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
Department of Medicine, Division of Hematology/Oncology
Medical Subject Headings
Age Factors; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; effects; Bleomycin; Dacarbazine; Doxorubicin; Etoposide; Female; Hematologic Diseases; Hodgkin Disease; Humans; Lung Diseases; Male; Mechlorethamine; Middle Aged; Neoplasm Staging; Prednisone; Survival Analysis; Treatment Outcome; Vinblastine; Vincristine
Clinical Epidemiology | Hematology | Hemic and Lymphatic Diseases | Oncology
There is a lack of contemporary prospective data examining the adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) and Stanford V (SV; doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, prednisone) regimens in older Hodgkin lymphoma (HL) patients. Forty-four advanced-stage, older HL patients (aged >/=60 years) were treated on the randomized study, E2496. Toxicities were mostly similar between chemotherapy regimens, although 24% of older patients developed bleomycin lung toxicity (BLT), which occurred mainly with ABVD (91%). Further, the BLT-related mortality rate was 18%. The overall treatment-related mortality for older HL patients was 9% vs. 0.3% for patients aged (P < 0.001). Among older patients, there were no survival differences between ABVD and SV. According to age, outcomes were significantly inferior for older versus younger patients (5-year failure-free survival: 48% vs. 74%, respectively, P = 0.002; 5-year overall survival: 58% and 90%, respectively, P < 0.0001), although time-to-progression (TTP) was not significantly different (5-year TTP: 68% vs. 78%, respectively, P = 0.37). Furthermore, considering progression and death without progression as competing risks, the risk of progression was not different between older and younger HL patients (5 years: 30% and 23%, respectively, P = 0.30); however, the incidence of death without progression was significantly increased for older HL patients (22% vs. 9%, respectively, P < 0.0001). Altogether, the marked HL age-dependent survival differences appeared attributable primarily to non-HL events.
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Citation: Br J Haematol. 2013 Apr;161(1):76-86. doi: 10.1111/bjh.12222. Epub 2013 Jan 29. Link to article on publisher's site
Evens, Andrew; Hong, Fangxin; Gordon, Leo I.; Fisher, Richard I.; Bartlett, Nancy L.; Connors, Joseph M.; Gascoyne, Randy D.; Wagner, Henry; Gospodarowicz, Mary; Cheson, Bruce D.; Stiff, Patrick J.; Advani, Ranjana; Miller, Thomas P.; Hoppe, Richard T.; Kahl, Brad S.; and Horning, Sandra J., "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" (2013). University of Massachusetts Medical School Faculty Publications. 105.