Imhoff G, Merli F, Bouabdallah R, Sebban C, Specht L, Stamatoullas A, Delarue R, Fiaccadori V, Bellei M, Raveloarivahy T, Versari A, Hutchings M, Meignan M, Raemaekers J. Early positron emission tomography response-adapted treatment in stage I and II Hodgkin lymphoma: final results of the randomized EORTC/LYSA/FIL H10 trial. J Clin Oncol. 2017 Jun 1;35(16):1786-1794. Epub 2017 Mar 14. link to original article PubMed
- Update: Federico M, Fortpied C, Stepanishyna Y, Gotti M, van der Maazen R, Cristinelli C, Re A, Plattel W, Lazarovici J, Merli F, Specht L, Schiano de Colella JM, Hutchings M, Versari A, Edeline V, Stamatoulas A, Girinsky T, Ricardi U, Aleman B, Meulemans B, Tonino S, Raemaekers J, André M. Long-Term Follow-Up of the Response-Adapted Intergroup EORTC/LYSA/FIL H10 Trial for Localized Hodgkin Lymphoma. J Clin Oncol. 2024 Jan 1;42(1):19-25. Epub 2023 Nov 15. link to original article link to PMC article PubMed
- GHSG HD13: Behringer K, Goergen H, Hitz F, Zijlstra JM, Greil R, Markova J, Sasse S, Fuchs M, Topp MS, Soekler M, Mathas S, Meissner J, Wilhelm M, Koch P, Lindemann HW, Schalk E, Semrau R, Kriz J, Vieler T, Bentz M, Lange E, Mahlberg R, Hassler A, Vogelhuber M, Hahn D, Mezger J, Krause SW, Skoetz N, Böll B, von Tresckow B, Diehl V, Hallek M, Borchmann P, Stein H, Eich H, Engert A; German Hodgkin Study Group; Swiss Group for Clinical Cancer Research; Arbeitsgemeinschaft Medikamentöse Tumortherapie. Omission of dacarbazine or bleomycin, or both, from the ABVD regimen in treatment of early-stage favourable Hodgkin's lymphoma (GHSG HD13): an open-label, randomised, non-inferiority trial. Lancet. 2015 Apr 11;385(9976):1418-27. Epub 2014 Dec 22. Erratum in: Lancet. 2015 Apr 11;385(9976):1396. link to original article does not contain dosing details in manuscript PubMed ISRCTN63474366
- Pooled subgroup analysis: Böll B, Goergen H, Behringer K, Bröckelmann PJ, Hitz F, Kerkhoff A, Greil R, von Tresckow B, Eichenauer DA, Bürkle C, Borchmann S, Fuchs M, Diehl V, Engert A, Borchmann P. Bleomycin in older early-stage favorable Hodgkin lymphoma patients: analysis of the German Hodgkin Study Group (GHSG) HD10 and HD13 trials. Blood. 2016 May 5;127(18):2189-92. Epub 2016 Feb 1. link to original article PubMed
- UK NCRI RAPID: Radford J, Illidge T, Counsell N, Hancock B, Pettengell R, Johnson P, Wimperis J, Culligan D, Popova B, Smith P, McMillan A, Brownell A, Kruger A, Lister A, Hoskin P, O'Doherty M, Barrington S. Results of a trial of PET-directed therapy for early-stage Hodgkin's lymphoma. N Engl J Med. 2015 Apr 23;372(17):1598-607. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00943423
- MSK 13-034: Kumar A, Casulo C, Yahalom J, Schöder H, Barr PM, Caron P, Chiu A, Constine LS, Drullinsky P, Friedberg JW, Gerecitano JF, Hamilton A, Hamlin PA, Horwitz SM, Jacob AG, Matasar MJ, McArthur GN, McCall SJ, Moskowitz AJ, Noy A, Palomba ML, Portlock CS, Straus DJ, VanderEls N, Verwys SL, Yang J, Younes A, Zelenetz AD, Zhang Z, Moskowitz CH. Brentuximab vedotin and AVD followed by involved-site radiotherapy in early stage, unfavorable risk Hodgkin lymphoma. Blood. 2016 Sep 15;128(11):1458-64. Epub 2016 Jul 25. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT01868451
- GHSG HD17: Borchmann P, Plütschow A, Kobe C, Greil R, Meissner J, Topp MS, Ostermann H, Dierlamm J, Mohm J, Thiemer J, Sökler M, Kerkhoff A, Ahlborn M, Halbsguth TV, Martin S, Keller U, Balabanov S, Pabst T, Vogelhuber M, Hüttmann A, Wilhelm M, Zijlstra JM, Moccia A, Kuhnert G, Bröckelmann PJ, von Tresckow B, Fuchs M, Klimm B, Rosenwald A, Eich H, Baues C, Marnitz S, Hallek M, Diehl V, Dietlein M, Engert A. PET-guided omission of radiotherapy in early-stage unfavourable Hodgkin lymphoma (GHSG HD17): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2021 Feb;22(2):223-234. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT01356680
Relapsed or refractory, all lines of therapy
Note: most regimens in this section are salvage therapy, i.e., considered as part of a curative treatment approach, often prior to autologous or allogeneic HSCT. Some are for later line therapy and for transplant-ineligible patients and these are in the process of being moved to a new section, below.
ABVD
ABVD: Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Radford et al. 2015 (UK NCRI RAPID) | 2003-2010 | Non-randomized part of phase 3 RCT |
Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.
Preceding treatment
- Induction ABVD x 3, with interim PET-CT showing Deauville score 3 to 5 refractory disease
Chemotherapy
- Doxorubicin (Adriamycin) 25 mg/m2 IV once per day on days 1 & 15
- Bleomycin (Blenoxane) 10 units/m2 IV once per day on days 1 & 15
- Vinblastine (Velban) 6 mg/m2 IV once per day on days 1 & 15
- Dacarbazine (DTIC) 375 mg/m2 IV once per day on days 1 & 15
28-day course
Subsequent treatment
- IFRT consolidation
References
- UK NCRI RAPID: Radford J, Illidge T, Counsell N, Hancock B, Pettengell R, Johnson P, Wimperis J, Culligan D, Popova B, Smith P, McMillan A, Brownell A, Kruger A, Lister A, Hoskin P, O'Doherty M, Barrington S. Results of a trial of PET-directed therapy for early-stage Hodgkin's lymphoma. N Engl J Med. 2015 Apr 23;372(17):1598-607. link to original article does not contain dosing details in manuscript PubMed NCT00943423
BEACOPP-14 (Prednisolone)
BEACOPP-14: Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisolone, 14-day course
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Johnson et al. 2016 (RATHL) | 2008-2012 | Non-randomized part of phase 3 RCT |
Note: unlike most BEACOPP regimens, this one uses prednisolone (not prednisone).
Preceding treatment
- Induction ABVD x 2, with interim PET-CT showing Deauville score 4 or 5 refractory disease
Chemotherapy
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Etoposide (Vepesid) 100 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 25 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 650 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
Glucocorticoid therapy
- Prednisolone (Millipred) 80 mg/m2 PO once per day on days 1 to 7
Supportive therapy
- Growth factor support with ONE of the following:
- G-CSF (type not specified) 263 or 300 mcg SC once per day on days 9 to 13 OR
- Pegfilgrastim (Neulasta) (dose/day not specified) SC once
14-day cycle for 4 to 6 cycles
References
- RATHL: Johnson P, Federico M, Kirkwood A, Fosså A, Berkahn L, Carella A, d'Amore F, Enblad G, Franceschetto A, Fulham M, Luminari S, O'Doherty M, Patrick P, Roberts T, Sidra G, Stevens L, Smith P, Trotman J, Viney Z, Radford J, Barrington S. Adapted treatment guided by interim PET-CT scan in advanced Hodgkin's lymphoma. N Engl J Med. 2016 Jun 23;374(25):2419-29. link to original article link to protocol dosing details in supplement have been reviewed by our editors link to PMC article PubMed NCT00678327
- Update: Luminari S, Fossa A, Trotman J, Molin D, d'Amore F, Enblad G, Berkahn L, Barrington SF, Radford J, Federico M, Kirkwood AA, Johnson PWM. Long-Term Follow-Up of the Response-Adjusted Therapy for Advanced Hodgkin Lymphoma Trial. J Clin Oncol. 2024 Jan 1;42(1):13-18. Epub 2023 Oct 26. link to original article link to PMC article PubMed
BEACOPP
BEACOPP: Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone
BEACOPPbaseline
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Gallamini et al. 2018 (GITIL/FIL HD 0607) | 2008-2014 | Non-randomized part of phase 3 RCT |
Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.
Preceding treatment
- eBEACOPP salvage x 4
Chemotherapy
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Etoposide (Vepesid) 100 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 25 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 650 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
21-day cycle for 4 cycles
References
- GITIL/FIL HD 0607: Gallamini A, Tarella C, Viviani S, Rossi A, Patti C, Mulé A, Picardi M, Romano A, Cantonetti M, La Nasa G, Trentin L, Bolis S, Rapezzi D, Battistini R, Gottardi D, Gavarotti P, Corradini P, Cimminiello M, Schiavotto C, Parvis G, Zanotti R, Gini G, Ferreri AJM, Viero P, Miglino M, Billio A, Avigdor A, Biggi A, Fallanca F, Ficola U, Gregianin M, Chiaravalloti A, Prosperini G, Bergesio F, Chauvie S, Pavoni C, Gianni AM, Rambaldi A. Early chemotherapy intensification with escalated BEACOPP in patients with advanced-stage Hodgkin lymphoma with a positive interim positron emission tomography/computed tomography scan after two ABVD cycles: long-term results of the GITIL/FIL HD 0607 trial. J Clin Oncol. 2018 Feb 10;36(5):454-462. Epub 2018 Jan 23. link to original article dosing details in supplement have been reviewed by our editors PubMed NCT00795613
- Update: Gallamini A, Rossi A, Patti C, Picardi M, Romano A, Cantonetti M, Oppi S, Viviani S, Bolis S, Trentin L, Gini G, Battistini R, Chauvie S, Sorasio R, Pavoni C, Zanotti R, Cimminiello M, Schiavotto C, Viero P, Mulé A, Fallanca F, Ficola U, Tarella C, Guerra L, Rambaldi A. Consolidation Radiotherapy Could Be Safely Omitted in Advanced Hodgkin Lymphoma With Large Nodal Mass in Complete Metabolic Response After ABVD: Final Analysis of the Randomized GITIL/FIL HD0607 Trial. J Clin Oncol. 2020 Nov 20;38(33):3905-3913. Epub 2020 Sep 18. Erratum in: J Clin Oncol. 2021 Jan 1;39(1):96. link to original article PubMed
eBEACOPP
eBEACOPP: escalated Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone
Regimen variant #1, 2 cycles
Study | Dates of enrollment | Evidence |
---|---|---|
Raemaekers et al. 2014 (EORTC/LYSA/FIL H10) | 2006-2009 | Non-randomized part of phase 3 RCT |
Note: dosing is not described in the paper; this is the standard escalated BEACOPP as described elsewhere.
Preceding treatment
Chemotherapy
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Etoposide (Vepesid) 200 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 35 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
21-day cycle for 2 cycles
Subsequent treatment
- INRT consolidation
Regimen variant #2, 4 cycles
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Borchmann et al. 2017 (GHSG HD18) | 2008-2011 | Non-randomized part of phase 3 RCT | ||
Gallamini et al. 2018 (GITIL/FIL HD 0607) | 2008-2014 | Phase 3 (C) | R-BEACOPP | Did not meet primary endpoint of PFS |
Note: patients in GHSG HD18 enrolled after June 2011 would receive a total of 6 cycles.
Preceding treatment
Chemotherapy
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Etoposide (Vepesid) 200 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 35 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 1200 to 1250 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
Supportive therapy
- Filgrastim (Neupogen) 300 mcg SC once per day, starting day 8, continues until ANC greater than 1000/μL
21-day cycle for 4 cycles (see note)
Subsequent treatment
- GITIL/FIL HD 0607, negative interim PET-CT: BEACOPP (baseline) de-intensification x 4
- GITIL/FIL HD 0607, positive interim PET-CT: DHAP salvage
Regimen variant #3, 6 cycles
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Borchmann et al. 2017 (GHSG HD18) | 2008-2011 | Phase 3 (C) | R-BEACOPPescalated | Did not meet primary endpoint of PFS60 PFS36: 91.4% vs 93% |
Press et al. 2016 (SWOG S0816) | 2009-2012 | Phase 2 |
Note: patients in GHSG HD18 enrolled prior to June 2011 would receive a total of 8 cycles.
