Hodgkin lymphoma

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J.C. Villasboas Bisneto, MD
Rochester, MN

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83 regimens on this page
131 variants on this page

Contents


Guidelines

ASBMT

ESMO

Older

NCCN

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

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ABVD: Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine

Example orders

Variant #1, 2 cycles

Study Evidence Comparator Efficacy
Engert et al. 2007 (GHSG HD7) Phase III (E) No chemotherapy Superior FFTF
Engert et al. 2010 (GHSG HD10) Phase III (E) ABVD x 4 Seems not superior
Behringer et al. 2014 (GHSG HD13) Phase III (C) 1. ABV Superior FFTF
2. AV Superior FFTF
3. AVD Might have superior 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

28-day cycle for 2 cycles

Subsequent treatment

Variant #2, 2 cycles with response adaptation

Study Evidence Comparator Efficacy
Raemaekers et al. 2014 (EORTC/LYSA/FIL H10 F) Phase III (E) See link See link
Straus et al. 2018 (CALGB 50604) 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

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): 2 more cycles of ABVD (4 cycles total) versus 1 more cycle of ABVD, then INRT
  • EORTC/LYSA/FIL H10 F, positive interim PET-CT: eBEACOPP, then INRT
  • CALGB 50604, negative interim PET-CT (1 to 3 points on the 5-point Deauville scale): 2 more cycles of ABVD (4 cycles total)
  • CALGB 50604, positive interim PET-CT: eBEACOPP x 2, then IFRT x 30.6 Gy

Variant #3, 3 cycles with response adaptation

Study Evidence
Radford et al. 2015 (UK NCRI RAPID) Non-randomized portion of RCT

Chemotherapy

28-day cycle for 3 cycles

Subsequent treatment

Variant #4, 4 cycles

Study Evidence Comparator Efficacy
Bonadonna et al. 2004 Non-randomized portion of RCT
Meyer et al. 2005 (NCIC CTG/ECOG HD.6) Phase III (E) STNI Seems to have superior OS (*)
Engert et al. 2010 (GHSG HD10) Phase III (C) ABVD x 2 Seems not superior

Note: efficacy for NCIC CTG/ECOG HD.6 is based on the 2011 update.

Chemotherapy

28-day cycle for 4 cycles

Subsequent treatment

References

  1. 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. link to original article contains protocol PubMed
  2. NCIC CTG/ECOG HD.6: 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; Eastern Cooperative Oncology Group. 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 PubMed
    1. 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; Eastern Cooperative Oncology Group. 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 contains protocol PubMed
  3. 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. link to original article contains protocol PubMed
    1. 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
  4. 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 PubMed
    1. Pooled sub-group 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
    2. Pooled sub-group 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
    3. 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
  5. 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 contains protocol PubMed
    1. 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
  6. 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 PubMed
    1. Pooled sub-group 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
  7. 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
  8. 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 contains protocol PubMed
  9. 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 contains protocol link to PMC article PubMed

AVD

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AVD: Adriamycin (Doxorubicin), Vinblastine, Dacarbazine

Regimen

Study Evidence Comparator Efficacy
Behringer et al. 2014 (GHSG HD13) Phase III (E) 1. ABV Not reported
2. ABVD Might have inferior FFTF
3. AV Not reported

Chemotherapy

28-day cycle for 2 cycles

Subsequent treatment

References

  1. 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 PubMed
    1. Pooled sub-group 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

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MOPP-ABV: Mustargen (Mechlorethamine), Oncovin (Vincristine), Procarbazine, Prednisone, Adriamycin (Doxorubicin), Bleomycin, Vinblastine

Regimen

Study Evidence Comparator Efficacy
Fermé et al. 2007 (EORTC-GELA H8-F) Phase III (E) See link See link

Chemotherapy

28-day cycle for 3 cycles

Subsequent treatment

  • IFRT, 3 to 4 weeks later

References

  1. 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 H8 Trial. 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 contains verified protocol in supplement PubMed

Radiation therapy

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RT: Radiation Therapy

Variant #1, 35 Gy of subtotal nodal irradiation (STNI)

Study Evidence Comparator Efficacy
Meyer et al. 2005 (NCIC CTG/ECOG HD.6) Phase III (C) ABVD Seems to have inferior OS (*)

Note: efficacy for NCIC CTG/ECOG HD.6 is based on the 2011 update.

Radiotherapy

Variant #2, 36 Gy of STNI + 4 Gy boost

Study Evidence Comparator Efficacy
Fermé et al. 2007 (EORTC-GELA H8-F) Phase III (C) MOPP-ABV, then IFRT Inferior OS

Radiotherapy

References

  1. Carde P, Hagenbeek A, Hayat M, Monconduit M, Thomas J, Burgers MJ, Noordijk EM, Tanguy A, Meerwaldt JH, Le Fur R et al. 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 Organization for Research and Treatment of Cancer Lymphoma Cooperative Group. J Clin Oncol. 1993 Nov;11(11):2258-72. link to original article PubMed
  2. NCIC CTG/ECOG HD.6: 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; Eastern Cooperative Oncology Group. 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 PubMed
    1. 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; Eastern Cooperative Oncology Group. 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 contains protocol PubMed
  3. 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 H8 Trial. 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 contains verified protocol in supplement PubMed

Stanford V

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Regimen

Study Evidence
Advani et al. 2013 (G4) Non-randomized

Chemotherapy

8-week course

Subsequent treatment

  • IFRT, 1 to 3 weeks later

References

  1. 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. contains limited protocol link to PMC article PubMed

VAMP

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VAMP: Vinblastine, Adriamycin (Doxorubicin), Methrotrexate, Prednisone

Regimen

Study Evidence
Metzger et al. 2012 (HOD99) Non-randomized portion of RCT

To be completed?

Chemotherapy

4 cycles

Subsequent treatment

References

  1. HOD99: Metzger ML, Weinstein HJ, Hudson MM, Billett AL, Larsen EC, Friedmann A, Howard SC, Donaldson SS, Krasin MJ, Kun LE, Marcus KJ, Yock TI, Tarbell N, Billups CA, Wu J, Link MP. Association between radiotherapy vs no radiotherapy based on early response to VAMP chemotherapy and survival among children with favorable-risk Hodgkin lymphoma. JAMA. 2012 Jun 27;307(24):2609-16. link to original article 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

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ABVD: Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine

Example orders

Variant #1, 2 cycles

Study Evidence Comparator Efficacy
Meyer et al. 2005 (NCIC CTG/ECOG HD.6) Phase III (E) 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.

Preceding treatment

Chemotherapy

28-day cycle for 2 cycles

Subsequent treatment

  • NCIC CTG/ECOG HD.6: STNI
  • GHSG HD14: IFRT x 30 Gy

Variant #2, 2 cycles with response adaptation

Study Evidence Comparator Efficacy
Raemaekers et al. 2014 (EORTC/LYSA/FIL H10 U) Phase III (E) 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

28-day cycle for 2 cycles

Subsequent treatment

  • Negative interim PET-CT (1 or 2 points on the 5-point Deauville scale): 4 more cycles of ABVD versus 2 more cycles of ABVD, then INRT
  • Positive interim PET-CT: eBEACOPP, then INRT

Variant #3, 4 cycles

Study Evidence Comparator Efficacy
Meyer et al. 2005 (NCIC CTG/ECOG HD.6) Phase III (E) ABVD x 2, then STNI Seems to have superior OS (*)
Eich et al. 2010 (GHSG HD11) Phase III (C) See link See link
von Tresckow et al. 2012 (GHSG HD14) Phase III (C) See link See link

Note: efficacy for NCIC CTG/ECOG HD.6 is based on the 2011 update.

Chemotherapy

28-day cycle for 4 cycles

Subsequent treatment

  • GHSG HD11: IFRT x 20 Gy versus IFRT x 30 Gy
  • GHSG HD14: IFRT x 30 Gy

Variant #4, 6 to 8 cycles

Study Evidence Comparator Efficacy
Carde et al. 1993 (EORTC H6U) Phase III (E) MOPP Superior FFP
Straus et al. 2004 Non-randomized portion of RCT
Gordon et al. 2012 (ECOG E2496) Phase III (C) Stanford V Seems not superior

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

28-day cycle for 6 to 8 cycles

Subsequent treatment

References

  1. 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. 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 Organization for Research and Treatment of Cancer Lymphoma Cooperative Group. J Clin Oncol. 1993 Nov;11(11):2258-72. link to original article PubMed
  2. 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
  3. NCIC CTG/ECOG HD.6: 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; Eastern Cooperative Oncology Group. 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 PubMed
    1. 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; Eastern Cooperative Oncology Group. 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 contains protocol PubMed
  4. 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 contains verified protocol PubMed
    1. Pooled sub-group 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
    2. 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
  5. 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 contains verified protocol PubMed
  6. 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
    1. 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 PMC article PubMed
    2. 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
  7. 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 contains protocol PubMed
    1. 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
  8. 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

A+AVD

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A+AVD: Adcetris (Brentuximab vedotin), Adriamycin (Doxorubicin), Vinblastine, Dacarbazine
BV + AVD: Brentuximab Vedotin, Adriamycin (Doxorubicin), Vinblastine, Dacarbazine

Regimen

Study Evidence
Kumar et al. 2016 Phase II

Chemotherapy

28-day cycle for 4 cycles

Subsequent treatment

  • Patients with a negative repeat PET-CT: ISRT

References

  1. 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 contains verified protocol link to PMC article PubMed

BEACOPP

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BEACOPP: Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone
BEACOPPbaseline

Regimen

Study Evidence Comparator Efficacy
Eich et al. 2010 (GHSG HD11) Phase III (E) 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

21-day cycle for 4 cycles

Subsequent treatment

References

  1. 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 contains verified protocol PubMed
    1. 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

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eBEACOPP: escalated Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone

Regimen

Study Evidence Comparator Efficacy
von Tresckow et al. 2012 (GHSG HD14) Phase III (E) 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

Supportive medications

  • Filgrastim (Neupogen) (dose not specified) SC once per day starting on day 8, continues until ANC greater than 1000/uL for 3 consecutive days

21-day cycle for 2 cycles

Subsequent treatment

References

  1. 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 contains verified protocol PubMed

