Background: The negative predictive value of PET-2 enabled a reduction from 6 to 4 cycles of eBEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone in escalated doses) without loss of efficacy in the GHSG HD18 trial for advanced stages of Hodgkin lymphoma (HL). Progression-free survival (PFS) of patients (pts) with PET-2 Deauville score (DS) 1-3 was comparable; however, pts with DS3 were treated with 6 to 8 cycles of eBEACOPP.
Methods: We analyzed the prognosis of pts with classical HL in advanced stages, including clinical stages IIB with massive mediastinal tumor (MMT) and/or extranodal involvement (EN), prospectively observed in the Czech Hodgkin Lymphoma Registry and treated with 6 or 4 cycles of eBEACOPP according to interim PET-2 as defined by the Lugano classification. Overall, 441 pts (aged 18-60 years) were treated with eBEACOPP between 2014 and 2024: 136 pts received 4 cycles and 305 pts received 6 cycles. Radiotherapy was indicated in 63 (14.3%) pts.
Results: PET-2 DS1-2 was achieved in 159 pts treated with 4 (84) or 6 cycles (75). PET-2 DS3 was reported in 107 pts treated with 4 (49) or 6 cycles (58), and PET-2 DS4-5 was achieved in 64 pts treated with 4 (1) or 6 (63) cycles, respectively. Interim PET-2 was not performed in 111 pts. Median follow-up was 59.7 months. There were no significant differences in the 5-year PFS in pts with PET-2 DS1-2 and DS3 treated with 4 cycles (91% [95% CI 84-99] vs. 78% [95% CI 64-95], p=0.061) or with 6 cycles (93% [95% CI 88-99] vs. 89% [95% CI 81-99], p=0.347). Differences between the 5-year PFS in pts with PET-2 DS1-2 vs. DS3 treated with 4 cycles or 6 cycles were not significant in subanalyses with MMT (p=0.858) and with EN disease (p=0.432). The 5-year PFS in pts with PET-2 DS4-5 treated with 6 cycles was 76% (95% CI 88-99). The 5-year OS in pts with PET-2 DS1-3 was 100% regardless of the number of treatment cycles, and in DS4-5 it was 96% (95% CI 92-100%).
Conclusion: There is a trend for 5-year PFS to be higher for PET-2 DS1-2 than for DS3 in pts treated with 4 cycles, but it has not reached statistical significance. Further evaluation is warranted. Additional data such as circulating tumor DNA (ongoing trial NCT06263530) and TARC analyses could help to better stratify pts with PET-2 DS3 into 4 or 6 cycles of eBEACOPP.
Supported by AZV NU22-03–00182 from Ministry of Health, Czech Rep., MH CZ DRO(FNOl_00098892) and Cooperatio Program Oncology and Hematology
Heidi Mocikova, Jana Markova, Lubica Gaherova, Maria Maco, Eva Maule, Jozef Michalka, Andrea Janikova, Alice Sykorova, Pavla Stepankova, Katarina Hradska, Juraj Duras, Alexandra Kredatusova, Vit Prochazka, Zdenek Kral, Tomas Kozak