Preceding treatment
Chemotherapy
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Etoposide (Vepesid) 200 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 35 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 1200 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
Glucocorticoid therapy
- Prednisone (Sterapred) 40 mg/m2 PO once per day on days 1 to 14
21-day cycle for 6 cycles
References
- EORTC/LYSA/FIL H10: Raemaekers JM, André MP, Federico M, Girinsky T, Oumedaly R, Brusamolino E, Brice P, Fermé C, van der Maazen R, Gotti M, Bouabdallah R, Sebban CJ, Lievens Y, Re A, Stamatoullas A, Morschhauser F, Lugtenburg PJ, Abruzzese E, Olivier P, Casasnovas RO, van Imhoff G, Raveloarivahy T, Bellei M, van der Borght T, Bardet S, Versari A, Hutchings M, Meignan M, Fortpied C. Omitting radiotherapy in early positron emission tomography-negative stage I/II Hodgkin lymphoma is associated with an increased risk of early relapse: Clinical results of the preplanned interim analysis of the randomized EORTC/LYSA/FIL H10 trial. J Clin Oncol. 2014 Apr 20;32(12):1188-94. Epub 2014 Mar 17. link to original article does not contain dosing details in manuscript PubMed NCT00433433
- Update: André MPE, Girinsky T, Federico M, Reman O, Fortpied C, Gotti M, Casasnovas O, Brice P, van der Maazen R, Re A, Edeline V, Fermé C, van Imhoff G, Merli F, Bouabdallah R, Sebban C, Specht L, Stamatoullas A, Delarue R, Fiaccadori V, Bellei M, Raveloarivahy T, Versari A, Hutchings M, Meignan M, Raemaekers J. Early positron emission tomography response-adapted treatment in stage I and II Hodgkin lymphoma: final results of the randomized EORTC/LYSA/FIL H10 trial. J Clin Oncol. 2017 Jun 1;35(16):1786-1794. Epub 2017 Mar 14. link to original article PubMed
- Update: Federico M, Fortpied C, Stepanishyna Y, Gotti M, van der Maazen R, Cristinelli C, Re A, Plattel W, Lazarovici J, Merli F, Specht L, Schiano de Colella JM, Hutchings M, Versari A, Edeline V, Stamatoulas A, Girinsky T, Ricardi U, Aleman B, Meulemans B, Tonino S, Raemaekers J, André M. Long-Term Follow-Up of the Response-Adapted Intergroup EORTC/LYSA/FIL H10 Trial for Localized Hodgkin Lymphoma. J Clin Oncol. 2024 Jan 1;42(1):19-25. Epub 2023 Nov 15. link to original article link to PMC article PubMed
- SWOG S0816: Press OW, Li H, Schöder H, Straus DJ, Moskowitz CH, LeBlanc M, Rimsza LM, Bartlett NL, Evens AM, Mittra ES, LaCasce AS, Sweetenham JW, Barr PM, Fanale MA, Knopp MV, Noy A, Hsi ED, Cook JR, Lechowicz MJ, Gascoyne RD, Leonard JP, Kahl BS, Cheson BD, Fisher RI, Friedberg JW. US Intergroup trial of response-adapted therapy for stage III to IV Hodgkin lymphoma using early interim fluorodeoxyglucose-positron emission tomography imaging: Southwest Oncology Group S0816. J Clin Oncol. 2016 Jun 10;34(17):2020-7. Epub 2016 Apr 11. link to original article does not contain dosing details in manuscript; refers to Engert et al. 2009 link to PMC article PubMed NCT00822120
- Update: Stephens DM, Li H, Schöder H, Straus DJ, Moskowitz CH, LeBlanc M, Rimsza LM, Bartlett NL, Evens AM, LaCasce AS, Barr PM, Knopp MV, Hsi ED, Leonard JP, Kahl BS, Smith SM, Friedberg JW. Five-year follow-up of SWOG S0816: limitations and values of a PET-adapted approach with stage III/IV Hodgkin lymphoma. Blood. 2019 Oct 10;134(15):1238-1246. link to original article link to PMC article PubMed
- GHSG HD18: Borchmann P, Haverkamp H, Lohri A, Mey U, Kreissl S, Greil R, Markova J, Feuring-Buske M, Meissner J, Dührsen U, Ostermann H, Keller U, Maschmeyer G, Kuhnert G, Dietlein M, Kobe C, Eich H, Baues C, Stein H, Fuchs M, Diehl V, Engert A. Progression-free survival of early interim PET-positive patients with advanced stage Hodgkin's lymphoma treated with BEACOPP(escalated) alone or in combination with rituximab (HD18): an open-label, international, randomised phase 3 study by the German Hodgkin Study Group. Lancet Oncol. 2017 Apr;18(4):454-463. Epub 2017 Feb 22. link to original article contains partial dosing details in supplement PubMed NCT00515554
- Update: Borchmann P, Goergen H, Kobe C, Lohri A, Greil R, Eichenauer DA, Zijlstra JM, Markova J, Meissner J, Feuring-Buske M, Hüttmann A, Dierlamm J, Soekler M, Beck HJ, Willenbacher W, Ludwig WD, Pabst T, Topp MS, Hitz F, Bentz M, Keller UB, Kühnhardt D, Ostermann H, Schmitz N, Hertenstein B, Aulitzky W, Maschmeyer G, Vieler T, Eich H, Baues C, Stein H, Fuchs M, Kuhnert G, Diehl V, Dietlein M, Engert A. PET-guided treatment in patients with advanced-stage Hodgkin's lymphoma (HD18): final results of an open-label, international, randomised phase 3 trial by the German Hodgkin Study Group. Lancet. 2017 Dec 23;390(10114):2790-2802. Epub 2017 Oct 20. link to original article PubMed
- Update: Kreissl S, Goergen H, Buehnen I, Kobe C, Moccia A, Greil R, Eichenauer DA, Zijlstra JM, Markova J, Meissner J, Feuring-Buske M, Soekler M, Beck HJ, Willenbacher W, Ludwig WD, Pabst T, Topp MS, Hitz F, Bentz M, Keller UB, Kühnhardt D, Ostermann H, Hertenstein B, Aulitzky W, Maschmeyer G, Vieler T, Eich H, Baues C, Stein H, Fuchs M, Diehl V, Dietlein M, Engert A, Borchmann P; German Hodgkin Study Group. PET-guided eBEACOPP treatment of advanced-stage Hodgkin lymphoma (HD18): follow-up analysis of an international, open-label, randomised, phase 3 trial. Lancet Haematol. 2021 Jun;8(6):e398-e409. link to original article PubMed
- GITIL/FIL HD 0607: Gallamini A, Tarella C, Viviani S, Rossi A, Patti C, Mulé A, Picardi M, Romano A, Cantonetti M, La Nasa G, Trentin L, Bolis S, Rapezzi D, Battistini R, Gottardi D, Gavarotti P, Corradini P, Cimminiello M, Schiavotto C, Parvis G, Zanotti R, Gini G, Ferreri AJM, Viero P, Miglino M, Billio A, Avigdor A, Biggi A, Fallanca F, Ficola U, Gregianin M, Chiaravalloti A, Prosperini G, Bergesio F, Chauvie S, Pavoni C, Gianni AM, Rambaldi A. Early chemotherapy intensification with escalated BEACOPP in patients with advanced-stage Hodgkin lymphoma with a positive interim positron emission tomography/computed tomography scan after two ABVD cycles: long-term results of the GITIL/FIL HD 0607 trial. J Clin Oncol. 2018 Feb 10;36(5):454-462. Epub 2018 Jan 23. link to original article dosing details in supplement have been reviewed by our editors PubMed NCT00795613
- Update: Gallamini A, Rossi A, Patti C, Picardi M, Romano A, Cantonetti M, Oppi S, Viviani S, Bolis S, Trentin L, Gini G, Battistini R, Chauvie S, Sorasio R, Pavoni C, Zanotti R, Cimminiello M, Schiavotto C, Viero P, Mulé A, Fallanca F, Ficola U, Tarella C, Guerra L, Rambaldi A. Consolidation Radiotherapy Could Be Safely Omitted in Advanced Hodgkin Lymphoma With Large Nodal Mass in Complete Metabolic Response After ABVD: Final Analysis of the Randomized GITIL/FIL HD0607 Trial. J Clin Oncol. 2020 Nov 20;38(33):3905-3913. Epub 2020 Sep 18. Erratum in: J Clin Oncol. 2021 Jan 1;39(1):96. link to original article PubMed
eBEACOPP (Prednisolone)
eBEACOPP: escalated Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisolone
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Johnson et al. 2016 (RATHL) | 2008-2012 | Non-randomized part of phase 3 RCT |
Note: unlike most BEACOPP regimens, this one uses prednisolone (not prednisone).
Preceding treatment
- Induction ABVD x 2, with interim PET-CT showing Deauville score 4 or 5 refractory disease
Chemotherapy
- Bleomycin (Blenoxane) 10 units/m2 IV once on day 8
- Etoposide (Vepesid) 200 mg/m2 IV once per day on days 1 to 3
- Doxorubicin (Adriamycin) 35 mg/m2 IV once on day 1
- Cyclophosphamide (Cytoxan) 1250 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2 mg) IV once on day 8
- Procarbazine (Matulane) 100 mg/m2 PO once per day on days 1 to 7
Glucocorticoid therapy
- Prednisolone (Millipred) 40 mg/m2 PO once per day on days 1 to 14
Supportive therapy
- Growth factor support with ONE of the following:
- G-CSF (type not specified) 263/300 mcg SC once per day on days 9 to 13 OR
- Pegfilgrastim (Neulasta) (dose/day not specified) SC once
21-day cycle for 3 cycles
Subsequent treatment
- RATHL, second interim PET-CT negative: eBEACOPP continuation x 1 (4 total)
References
- RATHL: Johnson P, Federico M, Kirkwood A, Fosså A, Berkahn L, Carella A, d'Amore F, Enblad G, Franceschetto A, Fulham M, Luminari S, O'Doherty M, Patrick P, Roberts T, Sidra G, Stevens L, Smith P, Trotman J, Viney Z, Radford J, Barrington S. Adapted treatment guided by interim PET-CT scan in advanced Hodgkin's lymphoma. N Engl J Med. 2016 Jun 23;374(25):2419-29. link to original article link to protocol dosing details in supplement have been reviewed by our editors link to PMC article PubMed NCT00678327
- Update: Luminari S, Fossa A, Trotman J, Molin D, d'Amore F, Enblad G, Berkahn L, Barrington SF, Radford J, Federico M, Kirkwood AA, Johnson PWM. Long-Term Follow-Up of the Response-Adjusted Therapy for Advanced Hodgkin Lymphoma Trial. J Clin Oncol. 2024 Jan 1;42(1):13-18. Epub 2023 Oct 26. link to original article link to PMC article PubMed
BeGEV
BeGEV: Bendamustine, GEmcitabine, Vinorelbine
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Santoro et al. 2016 (ONC-2010-002) | 2011-09 to 2014-03 | Phase 2 |
Chemotherapy
- Bendamustine 90 mg/m2 IV once per day on days 2 & 3
- Gemcitabine (Gemzar) 800 mg/m2 IV once per day on days 1 & 4
- Vinorelbine (Navelbine) 20 mg/m2 IV once on day 1
Glucocorticoid therapy
- Prednisolone (Millipred) 100 mg PO once per day on days 1 to 4
Supportive therapy
- Growth factor support
- PJP prophylaxis and antiemetics in accordance with institutional guidelines
21-day cycle for 4 cycles
Subsequent treatment
- ONC-2010-002, patients with PR/CR: BEAM, then autologous hematopoietic cell transplant or FEAM, then autologous hematopoietic cell transplant consolidation
References
- ONC-2010-002: Santoro A, Mazza R, Pulsoni A, Re A, Bonfichi M, Zilioli VR, Salvi F, Merli F, Anastasia A, Luminari S, Annechini G, Gotti M, Peli A, Liberati AM, Di Renzo N, Castagna L, Giordano L, Carlo-Stella C. Bendamustine in combination with gemcitabine and vinorelbine is an effective regimen as induction chemotherapy before autologous stem-cell transplantation for relapsed or refractory Hodgkin lymphoma: final results of a multicenter phase II study. J Clin Oncol. 2016 Sep 20;34(27):3293-9. Epub 2016 Jul 5. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT01884441
Bendamustine monotherapy
Regimen
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Moskowitz et al. 2013 (MSK 08-041) | 2008-2010 | Phase 2 | ORR: 53% |
Chemotherapy
- Bendamustine 120 mg/m2 IV once per day on days 1 & 2
Supportive therapy
- One of the following used each cycle; paper does not specify exact timing/duration:
- PCP prophylaxis and antiemetics according to institutional guidelines
28-day cycle for up to 6 cycles
References
- MSK 08-041: Moskowitz AJ, Hamlin PA Jr, Perales MA, Gerecitano J, Horwitz SM, Matasar MJ, Noy A, Palomba ML, Portlock CS, Straus DJ, Graustein T, Zelenetz AD, Moskowitz CH. Phase II study of bendamustine in relapsed and refractory Hodgkin lymphoma. J Clin Oncol. 2013 Feb 1;31(4):456-60. Epub 2012 Dec 17. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT00705250
Bendamustine & Brentuximab vedotin
BVB: Brentuximab Vedotin & Bendamustine
Regimen
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
LaCasce et al. 2018 (SGN35-016) | 2013-2014 | Phase 1/2 | ORR: 92.5% |
Prior treatment criteria
- Standard upfront chemotherapy
Chemotherapy
- Bendamustine 90 mg/m2 IV once per day on days 1 & 2
Antibody-drug conjugate therapy
- Brentuximab vedotin (Adcetris) 1.8 mg/kg IV once on day 1
21-day cycle for up to 6 cycles
Subsequent treatment
- Optional autologous HSCT consolidation any time after cycle 2; most received BEAM, then auto HSCT
- Optional brentuximab vedotin continuation for a maximum of 16 cycles
References
- SGN35-016: LaCasce AS, Bociek RG, Sawas A, Caimi P, Agura E, Matous J, Ansell SM, Crosswell HE, Islas-Ohlmayer M, Behler C, Cheung E, Forero-Torres A, Vose J, O'Connor OA, Josephson N, Wang Y, Advani R. Brentuximab vedotin plus bendamustine: a highly active first salvage regimen for relapsed or refractory Hodgkin lymphoma. Blood. 2018 Jul 5;132(1):40-48. Epub 2018 Apr 27. link to original article dosing details in abstract have been reviewed by our editors link to PMC article dosing details in manuscript have been reviewed by our editors PubMed NCT01874054
Brentuximab vedotin monotherapy
Regimen variant #1, q3wk cycle x 4
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Chen et al. 2015 (CoH 11051) | 2011-2014 | Phase 2 | ORR: 68% |
Antibody-drug conjugate therapy
- Brentuximab vedotin (Adcetris) 1.8 mg/kg IV over 30 minutes once on day 1
21-day cycle for 4 cycles
Subsequent treatment
- Auto HSCT consolidation, with choice of regimen left to discretion of treating physician]]
Regimen variant #2, 3 out of 4 weeks
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Moskowitz et al. 2015 (MSK 11-142) | 2012-01-05 to 2013-10-04 | Phase 2 | PET-negative rate: 27% (95% CI, 13-40) |
Antibody-drug conjugate therapy
- Brentuximab vedotin (Adcetris) 1.2 mg/kg IV over 30 minutes once per day on days 1, 8, 15
28-day cycle for 2 cycles
Subsequent treatment
- MSK 11-142, PET-negative patients (a Deauville score of 1 or 2): Autologous HSCT consolidation with BEAM, CBV, or high dose chemoradiotherapy
- MSK 11-142, PET-positive patients: Two cycles of augmented ICE intensification prior to transplant
References
- Retrospective: Rothe A, Sasse S, Goergen H, Eichenauer DA, Lohri A, Jäger U, Bangard C, Böll B, von Bergwelt Baildon M, Theurich S, Borchmann P, Engert A. Brentuximab vedotin for relapsed or refractory CD30+ hematologic malignancies: the German Hodgkin Study Group experience. Blood. 2012 Aug 16;120(7):1470-2. Epub 2012 Jul 11. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- Retrospective: Gopal AK, Bartlett NL, Forero-Torres A, Younes A, Chen R, Friedberg JW, Matous JV, Shustov AR, Smith SE, Zain J, O'Meara MM, Fanale MA. Brentuximab vedotin in patients aged 60 years or older with relapsed or refractory CD30-positive lymphomas: a retrospective evaluation of safety and efficacy. Leuk Lymphoma. 2014 Oct;55(10):2328-34. Epub 2014 Feb 24. link to original article PubMed
- Case series: Illidge T, Bouabdallah R, Chen R, Gopal AK, Moskowitz CH, Ramchandren R, Shustov AR, Tilly H, Trippett TM, Gibb A, Grove LE, Advani R. Allogeneic transplant following brentuximab vedotin in patients with relapsed or refractory Hodgkin lymphoma and systemic anaplastic large cell lymphoma. Leuk Lymphoma. 2015 Mar;56(3):703-10. Epub 2015 Jan 21 link to original article PubMed
- MSK 11-142: Moskowitz AJ, Schöder H, Yahalom J, McCall SJ, Fox SY, Gerecitano J, Grewal R, Hamlin PA, Horwitz S, Kobos R, Kumar A, Matasar M, Noy A, Palomba ML, Perales MA, Portlock CS, Sauter C, Shukla N, Steinherz P, Straus D, Trippett T, Younes A, Zelenetz A, Moskowitz CH. PET-adapted sequential salvage therapy with brentuximab vedotin followed by augmented ifosamide, carboplatin, and etoposide for patients with relapsed and refractory Hodgkin's lymphoma: a non-randomised, open-label, single-centre, phase 2 study. Lancet Oncol. 2015 Mar;16(3):284-92. Epub 2015 Feb 13. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT01508312
- CoH 11051: Chen R, Palmer JM, Martin P, Tsai N, Kim Y, Chen BT, Popplewell L, Siddiqi T, Thomas SH, Mott M, Sahebi F, Armenian S, Leonard J, Nademanee A, Forman SJ. Results of a multicenter phase II trial of brentuximab vedotin as second-line therapy before autologous transplantation in relapsed/refractory Hodgkin lymphoma. Biol Blood Marrow Transplant. 2015 Dec;21(12):2136-40. Epub 2015 Jul 26. link to original article link to PMC article dosing details in manuscript have been reviewed by our editors PubMed NCT01393717
- Subgroup analysis: Herrera AF, Palmer J, Martin P, Armenian S, Tsai NC, Kennedy N, Sahebi F, Cao T, Budde LE, Mei M, Siddiqi T, Popplewell L, Rosen ST, Kwak LW, Nademanee A, Forman SJ, Chen R. Autologous stem-cell transplantation after second-line brentuximab vedotin in relapsed or refractory Hodgkin lymphoma. Ann Oncol. 2018 Mar 1;29(3):724-730. link to original article link to PMC article PubMed
Brentuximab vedotin & Nivolumab
Regimen
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Herrera et al. 2017 (SGN35-025) | 2015-2016 | Phase 1/2 | ORR: 82% (95% CI, 70-91) |
Note: this is the dosing used for all patients in the trial, per the manuscript. Any subsequent treatment was at the discretion of the treating physician.
