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 Jr., Mary Gospodarowicz, Bruce D. Cheson, Patrick J. Stiff, Ranjana Advani, Thomas P. Miller, Richard T. Hoppe, Brad S. Kahl, Sandra J. Horning

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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 1 2013

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Dacarbazine
Vinblastine
Bleomycin
Hodgkin Disease
Doxorubicin
Survival
Mechlorethamine
Lung
Mortality
Vincristine
Etoposide
Prednisone
Non-Hodgkin's Lymphoma
Drug Therapy

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

Evens, Andrew M. ; Hong, Fangxin ; Gordon, Leo I. ; Fisher, Richard I. ; Bartlett, Nancy L. ; Connors, Joseph M. ; Gascoyne, Randy D. ; Wagner Jr., Henry ; Gospodarowicz, Mary ; Cheson, Bruce D. ; Stiff, Patrick J. ; Advani, Ranjana ; Miller, Thomas P. ; Hoppe, Richard T. ; Kahl, Brad S. ; 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. In: British Journal of Haematology. 2013 ; Vol. 161, No. 1. pp. 76-86.
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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.",
author = "Evens, {Andrew M.} and Fangxin Hong and Gordon, {Leo I.} and Fisher, {Richard I.} and Bartlett, {Nancy L.} and Connors, {Joseph M.} and Gascoyne, {Randy D.} and {Wagner Jr.}, Henry and Mary Gospodarowicz and Cheson, {Bruce D.} and Stiff, {Patrick J.} and Ranjana Advani and Miller, {Thomas P.} and Hoppe, {Richard T.} and Kahl, {Brad S.} and Horning, {Sandra J.}",
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Evens, AM, Hong, F, Gordon, LI, Fisher, RI, Bartlett, NL, Connors, JM, Gascoyne, RD, Wagner Jr., H, Gospodarowicz, M, Cheson, BD, Stiff, PJ, Advani, R, Miller, TP, Hoppe, RT, Kahl, BS & Horning, SJ 2013, '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', British Journal of Haematology, vol. 161, no. 1, pp. 76-86. https://doi.org/10.1111/bjh.12222

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

In: British Journal of Haematology, Vol. 161, No. 1, 01.04.2013, p. 76-86.

Research output: Contribution to journalArticle

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T1 - The efficacy and tolerability of adriamycin, bleomycin, vinblastine, dacarbazine and Stanford V in older Hodgkin lymphoma patients

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AU - Wagner Jr., Henry

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AU - Cheson, Bruce D.

AU - Stiff, Patrick J.

AU - Advani, Ranjana

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