TY - JOUR
T1 - G-CSF is not necessary to maintain over 99% dose-intensity with ABVD in the treatment of Hodgkin lymphoma
T2 - Low toxicity and excellent outcomes in a 10-year analysis
AU - Evens, Andrew M.
AU - Cilley, Jeffrey
AU - Ortiz, Taylor
AU - Gounder, Mrinal
AU - Hou, Nanjiang
AU - Rademaker, Alfred
AU - Miyata, Sarah
AU - Catsaros, Kara
AU - Augustyniak, Connie
AU - Bennett, Charles L.
AU - Tallman, Martin S.
AU - Variakojis, Daina
AU - Winter, Jane N.
AU - Gordon, Leo I.
PY - 2007/6
Y1 - 2007/6
N2 - Dose-intensity of chemotherapy is important in the treatment of Hodgkin lymphoma (HL) and granulocyte-colony stimulating factor (G-CSF) is commonly used to maintain it. We reviewed all newly diagnosed HL patients who were treated at our institution between 1996 and 2005. Fifty-nine patients received adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy with no dose reductions, treatment delays, and without G-CSF, regardless of absolute neutrophil count (ANC). The median ANC on all ABVD treatment days (n = 658) was 0.925 × 109/l, and was <0.5 × 109/l on 26% of treatment days. Median normalised ABVD dose-intensity was 99.1% (range, 93-100%) and median cycle duration was 28.2 d. Incidence of bleomycin lung toxicity was 1.6%, 0.44% treatments were complicated by febrile neutropenia, and no secondary malignancies have occurred (median follow-up 48 months; range, 11-130 months). Five-year event-free (EFS) and overall survival (OS) were 92.9% and 97.4% respectively. Furthermore, the 5-year EFS and OS (87.4% and 94.1% respectively) for advanced stage patients compared favourably with a similar ABVD patient group who received routine prophylactic G-CSF (n = 23) with EFS 80.0% and OS 91.3% (P = 0.46 and 0.67 respectively). Our experience suggests that ABVD may be safely and effectively administered at >99% dose-intensity without G-CSF support, regardless of the ANC.
AB - Dose-intensity of chemotherapy is important in the treatment of Hodgkin lymphoma (HL) and granulocyte-colony stimulating factor (G-CSF) is commonly used to maintain it. We reviewed all newly diagnosed HL patients who were treated at our institution between 1996 and 2005. Fifty-nine patients received adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy with no dose reductions, treatment delays, and without G-CSF, regardless of absolute neutrophil count (ANC). The median ANC on all ABVD treatment days (n = 658) was 0.925 × 109/l, and was <0.5 × 109/l on 26% of treatment days. Median normalised ABVD dose-intensity was 99.1% (range, 93-100%) and median cycle duration was 28.2 d. Incidence of bleomycin lung toxicity was 1.6%, 0.44% treatments were complicated by febrile neutropenia, and no secondary malignancies have occurred (median follow-up 48 months; range, 11-130 months). Five-year event-free (EFS) and overall survival (OS) were 92.9% and 97.4% respectively. Furthermore, the 5-year EFS and OS (87.4% and 94.1% respectively) for advanced stage patients compared favourably with a similar ABVD patient group who received routine prophylactic G-CSF (n = 23) with EFS 80.0% and OS 91.3% (P = 0.46 and 0.67 respectively). Our experience suggests that ABVD may be safely and effectively administered at >99% dose-intensity without G-CSF support, regardless of the ANC.
KW - Bleomycin lung toxicity
KW - Chemotherapy
KW - Dose-intensity
KW - Granulocyte-colony stimulating factor
KW - Hodgkin lymphoma
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U2 - 10.1111/j.1365-2141.2007.06598.x
DO - 10.1111/j.1365-2141.2007.06598.x
M3 - Article
C2 - 17459049
AN - SCOPUS:34249285155
SN - 0007-1048
VL - 137
SP - 545
EP - 552
JO - British Journal of Haematology
JF - British Journal of Haematology
IS - 6
ER -