EBVP

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EBVP: Epirubicin, Bleomycin, Vinblastine, Prednisone

Regimen

Study Evidence
Thomas et al. 2017 (EORTC-GELA H9-F) Non-randomized portion of RCT

Chemotherapy

21-day cycle for 6 cycles

Subsequent treatment

References

  1. 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. 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 contains verified protocol PubMed

MOPP-ABV

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MOPP-ABV: Mustargen (Mechlorethamine), Oncovin (Vincristine), Procarbazine, Prednisone, Adriamycin (Doxorubicin), Bleomycin, Vinblastine

Variant #1, 4 cycles

Study Evidence Comparator Efficacy
Fermé et al. 2007 (EORTC-GELA H8-U) Phase III (E) See link See link

Chemotherapy

28-day cycle for 4 cycles

Subsequent treatment

Variant #2, 6 cycles

Study Evidence Comparator Efficacy
Noordijk et al. 2006 (EORTC H7-U) Phase III (C) EBVD Seems to have superior OS
Fermé et al. 2007 (EORTC-GELA H8-U) Phase III (C) See link See link

Chemotherapy

28-day cycle for 6 cycles

Subsequent treatment

  • IFRT, in 3 to 4 weeks

References

  1. 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
  2. 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 H8 Trial. 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 contains verified protocol in supplement PubMed

RABVD

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RABVD: Rituximab, Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine

Regimen

Study Evidence
Kasamon et al. 2012 Phase II, <20 pts in subgroup

Patients were NOT required to have CD20+ disease.

Chemotherapy

28-day cycle for 6 to 8 cycles

References

  1. 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

Stanford V

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Regimen

Study Evidence Comparator Efficacy
Gordon et al. 2012 (ECOG E2496) Phase III (E) ABVD Seems not superior

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

28-day cycle for 3 cycles

Subsequent treatment

References

  1. 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
    1. 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 PMC article PubMed
    2. 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

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ABVD: Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine

Example orders

Variant #1, 2 cycles with response adaptation

Study Evidence
Zinzani et al. 2016 (HD0801) Non-randomized
Press et al. 2016 (SWOG S0816) Phase II
Johnson et al. 2016 (RATHL) Non-randomized portion of RCT
Gallamini et al. 2018 (GITIL/FIL HD 0607) Non-randomized portion of RCT

Chemotherapy

28-day cycle for 2 cycles

Subsequent treatment

Variant #2, 6 cycles

Study Evidence Comparator Efficacy
Gobbi et al. 2005 (GITIL HD9601) Phase III (C) 1. MOPPEBVCAD Seems not superior
2. Modified Stanford V Superior FFS
Federico et al. 2009 (GITIL/FIL HD2000) Phase III (C) 1. eBEACOPP x 4, then BEACOPP x 2 Seems not superior (*)
2. CEC Seems not superior
Zinzani et al. 2016 (HD0801) Non-randomized
Press et al. 2016 (SWOG S0816) Phase II
Johnson et al. 2016 (RATHL) Non-randomized portion of RCT
Connors et al. 2017 (ECHELON-1) Phase III (C) A+AVD Seems to have inferior modified PFS
Gallamini et al. 2018 (GITIL/FIL HD 0607) Non-randomized portion of RCT

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. Efficacy for GITIL/FIL HD2000 is based on the 2015 update.

Preceding treatment

Chemotherapy

28-day cycle for 6 cycles (see note)

Subsequent treatment

Variant #3, 8 cycles (ABVD8)

Study Evidence Comparator Efficacy
Bonadonna et al. 1975 Phase III (E) MOPP Seems not superior
Santoro et al. 1987 Phase III (E) MOPP Seems to have superior OS
Canellos et al. 1992 (CALGB 8251) Phase III (E) 1. MOPP Seems to have superior EFS (*)
2. MOPP/ABVD Seems not superior (*)
Duggan et al. 2003 (CALGB-8952) Phase III (C) MOPP-ABV Seems not superior
Johnson et al. 2005 (UKLG LY09) Phase III (C) 1. ChlVPP/EVA
2. ChlVPP/PABlOE
Seems not superior
Hoskin et al. 2009 (UK NCRI ISRCTN 64141244) Phase III (C) Stanford V Seems not superior
Viviani et al. 2011 (GSM-HD) Phase III (C) Escalated BEACOPP, then BEACOPP Seems to have inferior FFFP
Gordon et al. 2013 (ECOG E2496) Phase III (C) Stanford V Seems not superior
Mounier et al. 2014 (LYSA H34) Phase III (C) Escalated BEACOPP, then BEACOPP Might have inferior EFS
Carde et al. 2016 (EORTC 20012) Phase III (C) Escalated BEACOPP, then BEACOPP Seems not superior

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. Reported efficacy for CALGB 8251 is based on the 2009 update.

Chemotherapy

28-day cycle for 8 cycles

References

  1. 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 PubMed
  2. 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
  3. 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
    1. 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
    2. 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
  4. 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 protocol PubMed
  5. 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 contains protocol PubMed
    1. 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
  6. 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 LY09 Trial (ISRCTN97144519). 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 contains verified protocol PubMed
    1. 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
  7. 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 contains protocol PubMed
    1. 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
  8. UK NCRI ISRCTN 64141244: 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
  9. 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 contains verified protocol PubMed
  10. 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
    1. 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 PMC article PubMed
    2. 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
  11. 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 (LYSA). 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 contains verified protocol PubMed
  12. 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
  13. 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 contains verified protocol PubMed
  14. 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 contains verified protocol link to PMC article PubMed
  15. 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 contains verified protocol PubMed
  16. 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 contains verified protocol in supplement link to PMC article PubMed
  17. 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 contains verified protocol PubMed
  18. 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 contains protocol PubMed

ABVD, DD-DI

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ABVD, DD-DI: Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine, Dose-Dense and Dose-Intense

Regimen

Study Evidence
Russo et al. 2014 Phase II

Chemotherapy

Supportive medications

21-day cycle for 6 cycles

References

  1. 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 contains verified protocol PubMed

AVD

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AVD: Adriamycin (Doxorubicin), Vinblastine, Dacarbazine

Regimen

Study Evidence Comparator Efficacy
Johnson et al. 2016 (RATHL) Phase III (E) ABVD Inconclusive whether non-inferior

Preceding treatment

Chemotherapy

28-day cycle for 4 cycles

References

  1. 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 contains verified protocol in supplement link to PMC article PubMed

A+AVD

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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)

Regimen

Study Evidence Comparator Efficacy
Younes et al. 2013 Non-randomized
Connors et al. 2017 (ECHELON-1) Phase III (E) ABVD Seems to have superior modified PFS

Younes et al. 2013 was a phase I trial but had greater than 20 patients in the MTD expansion cohort.

Chemotherapy

28-day cycle for up to 6 cycles

Subsequent treatment

  • Younes et al. 2013: Consolidative radiotherapy was permitted at the investigator's discretion

References

  1. 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 contains verified protocol PubMed
    1. 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 PubMed
  2. 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 contains verified protocol PubMed

BEACOPP

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BEACOPP: Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone
bBEACOPP: baseline Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone

Variant #1, 4 cycles

Study Evidence Comparator Efficacy
Viviani et al. 2011 (GSM-HD) Phase III (E) See link See link
Borchmann et al. 2011 (GHSG HD12) Phase III (E) See link See link
Mounier et al. 2014 (LYSA H34) Phase III (E) See link See link
Carde et al. 2016 (EORTC 20012) Phase III (E) 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.

Preceding treatment

Chemotherapy

Supportive medications

  • Filgrastim (Neupogen) 300 mcg SC once per day starting day 8, continues until ANC greater than 1000/uL for 3 consecutive days (GSM-HD) or until day 14 (LYSA H34)

21-day cycle for 4 cycles

Subsequent treatment

Variant #2, 8 cycles

Study Evidence Comparator Efficacy
Diehl et al. 1997 Non-randomized ORR: 93%
Diehl et al. 1998 (GHSG HD9) Phase III (E) 1. Escalated dose BEACOPP Inferior FFTF
2. COPP/ABVD Seems to have superior OS

Note that this is technically "BEACOPP II." The original "BEACOPP I" is detailed in Diehl et al. 1997 but is of historical interest, only.

Chemotherapy

21-day cycle for 8 cycles

References

  1. Diehl V, Sieber M, Rüffer U, Lathan B, Hasenclever D, Pfreundschuh M, Loeffler M, Lieberz D, Koch P, Adler M, Tesch H; The 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 contains verified protocol PubMed
  2. 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 articlecontains verified protocol PubMed
    1. 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 contains protocol PubMed
    2. 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. link to original article PubMed
    3. 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. 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
  3. 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
    1. 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
  4. 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 contains verified protocol PubMed
  5. 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 PubMed
    1. 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. 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
  6. 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 (LYSA). 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 contains verified protocol PubMed
  7. 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 contains verified protocol PubMed

BEACOPP-14

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BEACOPP-14: Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone, 14-day course

Regimen

Study Evidence Comparator Efficacy
Sieber et al. 2003 Phase II
Engert et al. 2012 (GHSG HD15) Phase III (E) 1. Escalated BEACOPP x 8 Not reported
2. Escalated BEACOPP x 6 Non-inferior FFTF

Chemotherapy

Supportive medications

  • Filgrastim (Neupogen) as follows:
    • <75 kg body weight: 300 mcg SC once per day on days 8 to 13
    • greater than or equal to 75 kg body weight: 480 mcg SC once per day on days 8 to 13

14-day cycle for 8 cycles

References

  1. 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 contains verified protocol PubMed
  2. 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

eBEACOPP

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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

Example orders

Variant #1, 2 cycles with response adaptation

Study Evidence
Borchmann et al. 2017 (GHSG HD18) Non-randomized portion of 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

21-day cycle for 2 cycles

Subsequent treatment

  • PET-negative, prior to June 2011: eBEACOPP x 6 (total) versus eBEACOPP x 8 (total)
  • PET-negative, after June 2011: eBEACOPP x 4 (total) versus eBEACOPP x 6 (total)
  • PET-positive, prior to June 2011: eBEACOPP x 8 (total) versus R-eBEACOPP x 8 (total)
  • PET-positive, after June 2011: eBEACOPP x 6 (total)

Variant #2, 4 cycles

Study Evidence Comparator Efficacy
Viviani et al. 2011 (GSM-HD) Phase III (E) See link See link
Borchmann et al. 2011 (GHSG HD12) Phase III (E) See link See link
Mounier et al. 2014 (LYSA H34) Phase III (E) See link See link
Carde et al. 2016 (EORTC 20012) Phase III (E) See link See link
Borchmann et al. 2017 (GHSG HD18) Phase III (C) 1. eBEACOPP x 6
2. eBEACOPP x 8
Non-inferior PFS (*)

Note: except for GHSG HD18, this is a component of a sequential treatment protocol. Efficacy for GHSG HD18 is based on the 2017 update.