Antibody-drug conjugate therapy
- Brentuximab vedotin (Adcetris) 1.8 mg/kg IV over 30 minutes once on day 1
Immunotherapy
- Nivolumab (Opdivo) as follows:
- Cycle 1: 3 mg/kg IV over 60 minutes once on day 8
- Cycles 2 to 4: 3 mg/kg IV over 60 minutes once on day 1, given at least 30 minutes after brentuximab vedotin
21-day cycle for up to 4 cycles
References
- SGN35-025: Herrera AF, Moskowitz AJ, Bartlett NL, Vose JM, Ramchandren R, Feldman TA, LaCasce AS, Ansell SM, Moskowitz CH, Fenton K, Ogden CA, Taft D, Zhang Q, Kato K, Campbell M, Advani RH. Interim results of brentuximab vedotin in combination with nivolumab in patients with relapsed or refractory Hodgkin lymphoma. Blood. 2018 Mar 15;131(11):1183-1194. Epub 2017 Dec 11. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT02572167
Camrelizumab monotherapy
Regimen
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Song et al. 2019 (SHR-1210-II-204) | 2017 | Phase 2 | ORR: 76% (95% CI, 65-85) |
References
- SHR-1210-II-204: Song Y, Wu J, Chen X, Lin T, Cao J, Liu Y, Zhao Y, Jin J, Huang H, Hu J, Luo J, Zhang L, Xue H, Zhang Q, Wang W, Chen C, Feng J, Zhu J. A Single-Arm, Multicenter, Phase II Study of Camrelizumab in Relapsed or Refractory Classical Hodgkin Lymphoma. Clin Cancer Res. 2019 Dec 15;25(24):7363-7369. Epub 2019 Aug 16. link to original article dosing details in abstract have been reviewed by our editors PubMed NCT03155425
DexaBEAM
DexaBEAM: Dexamethasone, BiCNU (Carmustine), Etoposide, Ara-C (Cytarabine), Melphalan
Regimen variant #1, 2 cycles with standard-dose etoposide
Study | Dates of enrollment | Evidence |
---|---|---|
Pfreundschuh et al. 1994 | 1988-01 to 1990-12 | Phase 2 |
Glucocorticoid therapy
- Dexamethasone (Decadron) 8 mg PO three times per day on days 1 to 10
Chemotherapy
- Carmustine (BCNU) 60 mg/m2 IV once on day 2
- Etoposide (Vepesid) 75 mg/m2 IV once per day on days 4 to 7
- Cytarabine (Ara-C) 100 mg/m2 IV twice per day on days 4 to 7
- Melphalan (Alkeran) 20 mg/m2 IV once on day 3
Supportive therapy
- G-CSF starting on day 8, continued until WBC count recovery or the last day of stem-cell harvesting
28-day cycle for 2 cycles
Subsequent treatment
- Pfreundschuh et al. 1994, chemosensitive disease: DexaBEAM continuation x 2 to 3 more cycles or CBV, then autologous HSCT consolidation
Regimen variant #2, 2 cycles with higher-dose etoposide
Study | Dates of enrollment | Evidence |
---|---|---|
Schmitz et al. 2002 (GHSG HD-R1) | 1993-1997 | Non-randomized part of RCT |
Note: the dose of etoposide was reduced per a mid-protocol amendment.
Glucocorticoid therapy
- Dexamethasone (Decadron) 8 mg PO three times per day on days 1 to 10
Chemotherapy
- Carmustine (BCNU) 60 mg/m2 IV once on day 2
- Etoposide (Vepesid) 150 mg/m2 IV once per day on days 4 to 7
- Cytarabine (Ara-C) 100 mg/m2 IV twice per day on days 4 to 7
- Melphalan (Alkeran) 20 mg/m2 IV once on day 3
Supportive therapy
- G-CSF starting on day 8, continued until WBC count recovery or the last day of stem-cell harvesting
2 cycles (length not specified)
Subsequent treatment
- GHSG HD-R1, chemosensitive disease: DexaBEAM continuation x 2 versus BEAM, then autologous HSCT consolidation
Regimen variant #3, 4 cycles total with higher-dose etoposide
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Schmitz et al. 2002 (GHSG HD-R1) | 1993-1997 | Randomized (C) | BEAM, then autologous HSCT | Seems to have inferior FFTF |
Preceding treatment
- DexaBEAM salvage x 2
Glucocorticoid therapy
- Dexamethasone (Decadron) 8 mg PO three times per day on days 1 to 10
Chemotherapy
- Carmustine (BCNU) 60 mg/m2 IV once on day 2
- Etoposide (Vepesid) 150 mg/m2 IV once per day on days 4 to 7
- Cytarabine (Ara-C) 100 mg/m2 IV twice per day on days 4 to 7
- Melphalan (Alkeran) 20 mg/m2 IV once on day 3
Supportive therapy
- G-CSF starting on day 8, continued until WBC count recovery or the last day of stem-cell harvesting
2 cycles (length not specified) for a total of 4 cycles
References
- Pfreundschuh MG, Rueffer U, Lathan B, Schmitz N, Brosteanu O, Hasenclever D, Haas R, Kirchner H, Koch P, Kuse R, Loeffler M, Diehl V; GHSG. Dexa-BEAM in patients with Hodgkin's disease refractory to multidrug chemotherapy regimens: a trial of the German Hodgkin's Disease Study Group. J Clin Oncol. 1994 Mar;12(3):580-6. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- GHSG HD-R1: Schmitz N, Pfistner B, Sextro M, Sieber M, Carella AM, Haenel M, Boissevain F, Zschaber R, Müller P, Kirchner H, Lohri A, Decker S, Koch B, Hasenclever D, Goldstone AH, Diehl V; German Hodgkin's Lymphoma Study Group; Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin's disease: a randomised trial. Lancet. 2002 Jun 15;359(9323):2065-71. link to original article dosing details in manuscript have been reviewed by our editors PubMed
DHAP
DHAP: Dexamethasone, High-dose Ara-C (Cytarabine), Platinol (Cisplatin)
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Velasquez et al. 1988 | 1984-1986 | Phase 2 |
Josting et al. 2010 (GHSG HD-R2) | 2000-2006 | Non-randomized part of phase 3 RCT |
Sureda et al. 2011 (HDR-ALLO) | Not reported | Phase 2 |
Glucocorticoid therapy
- Dexamethasone (Decadron) 40 mg PO or IV over 15 minutes once per day on days 1 to 4
Chemotherapy
- Cytarabine (Ara-C) by the following age-based criteria:
- 70 years old or younger: 2000 mg/m2 IV over 3 hours every 12 hours on day 2 (total dose per cycle: 4000 mg/m2)
- Older than 70 years old: 1000 mg/m2 IV over 3 hours every 12 hours on day 2 (total dose per cycle: 2000 mg/m2)
- Cisplatin (Platinol) 100 mg/m2 IV continuous infusion over 24 hours, started on day 1
Supportive therapy
- Normal saline with mannitol 50 g/L given at 250 mL/H x 36 hours, starting 6 hours prior to cisplatin infusion was started
21- to 28-day cycles; cycle length depends on degree of myelosuppression
Subsequent treatment
- Velasquez et al. 1988: DHAP continuation x 6 to 10 cycles, with therapy given 4 cycles beyond the maximum antitumor effect
- GHSG HD-R2: BEAM with auto HSCT consolidation versus [[#Cyclophosphamide-Methotrexate-Etoposide_998|SHDCT] intensification followed by BEAM with auto HSCT consolidation
- HDR-ALLO, responders after 2 cycles: Flu-Mel RIC-allo HSCT consolidation
Dose and schedule modifications
- Aside from the table below (from Velasquez et al. 1988), there were no specific cutoff criteria about dose modifications or delays of treatment.
Dose modifications | ||
---|---|---|
Event | Cytarabine (Ara-C) | Cisplatin (Platinol) |
ANC less than 200/μL | 1000 mg/m2 x 2 doses | 100 mg/m2 |
Platelets less than 20 x 109/L | 1000 mg/m2 x 2 doses | 100 mg/m2 |
Sepsis associated with neutropenia | 500 mg/m2 x 1 dose | 100 mg/m2 |
Cr 1.5 to 2.0 | - | 75 mg/m2 |
Cr 2.1-3.0 | - | 50 mg/m2 |
References
- Velasquez WS, Cabanillas F, Salvador P, McLaughlin P, Fridrik M, Tucker S, Jagannath S, Hagemeister FB, Redman JR, Swan F, Barlogie B. Effective salvage therapy for lymphoma with cisplatin in combination with high-dose Ara-C and dexamethasone (DHAP). Blood. 1988 Jan;71(1):117-22. link to original article dosing details in abstract have been reviewed by our editors PubMed
- GHSG HD-R2: Josting A, Müller H, Borchmann P, Baars JW, Metzner B, Döhner H, Aurer I, Smardova L, Fischer T, Niederwieser D, Schäfer-Eckart K, Schmitz N, Sureda A, Glossmann J, Diehl V, DeJong D, Hansmann ML, Raemaekers J, Engert A. Dose intensity of chemotherapy in patients with relapsed Hodgkin's lymphoma. J Clin Oncol. 2010 Dec 1;28(34):5074-80. Epub 2010 Oct 25. link to original article dosing details in abstract have been reviewed by our editors PubMed NCT00025636
- HDR-ALLO: Sureda A, Canals C, Arranz R, Caballero D, Ribera JM, Brune M, Passweg J, Martino R, Valcárcel D, Besalduch J, Duarte R, León A, Pascual MJ, García-Noblejas A, López Corral L, Xicoy B, Sierra J, Schmitz N; GEL/TAMO. Allogeneic stem cell transplantation after reduced intensity conditioning in patients with relapsed or refractory Hodgkin's lymphoma: results of the HDR-ALLO study - a prospective clinical trial by the Grupo Español de Linfomas/Trasplante de Médula Osea (GEL/TAMO) and the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Haematologica. 2012 Feb;97(2):310-7. Epub 2011 Oct 11. link to original article dosing details in abstract have been reviewed by our editors link to PMC article PubMed EudraCT 02-0036
DHAP - time intensified
DHAP - time intensified: Dexamethasone, High-dose Ara-C (Cytarabine), Platinol (Cisplatin)
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Josting et al. 2002 | Not reported | Phase 2 |
Note: This was used as a salvage regimen for relapsed/refractory Hodgkin Lymphoma in patients who were planned for high-dose chemotherapy (HDCT) and autologous hematopoietic cell transplantation. Median time between cycle 1 and 2 was 16 days. The paper did not definitively specify what criteria needed to be fulfilled before cycle 2 was given.
Eligibility criteria
- WBC count more than 3.5 x 109/L
- Hgb greater than or equal to 8 g/dL
- Platelets greater than or equal to 100 x 109/L
Glucocorticoid therapy
- Dexamethasone (Decadron) 40 mg IV once per day on days 1 to 4
Chemotherapy
- Cytarabine (Ara-C) 2000 mg/m2 IV over 3 hours every 12 hours on day 2 (total dose per cycle: 4000 mg/m2)
- Cisplatin (Platinol) 100 mg/m2 IV continuous infusion over 24 hours, started on day 1
Supportive therapy
- Hydration at 250 mL/H started 2 to 6 hours prior to cisplatin infusion was started
- Prednisolone acetate 1% eyedrops 1 drop to both eyes three times per day, beginning 12 hours prior to cytarabine and continued for 2 days after administration complete
- Ondansetron (Zofran) 8 mg IV once per day on days 1 & 2
- Filgrastim (Neupogen) 5 mcg/kg SC once per day, beginning 24 hours after last dose of cytarabine and continued until ANC greater than 2500/μL for 3 days
Variable number of days between cycles depending on count recovery for 2 cycles
References
- Josting A, Rudolph C, Reiser M, Mapara M, Sieber M, Kirchner HH, Dörken B, Hossfeld DK, Diehl V, Engert A; Participating Centers. Time-intensified dexamethasone/cisplatin/cytarabine: an effective salvage therapy with low toxicity in patients with relapsed and refractory Hodgkin's disease. Ann Oncol. 2002 Oct;13(10):1628-35. link to original article dosing details in abstract have been reviewed by our editors PubMed
ESHAP
ESHAP: Etoposide, Solumedrol (Methylprednisolone) High-dose Ara-C (Cytarabine), Platinol (Cisplatin)
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Aparicio et al. 1999 | 1990-1997 | Phase 2 |
Note: the authors state that they used the protocol defined by Velasquez et al. 1994. However, there are some differences in the text describing methylprednisolone dosing from that in the original article. Below are the doses reported in the original article, with the addition of G-CSF as specified in Aparicio et al. 1999.
