The majority of young patients presenting with advanced stage Hodgkin lymphoma (HL) in the UK are managed with ABVD. However, following the 2009 HD9 trial publication, escalated BEACOPP (escB) was introduced as a treatment option in certain UK cancer centres. Here we present the data from advanced stage HL patients aged 16 to 59, who presented between 2004 and 2014 in the East of England Anglia Cancer Network with a referral population of 2.64 million. 250 cases were diagnosed, giving an incidence of 0.95 cases per 100,000 which is in-line with expected incidence of advanced HL in this age group. Six of the eight Anglia cancer centres introduced escalated BEACOPP for patents as determined by physician and patient choice. Over this 10 year period, 44 patients were managed with escB, 202 with ABVD, 3 with an alternative regimen and 1 patient died pre-treatment. The 5 year progression free survival (PFS) for all patients was 82% and 5 year overall survival (OS) was 92%. There was a clinician / patient preference for escB for worse prognosis patients as escB patients had a higher international prognostic score (IPS) than patients treated with ABVD (IPS3+: escB 75% vs ABVD 38%, p<0.0001).
For the whole cohort, PFS was better for patients treated with escB compared with ABVD (5 year PFS 95% vs 80%; HR 4.3 (95%CI:1.97-9.7), p=0.0261)), but there was no OS difference (5 year OS 97% vs 92%; HR 2.6 (95%CI:0.69-10.4), p=0.312). However, patients with IPS 3+ had both a PFS and OS advantage when treated with escB compared with ABVD (5 year PFS 96% vs 74%; HR 9.24 (95%CI:3.43-24.89), p=0.012: 5 year OS 100% vs 84%; p=0.0325). The use of consolidation radiotherapy(RT) was equal between regimens with 11% of patients receiving RT with both escB and ABVD. 29 ABVD-treated and 3 escB-treated patients had at least one subsequent transplant procedure (including 6 allografts post ABVD and 3 allografts post escB, including one allograft for tAML/MDS). Of the 20 pre-menopausal women treated with escB, 11 of 14 aged <30 regained menstrual periods (5 pregnancies) but only 1 of 6 aged > 30 regained menstrual periods which were not sustained beyond 3 years.
Our data reflect clinical trials results which indicate a first remission PFS but not OS advantage for unselected young advanced stage HL patients treated with escB compared with ABVD. However, our data strongly suggest that patients with a poor IPS score derive a PFS and OS benefit from treatment with escB compared with ABVD.