Chemotherapy

Supportive medications

  • Filgrastim (Neupogen) 300 mcg SC once per day starting day 8, continues until ANC greater than 1000/uL for 3 consecutive days (GSM-HD) or until day 14 (LYSA H34)

21-day cycle for 4 cycles

Subsequent treatment

Variant #3, 6 cycles

Study Evidence Comparator Efficacy
Engert et al. 2012 (GHSG HD15) Phase III (E) 1. BEACOPP-14 Non-inferior FFTF
2. Escalated BEACOPP x 8 Seems to have superior OS
Borchmann et al. 2017 (GHSG HD18) Phase III (C) 1. eBEACOPP x 4
2. eBEACOPP x 8
Non-inferior PFS (*)

Details are not available in the abstracts; it is assumed that the regimen is identical to escalated BEACOPP x 8, with 2 fewer cycles. Efficacy for GHSG HD18 is based on the 2017 update.

Chemotherapy

21-day cycle for 6 cycles

Variant #4, 8 cycles

Study Evidence Comparator Efficacy
Diehl et al. 1998 (GHSG HD9) Phase III (E) 1. BEACOPP Superior FFTF
2. COPP/ABVD Seems to have superior OS
Borchmann et al. 2011 (GHSG HD12) Phase III (C) See link See link
Engert et al. 2012 (GHSG HD15) Phase III (C) 1. BEACOPP-14 Not reported
2. Escalated BEACOPP x 6 Seems to have inferior OS
Borchmann et al. 2017 (GHSG HD18) Phase III (C) 1. eBEACOPP x 4
2. eBEACOPP x 6
Non-inferior PFS (*)

Efficacy for GHSG HD18 is based on the 2017 update.

Chemotherapy

21-day cycle for 8 cycles

Subsequent treatment

References

  1. 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 articlecontains verified protocol PubMed
    1. 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 contains protocol PubMed
    2. 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. link to original article PubMed
    3. 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. 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
  2. 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
    1. 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
  3. 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 contains verified protocol PubMed
  4. 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 PubMed
    1. 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. 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
  5. 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
  6. 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 (LYSA). 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 contains verified protocol PubMed
  7. 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 contains verified protocol PubMed
  8. 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 PubMed
    1. 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

C-MOPP/ABV

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C-MOPP/ABV: CyclophosphaMide, Oncovin (Vincristine), Procarbazine, Prednisone, Adriamycin (Doxorubicin), Bleomycin, Vinblastine

Regimen

Study Evidence
Montoto et al. 2000 Phase II

Chemotherapy

28-day cycle for 8 cycles

  • 25 to 40 Gy of radiation therapy given over extended fields (mantle or inverted "Y" type) to patients with bulky disease or ones with residual disease after completion of chemotherapy

References

  1. 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 contains protocol PubMed]

MOPP

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MOPP: Mechlorethamine, Oncovin (Vincristine), Procarbazine, Prednisone

Variant #1, 8 cycles, prednisone 25 mg/m2

Study Evidence Comparator Efficacy
Somers et al. 1994 Phase III (C) MOPP/ABVD Seems to have inferior FFS

Chemotherapy

28-day cycle for 8 cycles

Variant #2, capped vincristine

Study Evidence Comparator Efficacy
Canellos et al. 1992 (CALGB 8251) Phase III (C) 1. ABVD Seems to have inferior EFS (*)
2. MOPP/ABVD Seems to have inferior EFS (*)

Note: Reported efficacy is based on the 2009 update.

Chemotherapy

28-day cycle for 6 to 8 cycles

Variant #3, uncapped vincristine

Study Evidence Comparator Efficacy
Devita et al. 1970 Phase II
Bonadonna et al. 1975 Phase III (C) ABVD Seems not superior
Cooper et al. 1980 Phase III (C) 1. COPP Seems not superior
2. CVPP Seems to have inferior CR rate
3. MVPP Seems not superior
Santoro et al. 1982 Phase III (C) MOPP/ABVD Inferior PFS
Santoro et al. 1987 Phase III (C) ABVD Seems to have inferior OS
Longo et al. 1991 Phase III (C) MOPP/CABS Seems not superior

Chemotherapy

28-day cycle for 6 to 8 cycles

References

  1. 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 contains protocol PubMed content property of HemOnc.org
  2. 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 PubMed
  3. 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
  4. 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
    1. 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
  5. 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
  6. 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
  7. 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 protocol PubMed
    1. 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
    2. 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
  8. 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. 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 Organization 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 contains verified protocol PubMed

MOPP-ABV

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MOPP-ABV: Mustargen (Mechlorethamine), Oncovin (Vincristine), Procarbazine, Prednisone, Adriamycin (Doxorubicin), Bleomycin, Vinblastine
MOPP-ABV hybrid

Regimen

Study Evidence Comparator Efficacy
Klimo et al. 1985 Phase II
Connor et al. 1997 (NCIC CTG HD4) Phase III (E) MOPP/ABVD Seems not superior
Glick et al. 1998 Phase III (E) MOPP, then ABVD Seems to have superior OS
Duggan et al. 2003 (CALGB-8952) Phase III (E) ABVD Seems not superior
Aleman et al. 2003 (EORTC 20884) Non-randomized portion of RCT

Chemotherapy

28-day cycle for 6 to 8 cycles

Subsequent treatment

References

  1. 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 contains verified protocol PubMed
  2. 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
  3. 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
  4. 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 PubMed
  5. 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; European Organization for Research and Treatment of Cancer 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 contains verified protocol PubMed

MOPP/ABVD

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MOPP/ABVD: Mustargen (Mechlorethamine), Oncovin (Vincristine), Procarbazine, Prednisone alternating with Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine

Regimen

Study Evidence Comparator Efficacy
Santoro et al. 1982 Phase III (E) MOPP Superior PFS
Canellos et al. 1992 (CALGB 8251) Phase III (E) 1. ABVD Seems not superior (*)
2. MOPP Seems to have superior EFS (*)
Somers et al. 1994 Phase III (E) MOPP Seems to have superior FFS
Viviani et al. 1996 Phase III (C) MOPP-ABVD Seems not superior
Connor et al. 1997 (NCIC CTG HD4) Phase III (C) MOPP-ABV Seems not superior

Note: Reported efficacy for CALGB 8251 is based on the 2009 update.

Chemotherapy, MOPP portion

Chemotherapy, ABVD portion

References

  1. 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
    1. 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
  2. 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
    1. 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
    2. 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
  3. 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. 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 Organization 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 PubMed
  4. Viviani S, Bonadonna G, Santoro A, Bonfante V, Zanini M, Devizzi L, Soncini F, Valagussa P. Alternating versus hybrid MOPP and ABVD combinations in advanced Hodgkin's disease: ten-year results. J Clin Oncol. 1996 May;14(5):1421-30. link to original article PubMed
  5. 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

RABVD

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RABVD: Rituximab, Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine

Variant #1

Study Evidence
Younes et al. 2012 Phase II

Chemotherapy

28-day cycle for 6 cycles (except rituximab, which is given for a total of 6 doses)

Variant #2

Study Evidence
Kasamon et al. 2012 Phase II

Chemotherapy

28-day cycle for 6 to 8 cycles

References

  1. 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 contains protocol link to PMC article PubMed
  2. 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

Stanford V

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Regimen

Study Evidence Comparator Efficacy
Bartlett et al. 1995 Non-randomized
Horning et al. 2000 (ECOG E1492) Phase II
Hoskin et al. 2009 (UK NCRI ISRCTN 64141244) Phase III (E) ABVD Seems not superior
Gordon et al. 2013 (ECOG E2496) Phase III (E) ABVD Seems not superior

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
    • Patients older than 50: Cycle 3 doses reduced to 4 mg/m2 per dose
  • 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
    • Patients older than 50: Cycle 3 doses reduced to 1 mg/m2 per dose
  • Bleomycin (Blenoxane) 5 units/m2 IV once per day on days 8 & 22
  • Prednisone (Sterapred) as follows:
    • Cycles 1 & 2: 40 mg/m2 PO every other day
    • Cycle 3, week 1 (week 9): 40 mg/m2 PO every other day
    • Cycle 3, week 2 (week 10): 30 mg/m2 PO every other day
    • Cycle 3, week 3 (week 11): 20 mg/m2 PO every other day
    • Cycle 3, week 4 (week 12): 10 mg/m2 PO every other day

Supportive medications

  • 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 BID throughout the course of treatment
  • Trimethoprim/Sulfamethoxazole (Bactrim DS) (160/800 mg) PO BID throughout the course of treatment
  • Acyclovir (Zovirax) 200 mg PO TID 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 36 Gy, 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 reductions

References

  1. 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 contains verified protocol PubMed
    1. 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
  2. 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 contains protocol PubMed
  3. 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
    1. 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
  4. UK NCRI ISRCTN 64141244: 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
  5. 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
  6. 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
    1. 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 PMC article PubMed
    2. 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

VEBEP

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VEBEP: Vepesid (Etoposide), Epirubicin, Bleomycin, Endoxan (Cyclophosphamide), Prednisolone

Regimen

Study Evidence
Viviani et al. 1999 Phase II

To be completed

Chemotherapy

References

  1. Viviani S, Bonfante V, Santoro A, Zanini M, Devizzi L, Di Russo AD, Soncini F, Villani F, Ragni G, Valagussa P, Bonadonna G. Long-term results of an intensive regimen: VEBEP plus involved-field radiotherapy in advanced Hodgkin's disease. Cancer J Sci Am. 1999 Sep-Oct;5(5):275-82. PubMed

Untreated, pediatric

ABVE-PC

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ABVE-PC: Adriamycin (Doxorubicin), Bleomycin, Vincristine, Etoposide, Prednisone, Cyclophosphamide

Variant #1, 2 cycles with response adaptation

Study Evidence
Friedman et al. 2014 (AHOD0031) Non-randomized portion of RCT

This regimen is intended for pediatric patients, younger than 22 years old. This is the post-amendment dosing described by COG P9425; Friedman et al. 2014 does not contain dosing information.

