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

Andrew M. Evens*, Fangxin Hong, Leo I. Gordon, Richard I. Fisher, Nancy L. Bartlett, Joseph M. Connors, Randy D. Gascoyne, Henry Wagner, Mary Gospodarowicz, Bruce D. Cheson, Patrick J. Stiff, Ranjana Advani, Thomas P. Miller, Richard T. Hoppe, Brad S. Kahl, Sandra J. Horning

*Corresponding author for this work

Research output: Contribution to journalArticle

79 Scopus citations

Abstract

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 <60 years (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.

Original languageEnglish (US)
Pages (from-to)76-86
Number of pages11
JournalBritish Journal of Haematology
Volume161
Issue number1
DOIs
StatePublished - Apr 2013

Keywords

  • Bleomycin lung toxicity
  • Elderly
  • Hodgkin lymphoma
  • Treatment-related toxicity

ASJC Scopus subject areas

  • Hematology

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