Chemotherapy
- Etoposide (Vepesid) 40 mg/m2 IV over 60 minutes once per day on days 1 to 4
- Cytarabine (Ara-C) 2000 mg/m2 IV over 2 hours once on day 5
- Cisplatin (Platinol) 25 mg/m2/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 100 mg/m2)
Glucocorticoid therapy
- Methylprednisolone (Solumedrol) 250 to 500 mg IV over 15 minutes once per day on days 1 to 5
Supportive therapy
- At least 1 liter normal saline with 25 to 50 g Mannitol once per day throughout chemotherapy
- Metoclopramide (Reglan) 0.5 to 1 mg/kg (route not specified) "given regularly"
- Filgrastim (Neupogen) 5 mcg/kg SC once per day on days 6 to 18
21- to 28-day cycle for 3 cycles; see below
Subsequent treatment
- Aparicio et al. 1999, transplant-eligible patients with responsive disease: CBV with auto HSCT consolidation
- Aparicio et al. 1999, transplant-ineligible patients with responsive disease: ESHAP continuation x 3 (6 cycles total)
References
- Aparicio J, Segura A, Garcerá S, Oltra A, Santaballa A, Yuste A, Pastor M. ESHAP is an active regimen for relapsing Hodgkin's disease. Ann Oncol. 1999 May;10(5):593-5. link to original article dosing details in manuscript have been reviewed by our editors PubMed
Everolimus monotherapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Johnston et al. 2010 | 2005-08 to 2007-05 | Phase 2 |
Targeted therapy
- Everolimus (Afinitor) 10 mg PO once per day on days 1 to 28, taken on an empty stomach
Supportive therapy
- "Patients could receive white blood cell growth factors if neutropenia developed. Erythropoietin treatment for anemia was permitted."
28-day cycles
References
- Johnston PB, Inwards DJ, Colgan JP, Laplant BR, Kabat BF, Habermann TM, Micallef IN, Porrata LF, Ansell SM, Reeder CB, Roy V, Witzig TE. A Phase II trial of the oral mTOR inhibitor everolimus in relapsed Hodgkin lymphoma. Am J Hematol. 2010 May;85(5):320-4. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed
GCD
GCD: Gemcitabine, Carboplatin, Dexamethasone
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Gopal et al. 2010 (PSOC 2003) | 2003-12 to 2008-04 | Phase 2 |
Chemotherapy
- Gemcitabine (Gemzar) 1000 mg/m2 IV over 30 minutes once per day on days 1 & 8
- Carboplatin (Paraplatin) AUC 5 IV over 30 minutes once on day 1
Glucocorticoid therapy
- Dexamethasone (Decadron) 40 mg PO once per day on days 1 to 4
Supportive therapy
- Growth factor support and antibiotic prophylaxis used is at the discretion of the treating physician.
21-day cycle for up to 4 cycles; if counts not adequate, the next cycle can be delayed for up to 3 weeks until counts are adequate for treatment
Dose and schedule modifications
- Gemcitabine (Gemzar):
- If on day 8, platelets are 50 to 100 x 109/L or ANC 500 to 1000/μL: reduce dose by 25% for that dose only.
- If on day 8, platelets are less than 50 x 109/L or ANC less than 500/μL: No day 8 dose given.
- Subsequent cycles would be given at full dose if patients had platelets greater than or equal to 50 x 109/L or ANC greater than or equal to 1000/μL.
References
- PSOC 2003: Gopal AK, Press OW, Shustov AR, Petersdorf SH, Gooley TA, Daniels JT, Garrison MA, Gjerset GF, Lonergan M, Murphy AE, Smith JC, Pagel JM. Efficacy and safety of gemcitabine, carboplatin, dexamethasone, and rituximab in patients with relapsed/refractory lymphoma: a prospective multi-center phase II study by the Puget Sound Oncology Consortium. Leuk Lymphoma. 2010 Aug;51(8):1523-9. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT00072514
GCD-R
GCD-R: Gemcitabine, Carboplatin, Dexamethasone, Rituximab
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Gopal et al. 2010 (PSOC 2003) | 2003-12 to 2008-04 | Phase 2 |
Biomarker eligibility criteria
- CD20+ disease
Chemotherapy
- Gemcitabine (Gemzar) 1000 mg/m2 IV over 30 minutes once per day on days 1 & 8
- Carboplatin (Paraplatin) AUC 5 IV over 30 minutes once on day 1
Glucocorticoid therapy
- Dexamethasone (Decadron) 40 mg PO once per day on days 1 to 4
Targeted therapy
- Rituximab (Rituxan) 375 mg/m2 IV once on day 8
Supportive therapy
- Growth factor support and antibiotic prophylaxis used is at the discretion of the treating physician.
21-day cycle for up to 4 cycles; if counts not adequate, the next cycle can be delayed for up to 3 weeks until counts are adequate for treatment
Dose and schedule modifications
- Gemcitabine (Gemzar):
- If on day 8, platelets are 50 to 100 x 109/L or ANC 500 to 1000/μL: reduce dose by 25% for that dose only.
- If on day 8, platelets are less than 50 x 109/L or ANC less than 500/μL: No day 8 dose given.
- Subsequent cycles would be given at full dose if patients had platelets greater than or equal to 50 x 109/L or ANC greater than or equal to 1000/μL.
References
- PSOC 2003: Gopal AK, Press OW, Shustov AR, Petersdorf SH, Gooley TA, Daniels JT, Garrison MA, Gjerset GF, Lonergan M, Murphy AE, Smith JC, Pagel JM. Efficacy and safety of gemcitabine, carboplatin, dexamethasone, and rituximab in patients with relapsed/refractory lymphoma: a prospective multi-center phase II study by the Puget Sound Oncology Consortium. Leuk Lymphoma. 2010 Aug;51(8):1523-9. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT00072514
Gemcitabine monotherapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Santoro et al. 2000 | Not reported | Phase 2 |
Chemotherapy
- Gemcitabine (Gemzar) as follows:
- Cycle 1: 1250 mg/m2 IV over 30 minutes once per day on days 1, 8, 15
- Subsequent cycles (if no hematologic or nonhematologic toxicities): 1500 mg/m2 IV over 30 minutes once per day on days 1, 8, 15
28-day cycles
References
- Santoro A, Bredenfeld H, Devizzi L, Tesch H, Bonfante V, Viviani S, Fiedler F, Parra HS, Benoehr C, Pacini M, Bonadonna G, Diehl V. Gemcitabine in the treatment of refractory Hodgkin's disease: results of a multicenter phase II study. J Clin Oncol. 2000 Jul;18(13):2615-9. link to original article dosing details in manuscript have been reviewed by our editors PubMed
Gemcitabine & Rituximab
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Oki et al. 2007 | 2002-03 to 2005-08 | Phase 2 |
Prior treatment criteria
- At least 2 prior chemotherapy regimens
Targeted therapy
- Rituximab (Rituxan) as follows:
- Cycles 1 & 2: 375 mg/m2 IV once per day on days 1, 8, 15
Chemotherapy
- Gemcitabine (Gemzar) 1250 mg/m2 IV over 30 minutes once per day on days 1 & 8
21-day cycle for up to 6 cycles
Dose and schedule modifications
- Gemcitabine (Gemzar):
- Dose level 0: 1250 mg/m2
- Dose level -1: 1000 mg/m2
- Dose level -2: 750 mg/m2
- If ANC less than or equal to 1000/μL on day 1 of the following cycle, delay until count recovery
- If ANC remains less than or equal to 1000/μL for one week or longer, reduce dose by one level
- If platelets less than or equal to 50 x 109/L on day 1 of the following cycle, delay until count recovery AND reduce dose by one level
References
- Oki Y, Pro B, Fayad LE, Romaguera J, Samaniego F, Hagemeister F, Neelapu S, McLaughlin P, Goy A, Younes A. Phase 2 study of gemcitabine in combination with rituximab in patients with recurrent or refractory Hodgkin lymphoma. Cancer. 2008 Feb 15;112(4):831-6. link to original article dosing details in manuscript have been reviewed by our editors PubMed
GVD
GVD: Gemcitabine, Vinorelbine, Doxil (Pegylated liposomal doxorubicin)
Regimen variant #1, transplant-naive
Study | Dates of enrollment | Evidence |
---|---|---|
Bartlett et al. 2007 (CALGB 59804) | 2000-2003 | Phase 1/2 |
Note: this corresponds to dose level 1 used in the dose-finding portion of the protocol; see paper for further details.
Chemotherapy
- Gemcitabine (Gemzar) 1000 mg/m2 IV over 30 minutes once per day on days 1 & 8, given second
- Vinorelbine (Navelbine) 20 mg/m2 IV over 6 to 10 minutes once per day on days 1 & 8, given first
- Pegylated liposomal doxorubicin (Doxil) 15 mg/m2 IV over 30 to 60 minutes once per day on days 1 & 8, given third
Supportive therapy
- See dose modifications, below
21-day cycle for 2 to 6 cycles
Subsequent treatment
- CALGB 59804, SD or better: Autologous HSCT consolidation (details not specified)
Dose and schedule modifications
- If on day 8, platelets are 50 to 100 x 109/L or ANC 500 to 1000/μL: reduce gemcitabine dose by 25% for that dose only.
- If on day 8, platelets are less than 50 x 109/L or ANC less than 500/μL: No day 8 gemcitabine dose given.
- Subsequent cycles would be given at full dose if patients had platelets greater than or equal to 50 x 109/L or ANC greater than or equal to 1000/μL.
- If counts were not adequate, the next cycle can be delayed for up to 3 weeks until counts are adequate for treatment.
- If febrile neutropenia occurs: Decrease treatment by one dose level.
- If febrile neutropenia occurs on dose level -1: treating physician can choose to either:
- Use filgrastim or sargramostim
- Reduce dose of gemcitabine and vinorelbine by 25% for all subsequent cycles.
- If febrile neutropenia reoccurred despite dose reduction patient were discontinued from this protocol.
Regimen variant #2, post-transplant
Study | Dates of enrollment | Evidence |
---|---|---|
Bartlett et al. 2007 (CALGB 59804) | 2000-2003 | Phase 1/2 |
Note: this corresponds to dose level -1 used in the dose-finding portion of the protocol; see paper for further details.
Chemotherapy
- Gemcitabine (Gemzar) 800 mg/m2 IV over 30 minutes once per day on days 1 & 8, given second
- Vinorelbine (Navelbine) 15 mg/m2 IV over 6 to 10 minutes once per day on days 1 & 8, given first
- Pegylated liposomal doxorubicin (Doxil) 10 mg/m2 IV over 30 to 60 minutes once per day on days 1 & 8, given third
Supportive therapy
- See dose modifications, below
21-day cycle for 2 to 6 cycles
Dose and schedule modifications
- If on day 8, platelets are 50 to 100 x 109/L or ANC 500 to 1000/μL: reduce gemcitabine dose by 25% for that dose only.
- If on day 8, platelets are less than 50 x 109/L or ANC less than 500/μL: No day 8 gemcitabine dose given.
- Subsequent cycles would be given at full dose if patients had platelets greater than or equal to 50 x 109/L or ANC greater than or equal to 1000/μL.
- If counts were not adequate, the next cycle can be delayed for up to 3 weeks until counts are adequate for treatment.
- If febrile neutropenia occurs: Decrease treatment by one dose level.
- If febrile neutropenia occurs on dose level -1: treating physician can choose to either:
- Use filgrastim or sargramostim
- Reduce dose of gemcitabine and vinorelbine by 25% for all subsequent cycles.
- If febrile neutropenia reoccurred despite dose reduction patient were discontinued from this protocol.