Chemotherapy

21-day cycle for 2 cycles

Subsequent treatment

Variant #2, 3 cycles with response adaptation

Study Evidence
Schwartz et al. 2009 (COG P9425) Phase II

This regimen is intended for pediatric patients, younger than 22 years old. Note that first day of chemotherapy is day 0. Bleomycin and prednisone dosing is post-amendment.

Chemotherapy

Supportive medications

21-day cycle for 3 cycles

Subsequent treatment

Variant #3, 4 cycles with response adaptation

Study Evidence
Friedman et al. 2014 (AHOD0031) Non-randomized portion of RCT

This regimen is intended for pediatric patients, younger than 22 years old. This is the post-amendment dosing described by COG P9425; Friedman et al. 2014 does not contain dosing information.

Preceding treatment

  • ABVE-PC x 2

Chemotherapy

21-day cycle for 4 cycles, including the first 2 cycles

Subsequent treatment

Variant #4, 5 cycles

Study Evidence
Schwartz et al. 2009 (COG P9425) Phase II

This regimen is intended for pediatric patients, younger than 22 years old, who are slow early responders. Note that first day of chemotherapy is day 0. Bleomycin and prednisone dosing is post-amendment.

Preceding treatment

  • ABVE-PC x 3, with slow early response

Chemotherapy

Supportive medications

21-day cycle for 5 cycles, including the first 3 cycles

Subsequent treatment

References

  1. Schwartz CL, Constine LS, Villaluna D, London WB, Hutchison RE, Sposto R, Lipshultz SE, Turner CS, deAlarcon PA, Chauvenet A. A risk-adapted, response-based approach using ABVE-PC for children and adolescents with intermediate- and high-risk Hodgkin lymphoma: the results of P9425. Blood. 2009 Sep 3;114(10):2051-9. Epub 2009 Jul 7. Erratum: in Blood 2016 128:605 link to original article contains verified protocol link to PMC article PubMed
  2. Friedman DL, Chen L, Wolden S, Buxton A, McCarten K, FitzGerald TJ, Kessel S, De Alarcon PA, Chen AR, Kobrinsky N, Ehrlich P, Hutchison RE, Constine LS, Schwartz CL. Dose-intensive response-based chemotherapy and radiation therapy for children and adolescents with newly diagnosed intermediate-risk Hodgkin lymphoma: a report from the Children's Oncology Group Study AHOD0031. J Clin Oncol. 2014 Nov 10;32(32):3651-8. Epub 2014 Oct 13. link to original article does not contain protocol link to PMC article PubMed

OEPA

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OEPA: Oncovin (Vincristine), Etoposide, Prednisone, Adriamycin (Doxorubicin)

Regimen

Study Evidence
Mauz-Körholz et al. 2010 (GPOH-HD-2002) Phase II

This regimen is meant for boys as it is potentially less gonadotoxic. The original protocol used three doses of dacarbazine per cycle but this was increased to four after a mid-protocol amendment. Patients with early-stage disease only received the OEPA portion, see text for details.

Chemotherapy

28-day cycle for 2 cycles

Subsequent treatment

References

  1. GPOH-HD-2002: Mauz-Körholz C, Hasenclever D, Dörffel W, Ruschke K, Pelz T, Voigt A, Stiefel M, Winkler M, Vilser C, Dieckmann K, Karlén J, Bergsträsser E, Fosså A, Mann G, Hummel M, Klapper W, Stein H, Vordermark D, Kluge R, Körholz D. Procarbazine-free OEPA-COPDAC chemotherapy in boys and standard OPPA-COPP in girls have comparable effectiveness in pediatric Hodgkin's lymphoma: the GPOH-HD-2002 study. J Clin Oncol. 2010 Aug 10;28(23):3680-6. Epub 2010 Jul 12. link to original article contains verified protocol PubMed

OPPA

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OPPA: Oncovin (Vincristine), Procarbazine, Prednisone, Adriamycin (Doxorubicin)

Regimen

Study Evidence
Mauz-Körholz et al. 2010 (GPOH-HD-2002) Phase II

This regimen is meant for girls. Patients with early-stage disease only received the OPPA portion, see text for details.

Chemotherapy

28-day cycle for 2 cycles

Subsequent treatment

  • Treatment group 2: COPP x 2
  • Treatment group 3: COPP x 4

References

  1. GPOH-HD-2002: Mauz-Körholz C, Hasenclever D, Dörffel W, Ruschke K, Pelz T, Voigt A, Stiefel M, Winkler M, Vilser C, Dieckmann K, Karlén J, Bergsträsser E, Fosså A, Mann G, Hummel M, Klapper W, Stein H, Vordermark D, Kluge R, Körholz D. Procarbazine-free OEPA-COPDAC chemotherapy in boys and standard OPPA-COPP in girls have comparable effectiveness in pediatric Hodgkin's lymphoma: the GPOH-HD-2002 study. J Clin Oncol. 2010 Aug 10;28(23):3680-6. Epub 2010 Jul 12. link to original article contains verified protocol PubMed

Untreated, elderly

BEACOPP

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BEACOPP: Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone

Regimen

Study Evidence Comparator Efficacy
Ballova et al. 2005 (GHSG HD9elderly) Phase III (E) COPP/ABVD Seems not superior

Note that this is technically "BEACOPP II." The original "BEACOPP I" is detailed in Diehl et al. 1997 but is of historical interest, only.

Chemotherapy

21-day cycle for 8 cycles

References

  1. 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 articlecontains protocol PubMed

Brentuximab vedotin monotherapy

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Variant #1, standard-dose

Study Evidence Efficacy
Forero-Torres et al. 2015 Phase II ORR: 92%

Chemotherapy

Supportive medications

  • "according to institutional standards"

21-day cycle for up to 16 cycles, with continuing treatment allowed for those deriving clinical benefit

Variant #2, reduced-dose

Study Evidence
Forero-Torres et al. 2015 Phase II, <20 pts in this subgroup

This is 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.

Chemotherapy

Supportive medications

  • "according to institutional standards"

21-day cycle for up to 16 cycles, with continuing treatment allowed for those deriving clinical benefit

References

  1. 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 contains verified protocol link to PMC article PubMed

Brentuximab vedotin & Dacarbazine

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Variant #1, standard-dose

Study Evidence Efficacy
Friedberg et al. 2017 Phase II ORR: 100%

Chemotherapy

21-day cycle for up to 16 cycles, with continuing treatment allowed for those deriving clinical benefit

Variant #2, reduced-dose

Study Evidence Efficacy
Friedberg et al. 2017 Phase II, <20 pts in this subgroup ORR: 100%

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.

Chemotherapy

21-day cycle for up to 16 cycles, with continuing treatment allowed for those deriving clinical benefit

References

  1. 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 contains verified protocol PubMed

ChlVPP

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ChlVPP: Chllorambucil, Vinblastine, Procarbazine, Prednisone

Regimen

Study Evidence
International ChIVPP Treatment Group 1995 Phase II

Chemotherapy

28-day cycle to complete remission plus 2 cycles; minimum of 6 cycles and maximum of 8 cycles

References

  1. 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
  2. Case series: Selby P, Patel P, Milan S, Meldrum M, Mansi J, Mbidde E, Brada M, Perren T, Forgeson G, Gore M, et al. ChlVPP combination chemotherapy for Hodgkin's disease: long-term results. Br J Cancer. 1990 Aug;62(2):279-85. link to PMC article PubMed
  3. The 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 contains protocol PubMed

ChlVPP/EVA

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ChlVPP/EVA: Chllorambucil, Vinblastine, Procarbazine, Prednisone, Etoposide, Vincristine, Adriamycin (Doxorubicin)

Regimen

Study Evidence Comparator Efficacy
Radford et al. 2002 Phase III (C) VAPEC-B Seems to have superior OS

Chemotherapy

28-day cycle for 6 cycles

References

  1. 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 contains verified protocol PubMed

PVAG

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PVAG: Prednisone, Vinblastine, Adriamycin (Doxorubicin), Gemcitabine

Regimen

Study Evidence
Böll et al. 2011 Phase II

This regimen was open to patients with early unfavorable disease, but 93% of patients on study had advanced disease.

Chemotherapy

21-day cycle for 6 to 8 cycles

Patients with PR at the end of treatment underwent 30 Gy of radiotherapy.

References

  1. 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 contains verified protocol PubMed

VEPEMB

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VEPEMB: Vinblastine, Endoxan (Cyclophosphamide), Procarbazine, Etoposide, Mitoxantrone, Bleomycin

Regimen

Study Evidence Comparator Efficacy
Levis et al. 2004 Phase II
Zallio et al. 2016 Phase III (E) ABVD Might have inferior PFS

Note that this regimen includes prednisone, even though it is not spelled out in the acronym.

