Abstract P016

Implementing BrECADD for the treatment of adult patients with newly diagnosed advanced stage classical Hodgkin’s lymphoma (AS-cHL). A single center experience

Introduction: The HD21, compared BrECADD (brentuximab vedotin, etoposide, cyclophosphamide, doxorubicin, dacarbazine and dexamethasone) with escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone) in newly diagnosed patients with AS-cHL. The final analysis showed better treatment-related morbidity and the interim results reveled a strong trend of superiority in favor of BrECADD.

Methods: To report our experience on applying BrECADD on adults, with AS-cHL. Therefore, we collected data from 11 consecutive patients, treated in our department between 2020 and 2023. PET assessment was performed after the 2nd cycle (iPET) and at the end of treatment (EoT PET).

Results: Six men and 5 women with median age of 31 years (range 24-48) were diagnosed with AS-cHL. The histologic subtype was nodular sclerosis (NS) in 8, mixed cellularity (MC) in 2 and unclassified in 1 case. The Ann Arbor stage was IIIB in 2 and IVB in 9 patients. One patient showed mediastinal bulky disease. The International Prognostic Score (IPS) was 2 in 2 subjects, 3 in 4 patients, 4 in 3 and 5 in 2 cases. All patients had ECOG score 0-2, but 2 with scores of 3 and 4. Five patients, treated before the announcement of the non inferiority results of HD21 trial, received 6 cycles of BrECADD, weather 5 patients diagnosed later received 4 cycles. One patient was lost after the 1st course. iPET was performed in 8 subjects: Five patients showed Deauville score (DS) 2 and the remaining 3 had DS1, DS3 and DS4. All patients had EoT PET. All achieved complete metabolic response: 6 showed DS1, 3 DS2 and 1 subject DS3. Radiotherapy received one patient with remaining bulky disease of 6cm. All patients received GCSF prophylactic administration. Among them, seven (70%) showed neutropenia grade 4. In 5 (50%) neutropenia was accompanied by fever, which required hospitalization. Five cases (45%) were supported with transfusions of red blood cell concentrates. One patient manifested peripheral sensory neuropathy grade 2. With a median follow up of 11.5 months (range 0.5-49.7) all eleven patients are alive. The 10 patients who concluded treatment, all are in complete remission.

Conclusion: BrECADD regimen, showed deep complete metabolic responses with manageable toxicity. In addition, the short duration of treatment period together with the possibility of administration in an outpatient setting make the regimen very appealing for adult patients with AS-cHL.

Authors

Athanasios Gakopoulos, Chara Giatra, Michael Panousieris, Sotiris Bristogiannis, Athanasia Apsemidou, Antonia Mitkou, Christos Masaoutis, Ioannis Baltadakis, Maria Bouzani