References
- CALGB 59804: Bartlett NL, Niedzwiecki D, Johnson JL, Friedberg JW, Johnson KB, van Besien K, Zelenetz AD, Cheson BD, Canellos GP; Cancer and Leukemia Group B. Gemcitabine, vinorelbine, and pegylated liposomal doxorubicin (GVD), a salvage regimen in relapsed Hodgkin's lymphoma: CALGB 59804. Ann Oncol. 2007 Jun;18(6):1071-9. Epub 2007 Apr 10. link to original article dosing details in abstract have been reviewed by our editors PubMed
GVP
GVP: Gemcitabine, Vinorelbine, Prednisolone
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Naqi et al. 2013 | Not reported | Phase 2 |
Chemotherapy
- Gemcitabine (Gemzar) 1000 mg/m2 IV over 30 minutes once per day on days 1 & 8
- Vinorelbine (Navelbine) 30 mg/m2 IV bolus once per day on days 1 & 8
Glucocorticoid therapy
- Prednisolone (Millipred) 100 mg PO once per day on days 1 to 5
28-day cycle for 4 cycles
References
- Naqi N, Ahmad S, Shah I, Khattak J. A multicentre phase-II feasibility study evaluating gemcitabine/vinorelbine / prednisolone combination chemotherapy in relapsed / refractory Hodgkin's lymphoma. J Coll Physicians Surg Pak. 2013 Jun;23(6):397-400. link to original article dosing details in manuscript have been reviewed by our editors PubMed
ICE
ICE: Ifosfamide, Carboplatin, Etoposide
Regimen variant #1
Study | Dates of enrollment | Evidence |
---|---|---|
Moskowitz et al. 2001 | 1994-10 to 1998-02 | Phase 2 |
Chemotherapy
- Ifosfamide (Ifex) 5000 mg/m2 IV continuous infusion over 24 hours, started on day 2, admixed with mesna
- Carboplatin (Paraplatin) AUC 5 (maximum dose of 800 mg) IV once on day 2
- Etoposide (Vepesid) 100 mg/m2 IV once per day on days 1 to 3
Supportive therapy
- Mesna (Mesnex) 5000 mg/m2 IV continuous infusion over 24 hours, started on day 2, admixed with ifosfamide
- Filgrastim (Neupogen) 5 mcg/kg SC once per day on days 5 to 12
14-day cycle for 2 cycles
Dose and schedule modifications
- No dose reductions--treatment is delayed until ANC is greater than 1000/μL and platelets greater than 50 x 109/L
Regimen variant #2, "Augmented ICE"
Study | Dates of enrollment | Evidence |
---|---|---|
Moskowitz et al. 2015 (MSK 11-142) | 2012-01-05 to 2013-10-04 | Phase 2 |
Preceding treatment
- Brentuximab vedotin salvage
Chemotherapy
- Ifosfamide (Ifex) 5000 mg/m2/day IV continuous infusion over 48 hours, started on day 1, admixed with mesna (total dose per cycle: 10,000 mg/m2)
- Carboplatin (Paraplatin) AUC 5 (maximum dose of 800 mg) IV once on day 3
- Etoposide (Vepesid) 200 mg/m2 IV over 60 minutes every 12 hours on days 1 & 2 (total dose per cycle: 600 mg/m2)
Supportive therapy
- Mesna (Mesnex) 5000 mg/m2/day IV continuous infusion over 48 hours, started on day 1, admixed with ifosfamide (total dose per cycle: 10,000 mg/m2)
2 cycles; second cycle started once ANC at least 1000/uL and platelet count at least 50 x 109/L
Subsequent treatment
- Autologous HSCT consolidation was "considered" after 2 cycles; criteria not listed in the abstract
References
- Moskowitz CH, Nimer SD, Zelenetz AD, Trippett T, Hedrick EE, Filippa DA, Louie D, Gonzales M, Walits J, Coady-Lyons N, Qin J, Frank R, Bertino JR, Goy A, Noy A, O'Brien JP, Straus D, Portlock CS, Yahalom J. A 2-step comprehensive high-dose chemoradiotherapy second-line program for relapsed and refractory Hodgkin disease: analysis by intent to treat and development of a prognostic model. Blood. 2001 Feb 1;97(3):616-23. link to original article dosing details in abstract have been reviewed by our editors PubMed
- MSK 11-142: Moskowitz AJ, Schöder H, Yahalom J, McCall SJ, Fox SY, Gerecitano J, Grewal R, Hamlin PA, Horwitz S, Kobos R, Kumar A, Matasar M, Noy A, Palomba ML, Perales MA, Portlock CS, Sauter C, Shukla N, Steinherz P, Straus D, Trippett T, Younes A, Zelenetz A, Moskowitz CH. PET-adapted sequential salvage therapy with brentuximab vedotin followed by augmented ifosamide, carboplatin, and etoposide for patients with relapsed and refractory Hodgkin's lymphoma: a non-randomised, open-label, single-centre, phase 2 study. Lancet Oncol. 2015 Mar;16(3):284-92. Epub 2015 Feb 13. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT01508312
Ifosfamide & Vinorelbine
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Bonfante et al. 1998 | 1994-04 to not reported | Phase 2 |
Chemotherapy
- Ifosfamide (Ifex) 3000 mg/m2/day IV continuous infusion over 96 hours, started on day 1, admixed with mesna (total dose per cycle: 12,000 mg/m2)
- Vinorelbine (Navelbine) 25 mg/m2 IV once per day on days 1 & 5
Glucocorticoid therapy
- Prednisone (Sterapred) 50 mg IV once per day on days 1 to 5
Supportive therapy
- Mesna (Mesnex) 3000 mg/m2/day IV continuous infusion over 96 hours, started on day 1, admixed with ifosfamide (total dose per cycle: 12,000 mg/m2)
- Filgrastim (Neupogen) 5 mcg/kg SC once per day on days 7 to 14
21-day cycles
References
- Bonfante V, Viviani S, Santoro A, Devizzi L, Di Russo A, Zanini M, Soncini F, Soto Parra H, Valagussa P, Bonadonna G. Ifosfamide and vinorelbine: an active regimen for patients with relapsed or refractory Hodgkin's disease. Br J Haematol. 1998 Nov;103(2):533-5. link to original article dosing details in manuscript have been reviewed by our editors PubMed
IGEV
IGEV: Ifosfamide, GEmcitabine, Vinorelbine
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Santoro et al. 2007 | 1997-2005 | Phase 2 |
Magagnoli et al. 2007 | 1997-2006 | Phase 2 |
Zinzani et al. 2016 (HD0801) | 2008-2013 | Non-randomized |
Note: Magagnoli et al. 2007 was primarily intended as a mobilization regimen.
Preceding treatment
- HD0801: ABVD salvage x 2
Chemotherapy
- Ifosfamide (Ifex) 2000 mg/m2 IV over 2 hours once per day on days 1 to 4
- Gemcitabine (Gemzar) 800 mg/m2 IV once per day on days 1 & 4
- Vinorelbine (Navelbine) 20 mg/m2 IV once on day 1
Glucocorticoid therapy
- Prednisolone (Millipred) 100 mg PO once per day on days 1 to 4
Supportive therapy
- 2L saline solution hyperhydration days 1 to 4
- Mesna (Mesnex) 2600 mg/m2 IV once per day on days 1 to 4
- Filgrastim (Neupogen) (dose not specified) SC once per day on days 7 to 12, or up to apheresis in the course of hematopoietic cell mobilization
21-day cycle for 4 cycles
Subsequent treatment
- HD0801, patients with CR: BEAM, then autologous HSCT consolidation
References
- Santoro A, Magagnoli M, Spina M, Pinotti G, Siracusano L, Michieli M, Nozza A, Sarina B, Morenghi E, Castagna L, Tirelli U, Balzarotti M. Ifosfamide, gemcitabine, and vinorelbine: a new induction regimen for refractory and relapsed Hodgkin's lymphoma. Haematologica. 2007 Jan;92(1):35-41. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- Magagnoli M, Spina M, Balzarotti M, Timofeeva I, Isa L, Michieli M, Capizzuto R, Morenghi E, Castagna L, Tirelli U, Santoro A. IGEV regimen and a fixed dose of lenograstim: an effective mobilization regimen in pretreated Hodgkin's lymphoma patients. Bone Marrow Transplant. 2007 Dec;40(11):1019-25. Epub 2007 Oct 1. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- HD0801: Zinzani PL, Broccoli A, Gioia DM, Castagnoli A, Ciccone G, Evangelista A, Santoro A, Ricardi U, Bonfichi M, Brusamolino E, Rossi G, Anastasia A, Zaja F, Vitolo U, Pavone V, Pulsoni A, Rigacci L, Gaidano G, Stelitano C, Salvi F, Rusconi C, Tani M, Freilone R, Pregno P, Borsatti E, Sacchetti GM, Argnani L, Levis A. Interim positron emission tomography response-adapted therapy in advanced-stage Hodgkin lymphoma: final results of the phase II part of the HD0801 study. J Clin Oncol. 2016 Apr 20;34(12):1376-85. Epub 2016 Feb 16. link to original article does not contain dosing details in manuscript; refers to Santoro et al. 2007 PubMed NCT00784537
Lenalidomide monotherapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Fehniger et al. 2011 (Wash U 07-0233) | 2007-2009 | Phase 2 |
Targeted therapy
- Lenalidomide (Revlimid) 25 mg PO once per day on days 1 to 21
Supportive therapy
- Aspirin (81 or 325 mg) PO once per day as prophylactic anticoagulation; those "deemed to be at high risk of deep venous thrombosis by the treating physician" were given Warfarin (Coumadin) or low-molecular-weight heparin.
28-day cycles
References
- Wash U 07-0233: Fehniger TA, Larson S, Trinkaus K, Siegel MJ, Cashen AF, Blum KA, Fenske TS, Hurd DD, Goy A, Schneider SE, Keppel CR, Wagner-Johnston ND, Carson KR, Bartlett NL. A phase 2 multicenter study of lenalidomide in relapsed or refractory classical Hodgkin lymphoma. Blood. 2011 Nov 10;118(19):5119-25. Epub 2011 Sep 21. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT00540007
MINE
MINE: Mesna, Ifosfamide, Novantrone (Mitoxantrone), Etoposide
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Rodriguez et al. 1995a | Not reported | Phase 2 |
Chemotherapy
- Ifosfamide (Ifex) 1333 mg/m2 IV over 60 minutes once per day on days 1 to 3, admixed with mesna
- Mitoxantrone (Novantrone) 8 mg/m2 IV once on day 1
- Etoposide (Vepesid) 65 mg/m2 IV over 60 minutes once per day on days 1 to 3
Supportive therapy
- Mesna (Mesnex) 1333 mg/m2 IV over 60 minutes once per day on days 1 to 3, admixed with ifosfamide, then 500 mg PO 4 hours after each IV dose of ifosfamide once per day on days 1 to 3
21- to 28-day cycle for up to 6 cycles
References
- Rodriguez MA, Cabanillas FC, Hagemeister FB, McLaughlin P, Romaguera JE, Swan F, Velasquez W. A phase II trial of mesna/ifosfamide, mitoxantrone and etoposide for refractory lymphomas. Ann Oncol. 1995 Jul;6(6):609-11. link to original article dosing details in abstract have been reviewed by our editors PubMed
Mini-BEAM
Mini-BEAM: dose-reduced BiCNU (Carmustine), Etoposide, Ara-C (Cytarabine), Melphalan
Regimen variant #1, 1 day of treatment/cycle
Study | Dates of enrollment | Evidence |
---|---|---|
Fernández-Jiménez et al. 1999 | 1992-02 to 1998-06 | Phase 2 |
Chemotherapy
- Carmustine (BCNU) 60 mg/m2 IV once on day 1
- Etoposide (Vepesid) 300 mg/m2 IV once on day 1
- Cytarabine (Ara-C) 800 mg/m2 IV once on day 1
- Melphalan (Alkeran) 30 mg/m2 IV once on day 1
28-day cycle for 2 to 3 cycles
Regimen variant #2, 6 days of treatment/cycle
Study | Dates of enrollment | Evidence |
---|---|---|
Colwill et al. 1995 | Not reported | Phase 2 |
Chemotherapy
- Carmustine (BCNU) 60 mg/m2 IV over 30 minutes once on day 1
- Etoposide (Vepesid) 75 mg/m2 IV over 30 minutes once per day on days 2 to 5
- Cytarabine (Ara-C) 100 mg/m2 IV every 12 hours on days 2 to 5
- Melphalan (Alkeran) 30 mg/m2 IV over 15 minutes once on day 6
Supportive therapy
- If febrile neutropenia occurred during previous cycle: Ciprofloxacin (Cipro) 500 mg PO once per day
- Patients were transfused to keep Hb greater than or equal to 8 g/dL, platelets greater than or equal to 20 x 109/L
- There was no routine use of G-CSF or GM-CSF
4- to 6-week cycles, depending on hematologic recovery Patients eligible for autologous hematopoietic cell transplant received no more than 2 cycles; otherwise total # of cycles not reported
References
- Linch DC, Winfield D, Goldstone AH, Moir D, Hancock B, McMillan A, Chopra R, Milligan D, Hudson GV. Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin's disease: results of a BNLI randomised trial. Lancet. 1993 Apr 24;341(8852):1051-4. link to original article PubMed
- Colwill R, Crump M, Couture F, Danish R, Stewart AK, Sutton DM, Scott JG, Sutcliffe SB, Brandwein JM, Keating A. Mini-BEAM as salvage therapy for relapsed or refractory Hodgkin's disease before intensive therapy and autologous bone marrow transplantation. J Clin Oncol. 1995 Feb;13(2):396-402. link to original article dosing details in abstract have been reviewed by our editors PubMed
- Fernández-Jiménez MC, Canales MA, Ojeda E, de Bustos JG, Aguado MJ, Hernández-Navarro F. Salvage chemotherapy with mini-BEAM for relapsed or refractory Hodgkin's disease prior to autologous peripheral blood stem cell transplantation. Haematologica. 1999 Nov;84(11):1007-11. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- Update: Martín A, Fernández-Jiménez MC, Caballero MD, Canales MA, Pérez-Simón JA, García de Bustos J, Vázquez L, Hernández-Navarro F, San Miguel JF. Long-term follow-up in patients treated with Mini-BEAM as salvage therapy for relapsed or refractory Hodgkin's disease. Br J Haematol. 2001 Apr;113(1):161-71. link to original article dosing details in abstract have been reviewed by our editors PubMed
Nivolumab monotherapy
Regimen variant #1, every 2 weeks
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Younes et al. 2016 (CheckMate 205) | 2014-2015 | Phase 2 (RT) | ORR: 69% (95% CI, 63-75)1 |
1Reported efficacy is based on the 2018 update.
Regimen variant #2, with lead-in
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Ansell et al. 2014 (CheckMate 039) | 2012 to not reported | Phase 1, >20 pts (RT) | ORR: 87% |
Immunotherapy
- Nivolumab (Opdivo) 3 mg/kg IV once on day 1
21-day course, then 14-day cycle for up to 51 cycles (2 years)
References
- CheckMate 039: Ansell SM, Lesokhin AM, Borrello I, Halwani A, Scott EC, Gutierrez M, Schuster SJ, Millenson MM, Cattry D, Freeman GJ, Rodig SJ, Chapuy B, Ligon AH, Zhu L, Grosso JF, Kim SY, Timmerman JM, Shipp MA, Armand P. PD-1 blockade with nivolumab in relapsed or refractory Hodgkin's lymphoma. N Engl J Med. 2015 Jan 22;372(4):311-9. Epub 2014 Dec 6. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT01592370
- CheckMate 205: Younes A, Santoro A, Shipp M, Zinzani PL, Timmerman JM, Ansell S, Armand P, Fanale M, Ratanatharathorn V, Kuruvilla J, Cohen JB, Collins G, Savage KJ, Trneny M, Kato K, Farsaci B, Parker SM, Rodig S, Roemer MG, Ligon AH, Engert A. Nivolumab for classical Hodgkin's lymphoma after failure of both autologous stem-cell transplantation and brentuximab vedotin: a multicentre, multicohort, single-arm phase 2 trial. Lancet Oncol. 2016 Sep;17(9):1283-94. Epub 2016 Jul 20. link to original article dosing details in abstract have been reviewed by our editors link to PMC article PubMed NCT02181738
- Update: Armand P, Engert A, Younes A, Fanale M, Santoro A, Zinzani PL, Timmerman JM, Collins GP, Ramchandren R, Cohen JB, De Boer JP, Kuruvilla J, Savage KJ, Trneny M, Shipp MA, Kato K, Sumbul A, Farsaci B, Ansell SM. Nivolumab for Relapsed/Refractory Classic Hodgkin Lymphoma After Failure of Autologous Hematopoietic Cell Transplantation: Extended Follow-Up of the Multicohort Single-Arm Phase II CheckMate 205 Trial. J Clin Oncol. 2018 May 10;36(14):1428-1439. Epub 2018 Mar 27. Erratum in: J Clin Oncol. 2018 Sep 10;36(26):2748. link to original article link to PMC article PubMed
- Update: Ansell SM, Bröckelmann PJ, von Keudell G, Lee HJ, Santoro A, Zinzani PL, Collins GP, Cohen JB, de Boer JP, Kuruvilla J, Savage KJ, Trněný M, Provencio M, Jäger U, Willenbacher W, Wen R, Akyol A, Mikita-Geoffroy J, Shipp MA, Engert A, Armand P. Nivolumab for relapsed/refractory classical Hodgkin lymphoma: 5-year survival from the pivotal phase 2 CheckMate 205 study. Blood Adv. 2023 Oct 24;7(20):6266-6274. Erratum in: Blood Adv. 2024 Feb 27;8(4):829-831. link to original article link to PMC article PubMed
O-ESHAP
O-ESHAP: Ofatumumab, Etoposide, Solumedrol (Methylprednisolone) High-dose Ara-C (Cytarabine), Platinol (Cisplatin)
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Martínez et al. 2016 (O-ESHAP-LH-2009) | 2010-2013 | Phase 2 |
Note: the ofatumumab dosing is described in the abstract but the ESHAP is not. The ESHAP doses here are from the protocol defined by Velasquez et al. 1994.