Chemotherapy

28-day cycle for 3 to 6 cycles

References

  1. 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 (IIL). 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
    1. Update: 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
  2. 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 contains verified protocol PubMed

Consolidation after upfront therapy

C-MOPP

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C-MOPP: CyclophosphaMide, Oncovin (Vincristine), Procarbazine, Prednisone
COPP: Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone

Variant #1, 2 cycles

Study Evidence
Mauz-Körholz et al. 2010 (GPOH-HD-2002) Phase II

Preceding treatment

Chemotherapy

28-day cycle for 2 cycles

Variant #2, 4 cycles

Study Evidence
Mauz-Körholz et al. 2010 (GPOH-HD-2002) Phase II

Preceding treatment

Chemotherapy

28-day cycle for 4 cycles

References

  1. GPOH-HD-2002: Mauz-Körholz C, Hasenclever D, Dörffel W, Ruschke K, Pelz T, Voigt A, Stiefel M, Winkler M, Vilser C, Dieckmann K, Karlén J, Bergsträsser E, Fosså A, Mann G, Hummel M, Klapper W, Stein H, Vordermark D, Kluge R, Körholz D. Procarbazine-free OEPA-COPDAC chemotherapy in boys and standard OPPA-COPP in girls have comparable effectiveness in pediatric Hodgkin's lymphoma: the GPOH-HD-2002 study. J Clin Oncol. 2010 Aug 10;28(23):3680-6. Epub 2010 Jul 12. link to original article contains verified protocol PubMed

COPDAC

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COPDAC: Cyclophosphamide, Oncovin (Vincristine), Prednisone, DACarbazine

Variant #1, 2 cycles

Study Evidence
Mauz-Körholz et al. 2010 (GPOH-HD-2002) Phase II

Preceding treatment

Chemotherapy

28-day cycle for 2 cycles

Variant #2, 4 cycles

Study Evidence
Mauz-Körholz et al. 2010 (GPOH-HD-2002) Phase II

Preceding treatment

Chemotherapy

28-day cycle for 4 cycles

References

  1. GPOH-HD-2002: Mauz-Körholz C, Hasenclever D, Dörffel W, Ruschke K, Pelz T, Voigt A, Stiefel M, Winkler M, Vilser C, Dieckmann K, Karlén J, Bergsträsser E, Fosså A, Mann G, Hummel M, Klapper W, Stein H, Vordermark D, Kluge R, Körholz D. Procarbazine-free OEPA-COPDAC chemotherapy in boys and standard OPPA-COPP in girls have comparable effectiveness in pediatric Hodgkin's lymphoma: the GPOH-HD-2002 study. J Clin Oncol. 2010 Aug 10;28(23):3680-6. Epub 2010 Jul 12. link to original article contains verified protocol PubMed

Observation

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Regimen

Study Evidence Comparator Efficacy
Aleman et al. 2003 (EORTC 20884) Phase III (C) IFRT Seems not superior
Straus et al. 2004 Phase III (C) EFRT Might have inferior OS
Borchmann et al. 2011 (GHSG HD12) Phase III (C) See link See link
Radford et al. 2015 (UK NCRI RAPID) Phase III (C) IFRT Inconclusive whether non-inferior
Thomas et al. 2017 (EORTC-GELA H9-F) Phase III (E) IFRT x 20 Gy Not reported
IFRT x 36 Gy Inferior RFS

No further treatment.

Preceding treatment

References

  1. 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; European Organization for Research and Treatment of Cancer 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 PubMed
  2. 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
  3. 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 PubMed
    1. 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. 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
  4. 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 contains protocol PubMed
  5. 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. 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 contains verified protocol PubMed

Radiation therapy

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RT: Radiation Therapy

Variant #1, 20 Gy of involved field RT (IFRT)

Study Evidence Comparator Efficacy
Engert et al. 2010 (GHSG HD10) Phase III (E) IFRT x 30 Gy Seems not superior
Eich et al. 2010 (GHSG HD11) Phase III (E) See link See link

Preceding treatment

Radiotherapy

Variant #2, 21 Gy of IFRT

Study Evidence Comparator Efficacy
Nachman et al. 2002 (CCG 5942) Phase III (C) Observation Superior EFS
Schwartz et al. 2009 (COG P9425) Phase II
Friedman et al. 2014 (AHOD0031) Phase III (C) Observation Seems not superior

This regimen is intended for pediatric patients, younger than 22 years old.

Preceding treatment

Radiotherapy

Variant #3, 24 Gy of IFRT

Study Evidence Comparator Efficacy
Aleman et al. 2003 (EORTC 20884) Phase III (E) Observation Seems not superior

Note: this is an experimental arm that did not meet its primary endpoint; included here because other variants of this regimen have demonstrated comparative superiority.

Preceding treatment

Radiotherapy

Variant #4, 30 Gy of IFRT

Study Evidence Comparator Efficacy
Aleman et al. 2003 (EORTC 20884) Phase III (E) Observation Seems not superior
Engert et al. 2003 (GHSG HD8) Phase III (E) EFRT 30 Gy + 10 Gy boost Equivalent FFTF
Engert et al. 2010 (GHSG HD10) Phase III (C) IFRT x 20 Gy Seems not superior
Eich et al. 2010 (GHSG HD11) Phase III (C) See link See link
von Tresckow et al. 2012 (GHSG HD14) Phase III (C) See link See link
Advani et al. 2013 (G4) Non-randomized
Behringer et al. 2014 (GHSG HD13) Non-randomized portion of RCT
Radford et al. 2015 (UK NCRI RAPID) Phase III (C) No further treatment Inconclusive whether non-inferior

Preceding treatment

Radiotherapy

Variant #5, 30 Gy of involved site RT (ISRT)

Study Evidence Comparator Efficacy
Borchmann et al. 2011 (GHSG HD12) Phase III (E) See link See link
Kumar et al. 2016 Phase II

Preceding treatment

Radiotherapy

Variant #6, 30 Gy of involved node RT (INRT) + 6 Gy boost

Study Evidence Comparator Efficacy
Raemaekers et al. 2014 (EORTC/LYSA/FIL H10) Phase III (C) See link See link

Preceding treatment

  • EORTC H10 F: ABVD x 3
  • EORTC H10 U: ABVD x 4

Radiotherapy

Variant #7, 30 Gy of extended-field RT (EFRT) + 10 Gy boost

Study Evidence Comparator Efficacy
Engert et al. 2003 (GHSG HD8) Phase III (C) IFRT 30 Gy + 10 Gy boost Equivalent FFTF
Engert et al. 2007 (GHSG HD7) Phase III (E) EFRT Superior FFTF

Preceding treatment

Radiotherapy

Variant #8, 35 Gy of subtotal nodal irradiation (STNI)

Study Evidence Comparator Efficacy
Meyer et al. 2005 (NCIC CTG/ECOG HD.6) Phase III (C) See link See link

Note: see link for use of STNI as definitive therapy.

Preceding treatment

  • Unfavorable risk: ABVD x 2

Radiotherapy

Variant #9, 36 Gy of IFRT

Study Evidence Comparator Efficacy
Bonadonna et al. 2004 Phase III (E) STNI x 36 Gy Seems not superior
Fermé et al. 2007 (EORTC-GELA H8-F) Phase III (C) See link See link
Fermé et al. 2007 (EORTC-GELA H8-U) Phase III (E) See link See link
Gordon et al. 2012 (ECOG E2496) Non-randomized portion of RCT

Preceding treatment

Radiotherapy

Variant #10, 36 Gy of STNI

Study Evidence Comparator Efficacy
Bonadonna et al. 2004 Phase III (C) IFRT x 36 Gy Seems not superior

Preceding treatment

Radiotherapy

Variant #11, 36 Gy of STNI + 4 Gy boost

Study Evidence Comparator Efficacy
Fermé et al. 2007 (EORTC-GELA H8-U) Phase III (C) See link See link

Preceding treatment

Radiotherapy

Variant #12, 40 Gy of IFRT

Study Evidence Comparator Efficacy
Bonadonna et al. 2004 Phase III (E) STNI x 40 Gy Seems not superior
Fermé et al. 2007 (EORTC-GELA H8-F) Phase III (C) See link See link
Fermé et al. 2007 (EORTC-GELA H8-U) Phase III (E) See link See link

Preceding treatment

  • Bonadonna et al. 2004: ABVD x 4, with CRu or PR
  • EORTC-GELA H8-F: MOPP-ABV x 3, with PR
  • EORTC-GELA H8-U: MOPP-ABV x 4 versus MOPP-ABV x 6, with PR

Radiotherapy

Variant #13, 40 Gy of STNI

Study Evidence Comparator Efficacy
Bonadonna et al. 2004 Phase III (C) IFRT x 40 Gy Seems not superior

Preceding treatment

  • ABVD x 4, with CRu or PR

Radiotherapy

References

  1. Carde P, Hagenbeek A, Hayat M, Monconduit M, Thomas J, Burgers MJ, Noordijk EM, Tanguy A, Meerwaldt JH, Le Fur R et al. 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 Organization for Research and Treatment of Cancer Lymphoma Cooperative Group. J Clin Oncol. 1993 Nov;11(11):2258-72. link to original article PubMed
  2. CCG 5942: Nachman JB, Sposto R, Herzog P, Gilchrist GS, Wolden SL, Thomson J, Kadin ME, Pattengale P, Davis PC, Hutchinson RJ, White K; Children's Cancer Group. Randomized comparison of low-dose involved-field radiotherapy and no radiotherapy for children with Hodgkin's disease who achieve a complete response to chemotherapy. J Clin Oncol. 2002 Sep 15;20(18):3765-71. link to original article contains verified protocol PubMed
    1. Update: Wolden SL, Chen L, Kelly KM, Herzog P, Gilchrist GS, Thomson J, Sposto R, Kadin ME, Hutchinson RJ, Nachman J. Long-term results of CCG 5942: a randomized comparison of chemotherapy with and without radiotherapy for children with Hodgkin's lymphoma--a report from the Children's Oncology Group. J Clin Oncol. 2012 Sep 10;30(26):3174-80. Epub 2012 May 29. link to original article link to PMC article PubMed
  3. 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; European Organization for Research and Treatment of Cancer 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 contains verified protocol PubMed
  4. 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 contains protocol PubMed
    1. 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
    2. 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
  5. 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. link to original article contains verified protocol PubMed
  6. NCIC CTG/ECOG HD.6: 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; Eastern Cooperative Oncology Group. 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 PubMed
    1. 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; Eastern Cooperative Oncology Group. 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 contains protocol PubMed
  7. 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. link to original article contains protocol PubMed
    1. 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
  8. 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 H8 Trial. 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 contains verified protocol in supplement PubMed
  9. Schwartz CL, Constine LS, Villaluna D, London WB, Hutchison RE, Sposto R, Lipshultz SE, Turner CS, deAlarcon PA, Chauvenet A. A risk-adapted, response-based approach using ABVE-PC for children and adolescents with intermediate- and high-risk Hodgkin lymphoma: the results of P9425. Blood. 2009 Sep 3;114(10):2051-9. Epub 2009 Jul 7. Erratum: in Blood 2016 128:605 link to original article contains verified protocol link to PMC article PubMed
  10. 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 PubMed
    1. Pooled sub-group 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
    2. Pooled sub-group 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
    3. 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
  11. 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 contains verified protocol PubMed
    1. Pooled sub-group 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
    2. 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
  12. 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 PubMed
    1. 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. 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
  13. 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 contains verified protocol PubMed
  14. 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. contains limited protocol link to PMC article PubMed
  15. 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
    1. 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 PMC article PubMed
    2. 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
  16. 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 contains protocol PubMed
    1. 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
  17. COG AHOD0031: Friedman DL, Chen L, Wolden S, Buxton A, McCarten K, FitzGerald TJ, Kessel S, De Alarcon PA, Chen AR, Kobrinsky N, Ehrlich P, Hutchison RE, Constine LS, Schwartz CL. Dose-intensive response-based chemotherapy and radiation therapy for children and adolescents with newly diagnosed intermediate-risk Hodgkin lymphoma: a report from the Children's Oncology Group Study AHOD0031. J Clin Oncol. 2014 Nov 10;32(32):3651-8. Epub 2014 Oct 13. link to original article does not contain protocol link to PMC article PubMed
  18. 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 PubMed
    1. Pooled sub-group 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
  19. 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 contains protocol PubMed
  20. 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 contains verified protocol link to PMC article PubMed

