G-CSF is not necessary to maintain over 99% dose-intensity with ABVD in the treatment of Hodgkin lymphoma: Low toxicity and excellent outcomes in a 10-year analysis

Andrew M. Evens*, Jeffrey Cilley, Taylor Ortiz, Mrinal Gounder, Nanjiang Hou, Alfred Rademaker, Sarah Miyata, Kara Catsaros, Connie Augustyniak, Charles L. Bennett, Martin S. Tallman, Daina Variakojis, Jane N. Winter, Leo I. Gordon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

67 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)545-552
Number of pages8
JournalBritish Journal of Haematology
Volume137
Issue number6
DOIs
StatePublished - Jun 2007

Keywords

  • Bleomycin lung toxicity
  • Chemotherapy
  • Dose-intensity
  • Granulocyte-colony stimulating factor
  • Hodgkin lymphoma

ASJC Scopus subject areas

  • Hematology

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