Targeted therapy
- Ofatumumab (Arzerra) as follows:
- Cycle 1: 1000 mg IV once per day on days 1 & 8
- Cycles 2 & 3: 1000 mg IV once on day 1
Chemotherapy
- Etoposide (Vepesid) 40 mg/m2 IV over 60 minutes once per day on days 1 to 4
- Cytarabine (Ara-C) 2000 mg/m2 IV over 2 hours once on day 5
- Cisplatin (Platinol) 25 mg/m2/day IV continuous infusion over 96 hours, started on day 1 (total dose per cycle: 100 mg/m2)
Glucocorticoid therapy
- Methylprednisolone (Solumedrol) 250 to 500 mg IV over 15 minutes once per day on days 1 to 5
Number of cycles not specified
References
- O-ESHAP-LH-2009: Martínez C, Díaz-López A, Rodriguez-Calvillo M, García-Sanz R, Terol MJ, Pérez-Ceballos E, Jiménez MJ, Cantalapiedra A, Domingo-Domenech E, Rodriguez MJ, Sampol A, Espeso M, López FJ, Briones J, García JF, Sureda A; GELTAMO. Phase II trial of ofatumumab plus ESHAP (O-ESHAP) as salvage treatment for patients with relapsed or refractory classical Hodgkin lymphoma after first-line chemotherapy. Br J Haematol. 2016 Sep;174(6):859-67. Epub 2016 May 17. link to original article dosing details in abstract have been reviewed by our editors PubMed NCT01195766
Penpulimab monotherapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Awaiting publication (AK105-201) | 2018 to not reported | Phase 2 |
References
- AK105-201: dosing details on CT.gov have been reviewed by our editors NCT03722147
Rituximab monotherapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Younes et al. 2003 | Not reported | Pilot, >20 pts |
Note: All reported patients had nodular sclerosis histology.
Prior treatment criteria
- Minimum of 2 prior systemic regimens
References
- Younes A, Romaguera J, Hagemeister F, McLaughlin P, Rodriguez MA, Fiumara P, Goy A, Jeha S, Manning JT Jr, Jones D, Abruzzo LV, Medeiros LJ. A pilot study of rituximab in patients with recurrent, classic Hodgkin disease. Cancer. 2003 Jul 15;98(2):310-4. link to original article dosing details in manuscript have been reviewed by our editors PubMed
Sintilimab monotherapy
Regimen
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Shi et al. 2019 (ORIENT-1) | 2017 | Phase 2 | ORR: 80% (95% CI, 71-88) |
References
- ORIENT-1: Shi Y, Su H, Song Y, Jiang W, Sun X, Qian W, Zhang W, Gao Y, Jin Z, Zhou J, Jin C, Zou L, Qiu L, Li W, Yang J, Hou M, Zeng S, Zhang Q, Hu J, Zhou H, Xiong Y, Liu P. Safety and activity of sintilimab in patients with relapsed or refractory classical Hodgkin lymphoma (ORIENT-1): a multicentre, single-arm, phase 2 trial. Lancet Haematol. 2019 Jan;6(1):e12-e19. link to original article dosing details in abstract have been reviewed by our editors PubMed NCT03114683
Tislelizumab monotherapy
Regimen
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Song et al. 2019 (RATIONALE-203) | 2017-04-21 to 2017-11-22 | Phase 2 | ORR: 87% (95% CI, 77-94)1 |
1Reported efficacy is based on the 2022 update.
References
- RATIONALE-203: Song Y, Gao Q, Zhang H, Fan L, Zhou J, Zou D, Li W, Yang H, Liu T, Wang Q, Lv F, Guo H, Yang L, Elstrom R, Huang J, Novotny W, Wei V, Zhu J. Treatment of relapsed or refractory classical Hodgkin lymphoma with the anti-PD-1, tislelizumab: results of a phase 2, single-arm, multicenter study. Leukemia. 2020 Feb;34(2):533-542. Epub 2019 Sep 13. link to original article link to PMC article dosing details in manuscript have been reviewed by our editors PubMed NCT03209973
- Update: Song Y, Gao Q, Zhang H, Fan L, Zhou J, Zou D, Li W, Yang H, Liu T, Wang Q, Lv F, Guo H, Zhao X, Wang D, Zhang P, Wang Y, Wang L, Liu T, Zhang Y, Shen Z, Huang J, Zhu J. Tislelizumab for Relapsed/Refractory Classical Hodgkin Lymphoma: 3-Year Follow-up and Correlative Biomarker Analysis. Clin Cancer Res. 2022 Mar 15;28(6):1147-1156. link to original article link to PMC article PubMed
Vinblastine monotherapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Little et al. 1998 | 1987-12 to 1996-12 | Retrospective |
Note: This was a retrospective study; we are not aware of a prospective trial of vinblastine monotherapy in this setting.
References
- Retrospective: Little R, Wittes RE, Longo DL, Wilson WH. Vinblastine for recurrent Hodgkin's disease following autologous bone marrow transplant. J Clin Oncol. 1998 Feb;16(2):584-8. link to original article dosing details in abstract have been reviewed by our editors PubMed
Vinorelbine monotherapy
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Devizzi et al. 1994 | 1992-03 to 1993-03 | Phase 2 |
Note: Complete responders received 6 additional doses past CR; others continued until progression or a maximum of 24 doses.
Chemotherapy
- Vinorelbine (Navelbine) 30 mg/m2 IV bolus once on day 1
7-day cycle for up to 24 cycles (see note)
References
- Devizzi L, Santoro A, Bonfante V, Viviani S, Balzarini L, Valagussa P, Bonadonna G. Vinorelbine: an active drug for the management of patients with heavily pretreated Hodgkin's disease. Ann Oncol. 1994 Nov;5(9):817-20. link to original article dosing details in manuscript have been reviewed by our editors PubMed
Zimberelimab monotherapy
Regimen
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Lin et al. 2021 (YH-S001-04) | 2018-2019 | Phase 2 | ORR: 91% (95% CI, 82-96) |
Immunotherapy
- Zimberelimab (Yu Duo) 240 mg IV once on day 1
14-day cycle for up to 52 cycles (2 years)
References
- YH-S001-04: Lin N, Zhang M, Bai H, Liu H, Cui J, Ke X, Zhang H, Liu L, Yan D, Jiang Y, Zang A, Qi J, Wang L, Liu Z, Xu B, Zhang Y, Zhang Z, Zhao X, Hu C, Yang S, Zhou H, Shi J, Shao Z, Xiang Y, Zhu J, Song Y, Zhu J. Efficacy and safety of GLS-010 (zimberelimab) in patients with relapsed or refractory classical Hodgkin lymphoma: A multicenter, single-arm, phase II study. Eur J Cancer. 2022 Mar;164:117-126. Epub 2021 Aug 27. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT03655483
Consolidation after salvage therapy
BEAM, then allo HSCT
BEAM: BiCNU (Carmustine), Etoposide, Ara-C (Cytarabine), Melphalan
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Sobol et al. 2013 | 2000-05 to 2012-04 | Phase 2 |
Chemotherapy
- Carmustine (BCNU) 300 mg/m2 IV once on day -6
- Etoposide (Vepesid) 100 mg/m2 IV once per day on days -5 to -2
- Cytarabine (Ara-C) 100 mg/m2 IV twice per day on days -5 to -2
- Melphalan (Alkeran) 140 mg/m2 IV once on day -1
Immunotherapy
- Allogeneic stem cells transfused on day 0
GVHD prophylaxis
- Tacrolimus (Prograf) 0.03 mg/kg/day IV continuous infusion, started on day -2
- Methotrexate (MTX) 15 mg/m2 (route not specified) once per day on days +1, +3, +6
One course
Dose and schedule modifications
- Tacrolimus titrated to serum level 10 to 15 ng/mL
References
- Sobol U, Rodriguez T, Smith S, Go A, Vimr R, Parthasarathy M, Guo R, Stiff P. Seven-year follow-up of allogeneic transplant using BCNU, etoposide, cytarabine and melphalan chemotherapy in patients with Hodgkin lymphoma after autograft failure: importance of minimal residual disease. Leuk Lymphoma. 2014 Jun;55(6):1281-7. Epub 2013 Oct 3. link to original article dosing details in manuscript have been reviewed by our editors PubMed
BEAM, then auto HSCT
BEAM: Rituximab, BiCNU (Carmustine), Etoposide, Ara-C (Cytarabine), Melphalan
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Linch et al. 1993 | Not reported | Phase 3 (C) | Mini-BEAM | Superior PFS |
Schmitz et al. 2002 (GHSG HD-R1) | 1993-1997 | Randomized (E-esc) | DexaBEAM | Seems to have superior FFTF |
Linch et al. 1993 was closed early due to patient request for the HSCT arm; dosing details are not available in the abstract.
Preceding treatment
- GHSG HD-R1: DexaBEAM salvage x 2
Chemotherapy
- Carmustine (BCNU) 300 mg/m2 IV once on day -7
- Etoposide (Vepesid) 150 mg/m2 IV every 12 hours on days -7 to -4 (total dose: 1200 mg/m2)
- Cytarabine (Ara-C) 200 mg/m2 IV every 12 hours on days -7 to -4 (total dose: 1600 mg/m2)
- Melphalan (Alkeran) 140 mg/m2 IV once on day -3
Supportive therapy
- Autologous stem cells re-infused on day 0
One course
References
- Linch DC, Winfield D, Goldstone AH, Moir D, Hancock B, McMillan A, Chopra R, Milligan D, Hudson GV. Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin's disease: results of a BNLI randomised trial. Lancet. 1993 Apr 24;341(8852):1051-4. link to original article PubMed
- GHSG HD-R1: Schmitz N, Pfistner B, Sextro M, Sieber M, Carella AM, Haenel M, Boissevain F, Zschaber R, Müller P, Kirchner H, Lohri A, Decker S, Koch B, Hasenclever D, Goldstone AH, Diehl V; German Hodgkin's Lymphoma Study Group; Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin's disease: a randomised trial. Lancet. 2002 Jun 15;359(9323):2065-71. link to original article dosing details in manuscript have been reviewed by our editors PubMed
BeEAM, then auto HSCT
BeEAM: Bendamustine, Etoposide, Ara-C (Cytarabine), Melphalan
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Visani et al. 2011 | 2008-08 to 2010-06 | Phase 1/2, fewer than 20 pts in this subgroup |
Chemotherapy
- Bendamustine 200 mg/m2 IV once per day on days -7 & -6
- Etoposide (Vepesid) 200 mg/m2 IV once per day on days -5 to -2
- Cytarabine (Ara-C) 400 mg/m2 IV once per day on days -5 to -2
- Melphalan (Alkeran) 140 mg/m2 IV once on day -1
Supportive therapy
- Autologous stem cells re-infused on day 0
One course
References
- Visani G, Malerba L, Stefani PM, Capria S, Galieni P, Gaudio F, Specchia G, Meloni G, Gherlinzoni F, Giardini C, Falcioni S, Cuberli F, Gobbi M, Sarina B, Santoro A, Ferrara F, Rocchi M, Ocio EM, Caballero MD, Isidori A. BeEAM (bendamustine, etoposide, cytarabine, melphalan) before autologous stem cell transplantation is safe and effective for resistant/relapsed lymphoma patients. Blood. 2011 Sep 22;118(12):3419-25. Epub 2011 Aug 3. link to original article dosing details in manuscript have been reviewed by our editors PubMed EudraCT 2008-002736-15
CBV, then auto HSCT
CBV: Cyclophosphamide, BiCNU (Carmustine), VP-16 (Etoposide)
Regimen variant #1, 1500/300/250, all BSA-based
Study | Dates of enrollment | Evidence |
---|---|---|
Zinzani et al. 2003 | 1982-2000 | Retrospective |
Chemotherapy
- Cyclophosphamide (Cytoxan) 1500 mg/m2 IV once per day on days -6 to -3
- Carmustine (BCNU) 300 mg/m2 IV once on day -6
- Etoposide (Vepesid) 250 mg/m2 IV once per day on days -6 to -4
Supportive therapy
- Autologous stem cells re-infused on day 0
One course
Regimen variant #2, 1800/600/400
Study | Dates of enrollment | Evidence |
---|---|---|
Reece et al. 1994 | 1985-1988 | Phase 2, fewer than 20 pts |
Chemotherapy
- Cyclophosphamide (Cytoxan) 1800 mg/m2 IV over 2 hours once per day on days -7 to -4
- Carmustine (BCNU) 600 mg/m2 IV once on day -3
- Etoposide (Vepesid) 400 mg/m2 IV over 60 minutes every 12 hours on days -7 to -5
Supportive therapy
- Autologous stem cells re-infused on day 0
One course
References
- Reece DE, Connors JM, Spinelli JJ, Barnett MJ, Fairey RN, Klingemann HG, Nantel SH, O'Reilly S, Shepherd JD, Sutherland HJ, Voss N, Chan KW, Phillips GL. Intensive therapy with cyclophosphamide, carmustine, etoposide +/- cisplatin, and autologous bone marrow transplantation for Hodgkin's disease in first relapse after combination chemotherapy. Blood. 1994 Mar 1;83(5):1193-9. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- Retrospective: Zinzani PL, Tani M, Gabriele A, Gherlinzoni F, de Vivo A, Ricci P, Bandini G, Lemoli RM, Motta MR, Rizzi S, Giudice V, Zompatori M, Stefoni V, Alinari L, Musuraca G, Bassi S, Conte R, Pileri S, Tura S, Baccarani M. High-dose therapy with autologous transplantation for Hodgkin's disease: the Bologna experience. Haematologica. 2003 May;88(5):522-8. link to original article dosing details in manuscript have been reviewed by our editors PubMed
CBV-Mx, then auto HSCT
CBV-Mx: Cyclophosphamide, BiCNU (Carmustine), VP-16 (Etoposide), Mitoxantrone
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Morschhauser et al. 2008 (GELA/SFGM H96) | 1995-01 to 2002-12 | Phase 2 |
Chemotherapy
- Cyclophosphamide (Cytoxan) 1500 mg/m2/day IV on days -7 to -4
- Carmustine (BCNU) 300 mg/m2 IV once on day -4
- Etoposide (Vepesid) 250 mg/m2/day IV on days -7 to -4
- Mitoxantrone (Novantrone) 30 mg/m2 IV once on day -8
Supportive therapy
- Autologous stem cells re-infused on day 0
One course
References
- GELA/SFGM H96: Morschhauser F, Brice P, Fermé C, Diviné M, Salles G, Bouabdallah R, Sebban C, Voillat L, Casasnovas O, Stamatoullas A, Bouabdallah K, André M, Jais JP, Cazals-Hatem D, Gisselbrecht C; GELA; SFGM. Risk-adapted salvage treatment with single or tandem autologous stem-cell transplantation for first relapse/refractory Hodgkin's lymphoma: results of the prospective multicenter H96 trial by the GELA/SFGM study group. J Clin Oncol. 2008 Dec 20;26(36):5980-7. Epub 2008 Nov 17. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- Update: Sibon D, Morschhauser F, Resche-Rigon M, Ghez D, Dupuis J, Marçais A, Deau-Fischer B, Bouabdallah R, Sebban C, Salles G, Brice P. Single or tandem autologous stem-cell transplantation for first-relapsed or refractory Hodgkin lymphoma: 10-year follow-up of the prospective H96 trial by the LYSA/SFGM-TC study group. Haematologica. 2016 Apr;101(4):474-81. Epub 2015 Dec 31. link to original article link to PMC article PubMed
FEAM, then auto HSCT
FEAM: Fotemustine, Etoposide, Ara-C (Cytarabine), Melphalan
Regimen
Study | Dates of enrollment | Evidence |
---|---|---|
Musso et al. 2009 | 2007-2008 | Phase 2 |
Musso et al. 2015 | 2007-2012 | Non-randomized |
Chemotherapy
- Fotemustine (Muphoran) 150 mg/m2 IV once per day on days -7 & -6 (total dose: 300 mg/m2)
- Etoposide (Vepesid) 200 mg/m2 IV once per day on days -5 to -2 (total dose: 800 mg/m2)
- Cytarabine (Ara-C) 400 mg/m2 IV once per day on days -5 to -2 (total dose: 1600 mg/m2)
- Melphalan (Alkeran) 140 mg/m2 IV once on day -1
Supportive therapy
- Autologous stem cells re-infused on day 0
One course
References
- Musso M, Scalone R, Marcacci G, Lanza F, Di Renzo N, Cascavilla N, Di Bartolomeo P, Crescimanno A, Perrone T, Pinto A. Fotemustine plus etoposide, cytarabine and melphalan (FEAM) as a new conditioning regimen for lymphoma patients undergoing auto-SCT: a multicenter feasibility study. Bone Marrow Transplant. 2010 Jul;45(7):1147-53. Epub 2009 Nov 9. link to original article dosing details in abstract have been reviewed by our editors PubMed
- Musso M, Messina G, Di Renzo N, Di Carlo P, Vitolo U, Scalone R, Marcacci G, Scalzulli PR, Moscato T, Matera R, Crescimanno A, Santarone S, Orciuolo E, Merenda A, Pavone V, Pastore D, Donnarumma D, Carella AM, Ciochetto C, Cascavilla N, Mele A, Lanza F, Di Nicola M, Bonizzoni E, Pinto A. Improved outcome of patients with relapsed/refractory Hodgkin lymphoma with a new fotemustine-based high-dose chemotherapy regimen. Br J Haematol. 2016 Jan;172(1):111-21. Epub 2015 Oct 12. link to original article link to PMC article dosing details in abstract have been reviewed by our editors PubMed
Fludarabine & Melphalan, then allo HSCT
Flu-Mel: Fludarabine & Melphalan
Regimen variant #1, 132/140
Study | Dates of enrollment | Evidence |
---|---|---|
Anderlini et al. 2008 | 2001-2005 | Phase 2 |
Note: the regimen as reported here is what the authors were using towards the end of the study period; see paper for details.