Relapsed or refractory, all lines of therapy

ABVD

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ABVD: Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine

Regimen

Study Evidence
Radford et al. 2015 (UK NCRI RAPID) Non-randomized portion of 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

Chemotherapy

28-day cycle for 1 cycle

Subsequent treatment

References

  1. 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 contains protocol PubMed

BEACOPP-14

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BEACOPP-14: Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone, 14-day course

Regimen

Study Evidence
Johnson et al. 2016 (RATHL) Non-randomized portion of RCT

Preceding treatment

Chemotherapy

Supportive medications

14-day cycle for 4 to 6 cycles

References

  1. 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 contains verified protocol in supplement link to PMC article PubMed

BEACOPP

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BEACOPP: Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone
BEACOPPbaseline

Regimen

Study Evidence
Gallamini et al. 2018 (GITIL/FIL HD 0607) Non-randomized portion of 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

Chemotherapy

21-day cycle for 4 cycles

References

  1. 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 contains verified protocol in supplement PubMed

eBEACOPP

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eBEACOPP: escalated Bleomycin, Etoposide, Adriamycin (Doxorubicin), Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone

Variant #1, 2 cycles

Study Evidence
Raemaekers et al. 2014 (EORTC/LYSA/FIL H10) Non-randomized portion of RCT

Note: dosing is not described in the paper; this is the standard escalated BEACOPP as described elsewhere.

Preceding treatment

Chemotherapy

21-day cycle for 2 cycles

Subsequent treatment

Variant #2, 3 cycles with response adaptation

Study Evidence
Johnson et al. 2016 (RATHL) Non-randomized portion of RCT

Preceding treatment

Chemotherapy

Supportive medications

21-day cycle for 3 cycles

Subsequent treatment

  • Second interim PET-CT negative: eBEACOPP x 1 (4 total)

Variant #3, 4 cycles

Study Evidence Comparator Efficacy
Borchmann et al. 2017 (GHSG HD18) Non-randomized portion of RCT
Gallamini et al. 2018 (GITIL/FIL HD 0607) Phase III (C) R-BEACOPP Seems not superior

Note: patients in GHSG HD18 enrolled after June 2011 would receive a total of 6 cycles.

Preceding treatment

  • GHSG HD18: eBEACOPP x 2, with positive interim PET-CT
  • GITIL/FIL HD 0607: ABVD x 2, with positive interim PET-CT

Chemotherapy

Supportive medications

21-day cycle for 4 cycles (see note)

Subsequent treatment

Variant #4, 6 cycles

Study Evidence Comparator Efficacy
Press et al. 2016 (SWOG S0816) Phase II
Borchmann et al. 2017 (GHSG HD18) Phase III (C) R-BEACOPPescalated Seems not superior

Note: patients in GHSG HD18 enrolled prior to June 2011 would receive a total of 8 cycles.

Preceding treatment

  • SWOG S0816: ABVD x 2, with interim PET-CT showing Deauville score 4 or 5 refractory disease
  • GHSG HD18: eBEACOPP x 2, with positive interim PET-CT

Chemotherapy

21-day cycle for 6 cycles

References

  1. 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 contains protocol PubMed
    1. 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
  2. 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 refers to original protocol link to PMC article PubMed
  3. 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 contains verified protocol in supplement link to PMC article PubMed
  4. 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 PubMed
    1. 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
  5. 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 contains verified protocol in supplement PubMed

BeGEV

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BeGEV: Bendamustine, GEmcitabine, Vinorelbine

Regimen

Study Evidence
Santoro et al. 2016 (ONC-2010-002) Phase II

Chemotherapy

Supportive medications

  • Growth factor support
  • PJP prophylaxis and antiemetics in accordance with institutional guidelines

21-day cycle for 4 cycles

Subsequent treatment

References

  1. 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 contains verified protocol PubMed

Bendamustine monotherapy

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Regimen

Study Evidence Efficacy
Moskowitz et al. 2013 Phase II ORR: 53%

Chemotherapy

Supportive medications

28-day cycle for up to 6 cycles

References

  1. 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 contains verified protocol link to PMC article PubMed

Brentuximab vedotin monotherapy

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Variant #1, q3wk cycle x 4

Study Evidence Efficacy
Chen et al. 2015 Phase II ORR: 68%

Chemotherapy

21-day cycle for 4 cycles

Subsequent treatment

  • Auto HSCT, with choice of regimen left to discretion of treating physician

Variant #2, q3wk, indefinite

Study Evidence Efficacy
Younes et al. 2010 (SG035-0001) Phase 1
Younes et al. 2012 (SG035-0003) Phase II ORR: 75% (95% CI, 65-83)
Gopal et al. 2012 (SGN35-006) Non-randomized 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.

Chemotherapy

Supportive medications

  • Rothe et al. 2012: "no premedications were administered"

21-day cycles, given until progression or up to 16 infusions (SG035-0003)

Variant #3, 3 out of 4 weeks

Study Evidence Efficacy
Moskowitz et al. 2015 (MSK 11-142) Phase II PET-negative rate: 27% (95% CI, 13-40)

Chemotherapy

28-day cycle for 2 cycles

Subsequent treatment

  • PET-negative patients (a Deauville score of 1 or 2): Autologous hematopoietic cell transplant with BEAM, CBV, or high dose chemoradiotherapy
  • PET-positive patients: Two cycles of augmented ICE prior to transplant

References

  1. Phase 1: 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
  2. 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 contains verified protocol link to PMC article PubMed
    1. 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
    2. 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
  3. 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 contains verified protocol link to PMC article PubMed
    1. 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 contains verified protocol link to PMC article PubMed
  4. 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 contains verified protocol PubMed
  5. 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
  6. 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
  7. 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 contains protocol PubMed
  8. 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 contains verified protocol PubMed
    1. 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

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Regimen

Study Evidence Efficacy
Herrera et al. 2017 (SGN35-025) Phase I/II ORR: 82% (95% CI, 70-91)

Note: this is the dosing used for all patients in the trial, per the manuscript.

Chemotherapy

  • Brentuximab vedotin (Adcetris) 1.8 mg/kg IV over 30 minutes once on day 1
  • 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

Subsequent treatment

  • At the discretion of the treating physician

References

  1. 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 contains verified protocol PubMed

BVB

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BVB: Brentuximab Vedotin & Bendamustine

Regimen

Study Evidence
LaCasce et al. 2018 (SGN35-016) Phase I/II

Chemotherapy

21-day cycle for up to 6 cycles

Subsequent treatment

References

  1. 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 contains verified protocol PubMed

DexaBEAM

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DexaBEAM: Dexamethasone, BiCNU (Carmustine), Etoposide, Ara-C (Cytarabine), Melphalan

Variant #1, 2 cycles with standard-dose etoposide

Study Evidence
Pfreundschuh et al. 1994 Phase II

Chemotherapy

Supportive medications

  • 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

Variant #2, 2 cycles with higher-dose etoposide

Study Evidence
Schmitz et al. 2002 Non-randomized portion of RCT

Note: the dose of etoposide was reduced per a mid-protocol amendment.

Chemotherapy

Supportive medications

  • 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

Variant #3, 4 cycles total with higher-dose etoposide

Study Evidence Comparator Efficacy
Schmitz et al. 2002 Phase III (C) BEAM, then autologous HSCT Seems to have inferior FFTF

Preceding treatment

  • DexaBEAM x 2

Chemotherapy

Supportive medications

  • 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

  1. Pfreundschuh MG, Rueffer U, Lathan B, Schmitz N, Brosteanu O, Hasenclever D, Haas R, Kirchner H, Koch P, Kuse R, Loeffler M, Diehl V. 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 contains verified protocol PubMed
  2. 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 contains verified protocol PubMed

DHAP

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DHAP: Dexamethasone, High-dose Ara-C (Cytarabine), Platinol (Cisplatin)

Regimen

Study Evidence
Valesquez et al. 1988 Phase II
Sureda et al. 2011 (HDR-ALLO) Phase II

Chemotherapy

  • Dexamethasone (Decadron) 40 mg PO/IV over 15 minutes once per day on days 1 to 4
  • Cytarabine (Cytosar) as follows:
    • 70 and younger: 2000 mg/m2 IV given over 3 hours Q12H x 2 doses on day 2
    • >70 years old: 1000 mg/m2 IV given over 3 hours Q12H x 2 doses on day 2
  • Cisplatin (Platinol) 100 mg/m2 IV continuous infusion over 24 hours on day 1

Supportive medications

  • Normal saline with mannitol 50 g/L given at 250 mL/H x 36 hours, starting 6 hours before Cisplatin (Platinol) infusion was started

21 to 28-day cycles (depending on degree of myelosuppression)

Subsequent treatment

  • Velasquez et al. 1988: 6 to 10 cycles, with therapy given 4 cycles beyond the maximum antitumor effect
  • Sureda et al. 2011 gave 2 cycles, with responders proceeding to Flu-Mel RIC-allo HSCT

Dose 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 (Cytosar) Cisplatin (Platinol)
ANC less than 200/uL 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

  1. 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 contains protocol PubMed
  2. 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. 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 contains protocol link to PMC article PubMed

DHAP - time intensified

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DHAP - time intensified: Dexamethasone, High-dose Ara-C (Cytarabine), Platinol (Cisplatin)

Regimen

Study Evidence
Josting et al. 2002 Phase II

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.