Preceding treatment
- Salvage treatment (not specified), with chemosensitive or stable disease
Chemotherapy
- Fludarabine (Fludara) 33 mg/m2 IV once per day on days -5 to -2
- Melphalan (Alkeran) 70 mg/m2 IV once per day on days -3 & -2
Immunotherapy
- Allogeneic stem cells transfused on day 0
GVHD prophylaxis
- ATG (type not specified) by the following donor-based criteria:
- Matched unrelated donor: 2 mg/kg IV once per day on days -4 to -2
- Tacrolimus (Prograf) IV starting on day -2, switched to PO as soon as possible. Continued for at least 6 months and then "tapered off" (instructions not given).
- Methotrexate (MTX) 5 mg/m2 IV once per day on days +1, +3, +6 (extra dose on day +11 for MUD recipients)
One course
Dose and schedule modifications
- Tacrolimus dosed to achieve serum levels 4 to 12 ng/mL
Regimen variant #2, 150/140
Study | Dates of enrollment | Evidence |
---|---|---|
Alvarez et al. 2006 | 1999-06 to 2004-01 | Prospective |
Sureda et al. 2011 (HDR-ALLO) | Not reported | Phase 2 |
Preceding treatment
- Alvarez et al. 2006: Not specified
- HDR-ALLO: DHAP salvage x 2
Chemotherapy
- Fludarabine (Fludara) 30 mg/m2 IV once per day on days -8 to -4
- Melphalan (Alkeran) 70 mg/m2 IV once per day on days -3 & -2
Immunotherapy
- Allogeneic stem cells transfused on day 0
GVHD prophylaxis
- Recipients of stem cells from matched unrelated donors received:
- Alvarez et al. 2006: Antithymocyte globulin, rabbit ATG (Thymoglobulin) 2.5 mg/kg IV once per day on days -4 to -2
- HDR-ALLO: ATG (type not specified) 45 mg/kg IV once per day on days -4 to -2
- Cyclosporine starting on day -2 at 1.5 mg/kg IV twice per day
- If no acute GVHD of grade 2 or more, cyclosporine A is tapered down by 10% per week starting on day +90 with planned discontinuation by day +150 (Alvarez et al. 2006) or +180 (HDR-ALLO).
- Methotrexate (MTX) 10 mg/m2 IV once per day on days +1, +3, +6, +11
One course
Regimen variant #3, 150/40, with alemtuzumab
Study | Dates of enrollment | Evidence |
---|---|---|
Peggs et al. 2005 | 1997-10-3 to 2003-08-21 | Non-randomized |
Chemotherapy
- Fludarabine (Fludara) 30 mg/m2 IV once per day on days -7 to -3
- Melphalan (Alkeran) 140 mg/m2 IV once on day -2
Immunotherapy
- Allogeneic stem cells transfused on day 0
GVHD prophylaxis
- Alemtuzumab (Campath) at varying doses IV (see paper for details)
One course
References
- Peggs KS, Hunter A, Chopra R, Parker A, Mahendra P, Milligan D, Craddock C, Pettengell R, Dogan A, Thomson KJ, Morris EC, Hale G, Waldmann H, Goldstone AH, Linch DC, Mackinnon S. Clinical evidence of a graft-versus-Hodgkin's-lymphoma effect after reduced-intensity allogeneic transplantation. Lancet. 2005 Jun 4-10;365(9475):1934-41. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- Alvarez I, Sureda A, Caballero MD, Urbano-Ispizua A, Ribera JM, Canales M, García-Conde J, Sanz G, Arranz R, Bernal MT, de la Serna J, Díez JL, Moraleda JM, Rubió-Félix D, Xicoy B, Martínez C, Mateos MV, Sierra J. Nonmyeloablative stem cell transplantation is an effective therapy for refractory or relapsed Hodgkin lymphoma: results of a Spanish prospective cooperative protocol. Biol Blood Marrow Transplant. 2006 Feb;12(2):172-83. link to original article dosing details in abstract have been reviewed by our editors PubMed
- Anderlini P, Saliba R, Acholonu S, Giralt SA, Andersson B, Ueno NT, Hosing C, Khouri IF, Couriel D, de Lima M, Qazilbash MH, Pro B, Romaguera J, Fayad L, Hagemeister F, Younes A, Munsell MF, Champlin RE. Fludarabine-melphalan as a preparative regimen for reduced-intensity conditioning allogeneic stem cell transplantation in relapsed and refractory Hodgkin's lymphoma: the updated MD Anderson Cancer Center experience. Haematologica. 2008 Feb;93(2):257-64. Epub 2008 Jan 26. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed
- HDR-ALLO: Sureda A, Canals C, Arranz R, Caballero D, Ribera JM, Brune M, Passweg J, Martino R, Valcárcel D, Besalduch J, Duarte R, León A, Pascual MJ, García-Noblejas A, López Corral L, Xicoy B, Sierra J, Schmitz N; GEL/TAMO; EBMT. Allogeneic stem cell transplantation after reduced intensity conditioning in patients with relapsed or refractory Hodgkin's lymphoma: results of the HDR-ALLO study - a prospective clinical trial by the Grupo Español de Linfomas/Trasplante de Médula Osea (GEL/TAMO) and the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. Haematologica. 2012 Feb;97(2):310-7. Epub 2011 Oct 11. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed EudraCT 02-0036
Radiation therapy
RT: Radiation Therapy
Regimen variant #1, involved node RT (INRT)
Study | Dates of enrollment | Evidence |
---|---|---|
Raemaekers et al. 2014 (EORTC/LYSA/FIL H10) | 2006-2009 | Non-randomized part of phase 3 RCT |
Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.
Preceding treatment
- eBEACOPP salvage x 2
Radiotherapy
- External beam radiotherapy 3000 cGy (+ 600 cGy boost)
Regimen variant #2, involved field RT (IFRT)
Study | Dates of enrollment | Evidence |
---|---|---|
Radford et al. 2015 (UK NCRI RAPID) | 2003-2010 | Non-randomized part of phase 3 RCT |
Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.
Preceding treatment
- Induction ABVD x 4
Radiotherapy
- External beam radiotherapy 3000 cGy
References
- EORTC/LYSA/FIL H10: Raemaekers JM, André MP, Federico M, Girinsky T, Oumedaly R, Brusamolino E, Brice P, Fermé C, van der Maazen R, Gotti M, Bouabdallah R, Sebban CJ, Lievens Y, Re A, Stamatoullas A, Morschhauser F, Lugtenburg PJ, Abruzzese E, Olivier P, Casasnovas RO, van Imhoff G, Raveloarivahy T, Bellei M, van der Borght T, Bardet S, Versari A, Hutchings M, Meignan M, Fortpied C. Omitting radiotherapy in early positron emission tomography-negative stage I/II Hodgkin lymphoma is associated with an increased risk of early relapse: Clinical results of the preplanned interim analysis of the randomized EORTC/LYSA/FIL H10 trial. J Clin Oncol. 2014 Apr 20;32(12):1188-94. Epub 2014 Mar 17. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00433433
- Update: André MPE, Girinsky T, Federico M, Reman O, Fortpied C, Gotti M, Casasnovas O, Brice P, van der Maazen R, Re A, Edeline V, Fermé C, van Imhoff G, Merli F, Bouabdallah R, Sebban C, Specht L, Stamatoullas A, Delarue R, Fiaccadori V, Bellei M, Raveloarivahy T, Versari A, Hutchings M, Meignan M, Raemaekers J. Early positron emission tomography response-adapted treatment in stage I and II Hodgkin lymphoma: final results of the randomized EORTC/LYSA/FIL H10 trial. J Clin Oncol. 2017 Jun 1;35(16):1786-1794. Epub 2017 Mar 14. link to original article PubMed
- Update: Federico M, Fortpied C, Stepanishyna Y, Gotti M, van der Maazen R, Cristinelli C, Re A, Plattel W, Lazarovici J, Merli F, Specht L, Schiano de Colella JM, Hutchings M, Versari A, Edeline V, Stamatoulas A, Girinsky T, Ricardi U, Aleman B, Meulemans B, Tonino S, Raemaekers J, André M. Long-Term Follow-Up of the Response-Adapted Intergroup EORTC/LYSA/FIL H10 Trial for Localized Hodgkin Lymphoma. J Clin Oncol. 2024 Jan 1;42(1):19-25. Epub 2023 Nov 15. link to original article link to PMC article PubMed
- UK NCRI RAPID: Radford J, Illidge T, Counsell N, Hancock B, Pettengell R, Johnson P, Wimperis J, Culligan D, Popova B, Smith P, McMillan A, Brownell A, Kruger A, Lister A, Hoskin P, O'Doherty M, Barrington S. Results of a trial of PET-directed therapy for early-stage Hodgkin's lymphoma. N Engl J Med. 2015 Apr 23;372(17):1598-607. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT00943423
Maintenance after salvage therapy
Brentuximab vedotin monotherapy
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Moskowitz et al. 2015 (AETHERA) | 2010-2012 | Phase 3 (E-RT-esc) | Placebo | Superior PFS (primary endpoint) Median PFS: 42.9 vs 24.1 mo (HR 0.57, 95% CI 0.40-0.81) |
Treatment begins 30 to 45 days after transplant.
Preceding treatment
- Autologous HSCT consolidation (preparative regimen not specified)
Antibody-drug conjugate therapy
- Brentuximab vedotin (Adcetris) 1.8 mg/kg IV once on day 1
21-day cycle for 16 cycles
References
- AETHERA: Moskowitz CH, Nademanee A, Masszi T, Agura E, Holowiecki J, Abidi MH, Chen AI, Stiff P, Gianni AM, Carella A, Osmanov D, Bachanova V, Sweetenham J, Sureda A, Huebner D, Sievers EL, Chi A, Larsen EK, Hunder NN, Walewski J; AETHERA Study Group. Brentuximab vedotin as consolidation therapy after autologous stem-cell transplantation in patients with Hodgkin's lymphoma at risk of relapse or progression (AETHERA): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2015 May 9;385(9980):1853-62. Epub 2015 Mar 18. Erratum in: Lancet. 2015 Aug 8;386(9993):532. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT01100502
- HRQoL analysis: Ramsey SD, Nademanee A, Masszi T, Holowiecki J, Abidi M, Chen A, Stiff P, Viviani S, Sweetenham JW, Radford J, Zhu Y, Bonthapally V, Thomas E, Richhariya A, Hunder NN, Walewski J, Moskowitz CH. Quality of life results from a phase 3 study of brentuximab vedotin consolidation following autologous haematopoietic stem cell transplant for persons with Hodgkin lymphoma. Br J Haematol. 2016 Dec;175(5):860-867. Epub 2016 Sep 21. link to original article link to PMC article PubMed
- Update: Moskowitz CH, Walewski J, Nademanee A, Masszi T, Agura E, Holowiecki J, Abidi MH, Chen AI, Stiff P, Viviani S, Bachanova V, Sureda A, McClendon T, Lee C, Lisano J, Sweetenham J. Five-year PFS from the AETHERA trial of brentuximab vedotin for Hodgkin lymphoma at high risk of progression or relapse. Blood. 2018 Dec 20;132(25):2639-2642. Epub 2018 Sep 28. link to original article PubMed
Relapsed or refractory, transplant ineligible or progressed after transplant
Brentuximab vedotin monotherapy
Regimen variant #1, q3wk cycle x 16
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Younes et al. 2012 (SG035-0003) | 2009 | Phase 2 (RT) | ORR: 75% (95% CI, 65-83) |
Antibody-drug conjugate therapy
- Brentuximab vedotin (Adcetris) 1.8 mg/kg IV over 30 minutes once on day 1
21-day cycle for up to 16 cycles
Regimen variant #2, q3wk cycle x 2 years
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Kuruvilla et al. 2021 (KEYNOTE-204) | 2016-2018 | Phase 3 (C) | Pembrolizumab | Inferior PFS |
Antibody-drug conjugate therapy
- Brentuximab vedotin (Adcetris) 1.8 mg/kg IV over 30 minutes once on day 1
21-day cycle for up to 35 cycles (2 years)
Regimen variant #3, q3wk, indefinite
Study | Dates of enrollment | Evidence | Efficacy |
---|---|---|---|
Younes et al. 2010 (SG035-0001) | 2006-2009 | Phase 1 | |
Gopal et al. 2012 (SGN35-006) | 2009 to not reported | Phase 2 | ORR: 50% |
Note: SGN35-006 is a re-treatment trial; all patients were previously exposed to brentuximab vedotin. Patients who had received the 1.2 mg/kg dose on a prior trial also received that dose at re-treatment.