Chemotherapy

Supportive medications

Variable number of days between cycles depending on count recovery for 2 cycles 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. Baseline eligibility criteria for the study included WBC count greater than 3.5 x 109/L, Hb greater than or equal to 8 g/dL, platelets greater than or equal to 100 x 109/L.

References

  1. 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 contains protocol PubMed

ESHAP

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ESHAP: Etoposide, Solumedrol (Methylprednisolone) High-dose Ara-C (Cytarabine), Platinol (Cisplatin)

Regimen

Study Evidence
Aparicio et al. 1999 Phase II

Note that 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

Supportive medications

21- to 28-day cycle for 3 cycles; see below

Subsequent treatment

  • Transplant eligible patients with "responsive disease" after 3 cycles: CBV with auto HSCT
  • Transplant ineligible patients with "responsive disease" received 3 more cycles of ESHAP (6 total)

References

  1. 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 contains verified protocol PubMed

Everolimus monotherapy

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Regimen

Study Evidence
Johnston et al. 2010 Phase II

Chemotherapy

Supportive medications

  • "Patients could receive white blood cell growth factors if neutropenia developed. Erythropoietin treatment for anemia was permitted."

28-day cycles, given until progression or unacceptable toxicity

References

  1. 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 contains verified protocol link to PMC article PubMed

GCD

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GCD: Gemcitabine, Carboplatin, Dexamethasone

Regimen

Study Evidence
Gopal et al. 2010 Phase II

Chemotherapy

Supportive medications

  • Growth factor support and antibiotic prophylaxis used is at the discretion of the treating physician.

21-day cycle for up to 4 cycles

Dose modifications

  • Gemcitabine (Gemzar):
    • If on day 8, platelets are 50 to 100 x 109/L or ANC 500 to 1000/uL: 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/uL: 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/uL.
    • If counts were not adequate, the next cycle can be delayed for up to 3 weeks until counts are adequate for treatment.

References

  1. 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. contains verified protocol link to PMC article PubMed

GCD-R

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GCD-R: Gemcitabine, Carboplatin, Dexamethasone, Rituximab

Regimen

Study Evidence
Gopal et al. 2010 Phase II

Only used when disease is CD20+.

Chemotherapy

Supportive medications

  • Growth factor support and antibiotic prophylaxis used is at the discretion of the treating physician.

21-day cycle for up to 4 cycles

Dose modifications

  • Gemcitabine (Gemzar):
    • If on day 8, platelets are 50 to 100 x 109/L or ANC 500 to 1000/uL: 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/uL: 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/uL.
    • If counts were not adequate, the next cycle can be delayed for up to 3 weeks until counts are adequate for treatment.

References

  1. 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. contains verified protocol link to PMC article PubMed

Gemcitabine monotherapy

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Regimen

Study Evidence
Santoro et al. 2000 Phase II

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 until progression or intolerance

References

  1. 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 contains verified protocol PubMed

Gemcitabine & Rituximab

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Regimen

Study Evidence
Oki et al. 2007 Phase II

Patients had received at least 2 prior chemotherapy regimens.

Chemotherapy

21-day cycle for up to 6 cycles

Dose 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/uL on day 1 of the following cycle, delay until count recovery
    • If ANC remains less than or equal to 1000/uL 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

  1. 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 contains verified protocol PubMed

GVD

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GVD: Gemcitabine, Vinorelbine, Doxil (Liposomal doxorubicin)

Variant #1, transplant-naive

Study Evidence
Bartlett et al. 2007 (CALGB 59804) Phase I/II

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 second medication given
    • If on day 8, platelets are 50 to 100 x 109/L or ANC 500 to 1000/uL: 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/uL: 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/uL.
    • If counts were not adequate, the next cycle can be delayed for up to 3 weeks until counts are adequate for treatment.
  • Vinorelbine (Navelbine) 20 mg/m2 IV over 6 to 10 minutes once per day on days 1 & 8 first medication given
  • Pegylated liposomal doxorubicin (Doxil) 15 mg/m2 IV over 30 to 60 minutes once per day on days 1 & 8 third medication given

Supportive medications

  • See dose modifications, below

21-day cycle for 2 to 6 cycles

Subsequent treatment

  • SD or better: HSCT (details not specified)

Dose modifications

  • If febrile neutropenia occurs: Decrease treatment by one dose level.
  • If febrile neutropenia occurs on dose level -1: treating physician can choose to either:
    1. Use filgrastim or sargramostim
    2. Reduce dose of Gemcitabine (Gemzar) and Vinorelbine (Navelbine) by 25% for all subsequent cycles.
  • If febrile neutropenia reoccurred despite dose reduction patient were discontinued from this protocol.

Variant #2, post-transplant

Study Evidence
Bartlett et al. 2007 (CALGB 59804) Phase I/II

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 second medication given
    • If on day 8, platelets are 50 to 100 x 109/L or ANC 500 to 1000/uL: 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/uL: 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/uL.
    • If counts were not adequate, the next cycle can be delayed for up to 3 weeks until counts are adequate for treatment.
  • Vinorelbine (Navelbine) 15 mg/m2 IV over 6 to 10 minutes once per day on days 1 & 8 first medication given
  • Pegylated liposomal doxorubicin (Doxil) 10 mg/m2 IV over 30 to 60 minutes once per day on days 1 & 8 third medication given

Supportive medications

  • See dose modifications, below

21-day cycle for 2 to 6 cycles

Dose modifications

  • If febrile neutropenia occurs: Decrease treatment by one dose level.
  • If febrile neutropenia occurs on dose level -1: treating physician can choose to either:
    1. Use filgrastim or sargramostim
    2. Reduce dose of Gemcitabine (Gemzar) and Vinorelbine (Navelbine) by 25% for all subsequent cycles.
  • If febrile neutropenia reoccurred despite dose reduction patient were discontinued from this protocol.

References

  1. CALGB 59804: Bartlett NL, Niedzwiecki D, Johnson JL, Friedberg JW, Johnson KB, van Besien K, Zelenetz AD, Cheson BD, Canellos GP; Cancer 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. link to original article contains protocol PubMed

GVP

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GVP: Gemcitabine, Vinorelbine, Prednisolone

Regimen

Study Evidence
Naqi et al. 2013 Phase II

Chemotherapy

28-day cycle for 4 cycles

References

  1. 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. PubMed

ICE

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ICE: Ifosfamide, Carboplatin, Etoposide

Variant #1

Study Evidence
Moskowitz et al. 2001 Phase II

Chemotherapy

Supportive medications

  • Mesna (Mesnex) 5000 mg/m2 IV continuous infusion over 24 hours on day 2; mixed in same solution as Ifosfamide (Ifex)
  • Filgrastim (Neupogen) 5 mcg/kg SC once per day on days 5 to 12
  • No dose reductions--treatment is delayed until ANC is greater than 1000/uL and platelets greater than 50 x 109/L

14-day cycle for 2 cycles

Variant #2, "Augmented ICE"

Study Evidence
Moskowitz et al. 2015 (MSK 11-142) Phase II

Preceding treatment

Chemotherapy

Supportive medications

2 cycles

Subsequent treatment

  • Autologous hematopoietic cell transplant was "considered" after 2 cycles; criteria not listed in the abstract

References

  1. 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 contains protocol PubMed
  2. 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 contains protocol PubMed

Ifosfamide & Vinorelbine

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Regimen

Study Evidence
Bonfante et al. 1998 Phase II

Chemotherapy

Supportive medications

21-day cycles

References

  1. 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 contains verified protocol PubMed
  2. Abstract: Bonfante V, Viviani S, Devizzi L, Di Russo A, Di Nicola M, Magni M, Matteucci P, Grisanti S, Valagussa P, Bonadonna G, Gianni AM. High-dose ifosfamide and vinorelbine as salvage therapy for relapsed or refractory Hodgkin's disease. Eur J Haematol Suppl. 2001 Jul;64:51-5. contains protocol PubMed

IGEV

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IGEV: Ifosfamide, GEmcitabine, Vinorelbine

Regimen

Study Evidence
Santoro et al. 2007 Phase II
Zinzani et al. 2016 (HD0801) Non-randomized

Preceding treatment

Chemotherapy

Supportive medications

  • 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, but could assume 5 mcg/kg) 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

References

  1. 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 contains verified protocol PubMed
  2. 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 refers to Santoro et al. 2007 PubMed

Lenalidomide monotherapy

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Regimen

Study Evidence
Fehniger et al. 2011 Phase II

Chemotherapy

Supportive medications

28-day cycles

References

  1. 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 contains verified protocol link to PMC article PubMed

MINE

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MINE: Mesna, Ifosfamide, Novantrone (Mitoxantrone), Etoposide

Regimen

Study Evidence
Rodriguez et al. 1995 Phase II

Chemotherapy

Supportive medications

3 to 4-week cycle for up to 6 cycles in responding patients

References

  1. 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 contains protocol PubMed

Mini-BEAM

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Mini-BEAM: dose-reduced BiCNU (Carmustine), Etoposide, Ara-C (Cytarabine), Melphalan

Variant #1, 1 day of treatment/cycle

Study Evidence
Fernández-Jiménez et al. 1999 Phase II

Chemotherapy

28-day cycle for 2 to 3 cycles

Variant #2, 6 days of treatment/cycle

Study Evidence
Colwill et al. 1995 Phase II

Chemotherapy

Supportive medications

  • 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

  1. 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
  2. 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 contains protocol PubMed
  3. 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 contains verified protocol PubMed
    1. 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 contains protocol PubMed

Nivolumab monotherapy

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Variant #1, every 2 weeks

Study Evidence Efficacy
Younes et al. 2016 (CheckMate 205) Phase II ORR: 66% (95% CI, 55-76)

Immunotherapy

Continued until disease progression or treatment intolerance

Variant #2, with lead-in

Study Evidence Efficacy
Ansell et al. 2014 Phase I, >20 pts ORR: 87%

Immunotherapy

Continued until disease progression, or complete response, or up to 2 years

References

  1. Phase 1: 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 contains verified protocol link to PMC article PubMed
  2. 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 contains protocol PubMed

O-ESHAP

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O-ESHAP: Ofatumumab, Etoposide, Solumedrol (Methylprednisolone) High-dose Ara-C (Cytarabine), Platinol (Cisplatin)

Regimen

Study Evidence
Martínez et al. 2016 (GELTAMO) Phase II

Note that 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.