Antibody-drug conjugate therapy
- Brentuximab vedotin (Adcetris) 1.8 mg/kg IV over 30 minutes once on day 1
Supportive therapy
- Rothe et al. 2012: "no premedications were administered"
21-day cycles
References
- SG035-0001: Younes A, Bartlett NL, Leonard JP, Kennedy DA, Lynch CM, Sievers EL, Forero-Torres A. Brentuximab vedotin (SGN-35) for relapsed CD30-positive lymphomas. N Engl J Med. 2010 Nov 4;363(19):1812-21. link to original article PubMed NCT00430846
- SG035-0003: Younes A, Gopal AK, Smith SE, Ansell SM, Rosenblatt JD, Savage KJ, Ramchandren R, Bartlett NL, Cheson BD, de Vos S, Forero-Torres A, Moskowitz CH, Connors JM, Engert A, Larsen EK, Kennedy DA, Sievers EL, Chen R. Results of a pivotal phase II study of brentuximab vedotin for patients with relapsed or refractory Hodgkin's lymphoma. J Clin Oncol. 2012 Jun 20;30(18):2183-9. Epub 2012 Mar 26. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT00848926
- Update: Gopal AK, Chen R, Smith SE, Ansell SM, Rosenblatt JD, Savage KJ, Connors JM, Engert A, Larsen EK, Chi X, Sievers EL, Younes A. Durable remissions in a pivotal phase 2 study of brentuximab vedotin in relapsed or refractory Hodgkin lymphoma. Blood. 2015 Feb 19;125(8):1236-43. Epub 2014 Dec 22. link to original article link to PMC article PubMed
- Update: Chen R, Gopal AK, Smith SE, Ansell SM, Rosenblatt JD, Savage KJ, Connors JM, Engert A, Larsen EK, Huebner D, Fong A, Younes A. Five-year survival and durability results of brentuximab vedotin in patients with relapsed or refractory Hodgkin lymphoma. Blood. 2016 Sep 22;128(12):1562-6. Epub 2016 Jul 18. link to original article link to PMC article PubMed
- SGN35-006: Gopal AK, Ramchandren R, O'Connor OA, Berryman RB, Advani RH, Chen R, Smith SE, Cooper M, Rothe A, Matous JV, Grove LE, Zain J. Safety and efficacy of brentuximab vedotin for Hodgkin lymphoma recurring after allogeneic stem cell transplantation. Blood. 2012 Jul 19;120(3):560-8. Epub 2012 Apr 17. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT00947856
- Update: Bartlett NL, Chen R, Fanale MA, Brice P, Gopal A, Smith SE, Advani R, Matous JV, Ramchandren R, Rosenblatt JD, Huebner D, Levine P, Grove L, Forero-Torres A. Retreatment with brentuximab vedotin in patients with CD30-positive hematologic malignancies. J Hematol Oncol. 2014 Mar 19;7:24. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed
- SGN35-007: Gopal AK, Ramchandren R, O'Connor OA, Berryman RB, Advani RH, Chen R, Smith SE, Cooper M, Rothe A, Matous JV, Grove LE, Zain J. Safety and efficacy of brentuximab vedotin for Hodgkin lymphoma recurring after allogeneic stem cell transplantation. Blood. 2012 Jul 19;120(3):560-8. Epub 2012 Apr 17. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT01026233
- Update: Bartlett NL, Chen R, Fanale MA, Brice P, Gopal A, Smith SE, Advani R, Matous JV, Ramchandren R, Rosenblatt JD, Huebner D, Levine P, Grove L, Forero-Torres A. Retreatment with brentuximab vedotin in patients with CD30-positive hematologic malignancies. J Hematol Oncol. 2014 Mar 19;7:24. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed
- SGN35-008: Gopal AK, Ramchandren R, O'Connor OA, Berryman RB, Advani RH, Chen R, Smith SE, Cooper M, Rothe A, Matous JV, Grove LE, Zain J. Safety and efficacy of brentuximab vedotin for Hodgkin lymphoma recurring after allogeneic stem cell transplantation. Blood. 2012 Jul 19;120(3):560-8. Epub 2012 Apr 17. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT01026415
- Update: Bartlett NL, Chen R, Fanale MA, Brice P, Gopal A, Smith SE, Advani R, Matous JV, Ramchandren R, Rosenblatt JD, Huebner D, Levine P, Grove L, Forero-Torres A. Retreatment with brentuximab vedotin in patients with CD30-positive hematologic malignancies. J Hematol Oncol. 2014 Mar 19;7:24. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed
- Retrospective: Rothe A, Sasse S, Goergen H, Eichenauer DA, Lohri A, Jäger U, Bangard C, Böll B, von Bergwelt Baildon M, Theurich S, Borchmann P, Engert A. Brentuximab vedotin for relapsed or refractory CD30+ hematologic malignancies: the German Hodgkin Study Group experience. Blood. 2012 Aug 16;120(7):1470-2. Epub 2012 Jul 11. link to original article dosing details in manuscript have been reviewed by our editors PubMed
- Retrospective: Gopal AK, Bartlett NL, Forero-Torres A, Younes A, Chen R, Friedberg JW, Matous JV, Shustov AR, Smith SE, Zain J, O'Meara MM, Fanale MA. Brentuximab vedotin in patients aged 60 years or older with relapsed or refractory CD30-positive lymphomas: a retrospective evaluation of safety and efficacy. Leuk Lymphoma. 2014 Oct;55(10):2328-34. Epub 2014 Feb 24. link to original article PubMed
- KEYNOTE-204: Kuruvilla J, Ramchandren R, Santoro A, Paszkiewicz-Kozik E, Gasiorowski R, Johnson NA, Fogliatto LM, Goncalves I, de Oliveira JSR, Buccheri V, Perini GF, Goldschmidt N, Kriachok I, Dickinson M, Komarnicki M, McDonald A, Ozcan M, Sekiguchi N, Zhu Y, Nahar A, Marinello P, Zinzani PL; KEYNOTE-204 investigators. Pembrolizumab versus brentuximab vedotin in relapsed or refractory classical Hodgkin lymphoma (KEYNOTE-204): an interim analysis of a multicentre, randomised, open-label, phase 3 study. Lancet Oncol. 2021 Apr;22(4):512-524. Epub 2021 Mar 12. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT02684292
Pembrolizumab monotherapy
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Chen et al. 2017 (KEYNOTE-087) | 2015-2016 | Phase 2 (RT) | ORR: 72% (95% CI, 65-78) | |
Kuruvilla et al. 2021 (KEYNOTE-204) | 2016-2018 | Phase 3 (E-RT-switch-ooc) | Brentuximab vedotin | Superior PFS (co-primary endpoint) Median PFS: 13.2 vs 8.3 mo (HR 0.65, 95% CI 0.48-0.88) |
Immunotherapy
- Pembrolizumab (Keytruda) 200 mg IV once on day 1
21-day cycle for up to 35 cycles (2 years)
References
- KEYNOTE-087: Chen R, Zinzani PL, Fanale MA, Armand P, Johnson NA, Brice P, Radford J, Ribrag V, Molin D, Vassilakopoulos TP, Tomita A, von Tresckow B, Shipp MA, Zhang Y, Ricart AD, Balakumaran A, Moskowitz CH; KEYNOTE-087 Investigators. Phase II study of the efficacy and safety of pembrolizumab for relapsed/refractory classic Hodgkin lymphoma. J Clin Oncol. 2017 Jul 1;35(19):2125-2132. Epub 2017 Apr 25. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article PubMed NCT02453594
- Update: Chen R, Zinzani PL, Lee HJ, Armand P, Johnson NA, Brice P, Radford J, Ribrag V, Molin D, Vassilakopoulos TP, Tomita A, von Tresckow B, Shipp MA, Lin J, Kim E, Nahar A, Balakumaran A, Moskowitz CH. Pembrolizumab in relapsed or refractory Hodgkin lymphoma: 2-year follow-up of KEYNOTE-087. Blood. 2019 Oct 3;134(14):1144-1153. Epub 2019 Aug 13. link to original article link to PMC article PubMed
- Update: Armand P, Zinzani PL, Lee HJ, Johnson NA, Brice P, Radford J, Ribrag V, Molin D, Vassilakopoulos TP, Tomita A, von Tresckow B, Shipp MA, Herrera AF, Lin J, Kim E, Chakraborty S, Marinello P, Moskowitz CH. Five-year follow-up of KEYNOTE-087: pembrolizumab monotherapy for relapsed/refractory classical Hodgkin lymphoma. Blood. 2023 Sep 7;142(10):878-886. link to original article link to PMC article PubMed
- KEYNOTE-204: Kuruvilla J, Ramchandren R, Santoro A, Paszkiewicz-Kozik E, Gasiorowski R, Johnson NA, Fogliatto LM, Goncalves I, de Oliveira JSR, Buccheri V, Perini GF, Goldschmidt N, Kriachok I, Dickinson M, Komarnicki M, McDonald A, Ozcan M, Sekiguchi N, Zhu Y, Nahar A, Marinello P, Zinzani PL; KEYNOTE-204 investigators. Pembrolizumab versus brentuximab vedotin in relapsed or refractory classical Hodgkin lymphoma (KEYNOTE-204): an interim analysis of a multicentre, randomised, open-label, phase 3 study. Lancet Oncol. 2021 Apr;22(4):512-524. Epub 2021 Mar 12. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT02684292
Prognosis
Advanced Stage Hodgkin Lymphoma International Prognostic Index (A-HIPI)
References
- Rodday AM, Parsons SK, Upshaw JN, Friedberg JW, Gallamini A, Hawkes E, Hodgson D, Johnson P, Link BK, Mou E, Savage KJ, Zinzani PL, Maurer M, Evens AM. The Advanced-Stage Hodgkin Lymphoma International Prognostic Index: Development and Validation of a Clinical Prediction Model From the HoLISTIC Consortium. J Clin Oncol. 2023 Apr 10;41(11):2076-2086. Epub 2022 Dec 10. Erratum in: J Clin Oncol. 2024 Jan 11. link to original article link to PMC article PubMed
Response criteria
NCI Sponsored International Working Group Criteria (1999)
Intended for non-Hodgkin lymphoma (NHL) but often referred to in the Hodgkin lymphoma literature.
- Cheson BD, Horning SJ, Coiffier B, Shipp MA, Fisher RI, Connors JM, Lister TA, Vose J, Grillo-López A, Hagenbeek A, Cabanillas F, Klippensten D, Hiddemann W, Castellino R, Harris NL, Armitage JO, Carter W, Hoppe R, Canellos GP. Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. NCI Sponsored International Working Group. J Clin Oncol. 1999 Apr;17(4):1244. Review. Erratum in: J Clin Oncol 2000 Jun;18(11):2351. link to original article PubMed
International Harmonization Project on Lymphoma (2007)
- Cheson BD, Pfistner B, Juweid ME, Gascoyne RD, Specht L, Horning SJ, Coiffier B, Fisher RI, Hagenbeek A, Zucca E, Rosen ST, Stroobants S, Lister TA, Hoppe RT, Dreyling M, Tobinai K, Vose JM, Connors JM, Federico M, Diehl V; International Harmonization Project on Lymphoma. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007 Feb 10;25(5):579-86. Epub 2007 Jan 22. link to original article PubMed
Juweid's criteria (2007)
- Juweid ME, Stroobants S, Hoekstra OS, Mottaghy FM, Dietlein M, Guermazi A, Wiseman GA, Kostakoglu L, Scheidhauer K, Buck A, Naumann R, Spaepen K, Hicks RJ, Weber WA, Reske SN, Schwaiger M, Schwartz LH, Zijlstra JM, Siegel BA, Cheson BD; Imaging Subcommittee of International Harmonization Project in Lymphoma. Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma. J Clin Oncol. 2007 Feb 10;25(5):571-8. Epub 2007 Jan 22. link to original article PubMed
Deauville criteria (2009)
Note: the definition of "positive" versus "negative" varies and should be confirmed within individual protocols. This is a 5-point scale.
- 1: no residual FDG uptake above the background level
- 2: residual FDG uptake less than or equal to the mediastinum
- 3: residual FDG uptake greater than the mediastinum but not greater than the liver
- 4: residual FDG uptake moderately increased compared with the liver
- 5: residual FDG uptake markedly increased compared with the liver or new sites of disease.
References
- Meignan M, Gallamini A, Meignan M, Gallamini A, Haioun C. Report on the First International Workshop on Interim-PET-Scan in Lymphoma. Leuk Lymphoma. 2009 Aug;50(8):1257-60. link to original article PubMed
- Barrington SF, Qian W, Somer EJ, Franceschetto A, Bagni B, Brun E, Almquist H, Loft A, Højgaard L, Federico M, Gallamini A, Smith P, Johnson P, Radford J, O'Doherty MJ. Concordance between four European centres of PET reporting criteria designed for use in multicentre trials in Hodgkin lymphoma. Eur J Nucl Med Mol Imaging. 2010 Oct;37(10):1824-33. Epub 2010 May 27. link to original article PubMed
- Biggi A, Gallamini A, Chauvie S, Hutchings M, Kostakoglu L, Gregianin M, Meignan M, Malkowski B, Hofman MS, Barrington SF. International validation study for interim PET in ABVD-treated, advanced-stage Hodgkin lymphoma: interpretation criteria and concordance rate among reviewers. J Nucl Med. 2013 May;54(5):683-90. Epub 2013 Mar 20. link to original article PubMed