Chemotherapy

Number of cycles not specified

References

  1. 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; Hodgkin Lymphoma Subcommittee of Spanish Group of Lymphoma Bone Marrow Transplantation(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. 2016 May 17. link to original article contains protocol PubMed

Panobinostat monotherapy

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Regimen

Study Evidence Efficacy
Younes et al. 2012 Phase II Investigator assessment: 27%
Central review: 22%

Patients had progressed after auto HSCT and had a median of 4 prior systemic regimens (range 2 to 7).

Chemotherapy

21-day cycles until progression or intolerance

References

  1. Younes A, Sureda A, Ben-Yehuda D, Zinzani PL, Ong TC, Prince HM, Harrison SJ, Kirschbaum M, Johnston P, Gallagher J, Le Corre C, Shen A, Engert A. Panobinostat in patients with relapsed/refractory Hodgkin's lymphoma after autologous stem-cell transplantation: results of a phase II study. J Clin Oncol. 2012 Jun 20;30(18):2197-203. Epub 2012 Apr 30. link to original article contains verified protocol PubMed

Pembrolizumab monotherapy

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Regimen

Study Evidence Efficacy
Chen et al. 2017 (KEYNOTE-087) Phase II ORR: 69%

Immunotherapy

21-day cycles for up to 2 years

References

  1. 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. 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 contains verified protocol PubMed

Rituximab monotherapy

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Regimen

Study Evidence
Younes et al. 2003 Pilot, >20 pts

Patients had received a minimum of 2 prior systemic regimens. All reported patients had nodular sclerosis histology.

Chemotherapy

6-week course (6 doses total)

References

  1. 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 contains verified protocol PubMed

Sirolimus & Vorinostat

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Regimen

Study Evidence
Janku et al. 2014 Non-randomized

This is a very heavily pre-treated cohort, median of 6 prior therapies; doses here are one level below MTD and are proposed as the ongoing doses to be studied.

Chemotherapy

28-day cycles

References

  1. Abstract: Filip Janku, Yasuhiro Oki, Gerald Steven Falchook, Vivek Subbiah, Aung Naing, Vivianne Marie Velez Bravo, David S. Hong, Jason R. Westin, Cesar Nunez, Luis Fayad, Sattva Swarup Neelapu, Larry W. Kwak, Elizabeth J. Shpall, Jennifer J. Wheler, Tamara Barnes, Winnie S. Liang, Bodour Salhia, Funda Meric-Bernstam, Razelle Kurzrock, Michelle A. Fanale. Activity of the mTOR inhibitor sirolimus and HDAC inhibitor vorinostat in heavily pretreated refractory Hodgkin lymphoma patients. J Clin Oncol 32:5s, 2014 (suppl; abstr 8508) link to original abstract

Vinblastine monotherapy

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Regimen

Study Evidence
Little et al. 1998 Retrospective

This is a retrospective study; we are not aware of a prospective trial of vinblastine monotherapy in this setting.

Chemotherapy

1 to 2-week cycles

References

  1. 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 PubMed

Vinorelbine monotherapy

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Regimen

Study Evidence
Devizzi et al. 1994 Phase II

Chemotherapy

Complete responders received 6 additional doses past CR; others continued until progression or a maximum of 24 doses

References

  1. 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 contains verified protocol PubMed

Consolidation after salvage therapy

BEAM, then allo HSCT

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BEAM: BiCNU (Carmustine), Etoposide, Ara-C (Cytarabine), Melphalan

Regimen

Study Evidence
Sobol et al. 2013 Phase II

Chemotherapy

GVHD prophylaxis and key supportive medications

Stem cells transfused on day 0

References

  1. 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 PubMed

BEAM, then auto HSCT

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BEAM: Rituximab, BiCNU (Carmustine), Etoposide, Ara-C (Cytarabine), Melphalan

Regimen

Study Evidence Comparator Efficacy
Linch et al. 1993 Phase III (E) Mini-BEAM Superior PFS
Schmitz et al. 2002 Phase III (E) 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

Chemotherapy

Stem cells re-infused on day 0

References

  1. 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
  2. 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 contains verified protocol PubMed

BeEAM, then auto HSCT

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BeEAM: Bendamustine, Etoposide, Ara-C (Cytarabine), Melphalan

Regimen

Study Evidence
Visani et al. 2011 Phase I/II, <20 pts in this subgroup

Chemotherapy

Stem cells re-infused on day 0

References

  1. 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 contains verified protocol PubMed

CBV, then auto HSCT

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CBV: Cyclophosphamide, BiCNU (Carmustine), VP-16 (Etoposide)

Variant #1, 1500/300/250, all BSA-based

Study Evidence
Zinzani et al. 2003 Retrospective

Chemotherapy

Stem cells re-infused on day 0

Variant #2, 1800/600/400

Study Evidence
Reece et al. 1994 Phase II, <20 pts

Note: the lower of IBW or ABW was used in the dosing calculations.

Chemotherapy

Stem cells re-infused on day 0

References

  1. 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 contains verified protocol PubMed
  2. 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 contains verified protocol PubMed

CBV-Mx, then auto HSCT

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CBV-Mx: Cyclophosphamide, BiCNU (Carmustine), VP-16 (Etoposide), Mitoxantrone

Regimen

Study Evidence
Morschhauser et al. 2008 (GELA/SFGM H96) Non-randomized

Chemotherapy

Stem cells re-infused on day 0

References

  1. 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 Study Group. 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 contains verified protocol PubMed
    1. 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

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FEAM: Fotemustine, Etoposide, Ara-C (Cytarabine), Melphalan

Regimen

Study Evidence
Musso et al. 2009 Phase II
Musso et al. 2015 Phase II

Chemotherapy

References

  1. 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 PubMed
  2. 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 PubMed

Flu-Mel, then allo HSCT

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Flu-Mel: Fludarabine & Melphalan

Variant #1, 132/140

Study Evidence
Anderlini et al. 2008 Phase II

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
  • Recipients of stem cells from matched unrelated donors also received:
    • ATG (type not specified) 2 mg/kg IV once per day on days -4 to -2

GVHD prophylaxis

  • Tacrolimus (Prograf) IV starting on day -2, dosed to achieve serum levels 4 to 12 ng/mL and 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)

Variant #2, 150/140

Study Evidence
Alvarez et al. 2006 Prospective
Sureda et al. 2011 (HDR-ALLO) Phase II

Preceding treatment

  • Alvarez et al. 2006: Not specified
  • HDR-ALLO: DHAP x 2

Note: Alvarez et al. 2006 began CsA on day -1 and did not give day +11 MTX.

Chemotherapy

GVHD prophylaxis

  • Cyclosporine A (not specified whether modified or non-modified) starting on day -2 at 1.5 mg/kg IV BID
    • 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 and +11

Stem cells transfused on day 0

References

  1. 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 contains protocol PubMed
  2. 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 contains verified protocol link to PMC article PubMed
  3. 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. 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 contains verified protocol link to PMC article PubMed

Radiation therapy

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RT: Radiation Therapy

Variant #1, involved node RT (INRT)

Study Evidence
Raemaekers et al. 2014 (EORTC/LYSA/FIL H10) Non-randomized portion of 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

Radiotherapy

Variant #2, involved field RT (IFRT)

Study Evidence
Radford et al. 2015 (UK NCRI RAPID) Non-randomized portion of 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

Radiotherapy

References

  1. 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 contains protocol PubMed
  2. 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 contains protocol PubMed

Maintenance after salvage therapy

Brentuximab vedotin monotherapy

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Regimen

Study Evidence Comparator Efficacy
Moskowitz et al. 2015 (AETHERA) Phase III (E) Placebo Superior PFS

Treatment begins 30 to 45 days after transplant.

Preceding treatment

  • Autologous HSCT (preparative regimen not specified)

Chemotherapy

21-day cycle for 16 cycles

References

  1. 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 contains verified protocol PubMed
    1. 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

Placebo

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Regimen

Study Evidence Comparator Efficacy
Moskowitz et al. 2015 (AETHERA) Phase III (C) Brentuximab vedotin Inferior PFS
[https://www.tandfonline.com/doi/full/10.1080/10428194.2016.1182164 von Treskckow et al. 2016 (PATH) Phase III (C) Panobinostat Seems not superior (*)

No further active antineoplastic treatment after transplant. Note that PATH had a very low accrual and was not powered to investigate the original primary endpoint (DFS).

Preceding treatment

  • Autologous HSCT (preparative regimen not specified)

References

  1. 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 contains verified protocol PubMed
    1. 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
  2. PATH: von Tresckow B, Morschhauser F, Szer J, Eichenauer DA, Abramson JS, Sureda A, Engert A. Panobinostat consolidation in patients with Hodgkin lymphoma at risk for relapse after high dose chemotherapy and autologous stem cell transplant: final results after early trial discontinuation. Leuk Lymphoma. 2017 Jan;58(1):222-225. Epub 2016 May 17. link to original article PubMed

Response criteria

NCI Sponsored International Working Group Criteria (1999)

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Intended for non-Hodgkin lymphoma (NHL) but often referred to in the Hodgkin lymphoma literature.

  1. 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)

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  1. 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)

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  1. 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)

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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

  1. 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
  2. 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
  3. 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

Investigational agents