The escalated BEACOPP (eBEACOPP) regimen represents one of the gold standard treatments for advanced-stage Hodgkin's Lymphoma (HL), as implemented by the German Hodgkin Study Group (GHSG). In Brazil, since 2008, procarbazine was replaced with dacarbazine 375mg/m2/cycle (eBEACOPDac protocol), due to its absence on the market. When the BRECADD (replacing bleomycin with brentuximab) phase II study was published, it was seen that the protocol used a higher dose of dacarbazine (500mg/m2/cycle), and this dose was incorporated into the eBEACODD regimen. After a certain period of follow-up of this increased dose of dacarbazine, it was found in our Cancer Center that we were having difficulty to continue the cycles due to toxicity related to the treatment. The aim of this investigation was to conduct a comparative analysis of the safety profiles between the two dosage regimens of the eBEACODD (375mg/m2/cycle versus 500mg/m2/cycle) in treating patients with advanced HL over a comparable timeframe. This retrospective study examined data from 31 patients treated at our institution from 2019 to 2021. Of these, seventeen patients received the higher dosage regimen (500-group), while fourteen received the lower dosage regimen (375-group). Upon evaluating response rates at the end of treatment, both groups demonstrated comparable outcomes, with 71% of patients in the 375-group achieving complete remission (CR), compared to 76% in the 500-group. However, an analysis of the incidence of febrile neutropenia (FN) events per cycle revealed a notable discrepancy. Specifically, the 500-group exhibited a threefold higher frequency of FN events (17.9%) compared to the 375-group (6.09%), with a statistically significant p-value of 0.04. Furthermore, within the 500-group, 47.1% of patients necessitated a protocol switch to ABVD due to treatment-related toxicities. In contrast, among patients of the 375-group no such protocol alterations were required, suggesting a more favorable toxicity profile. In conclusion, the utilization of a modified eBEACODD regimen incorporating 375mg/m2 of dacarbazine per cycle represents a potentially safer therapeutic strategy for patients with advanced HL, mitigating the risk of treatment-related toxicities, particularly FN. Further investigations with larger patient cohorts and multicenter studies are warranted to validate these findings and have data about efficacy.
Arthur Gomes Oliveira Braga, Larissa Hilario Dulley, Guilherme Garcia Rodrigues, Sergio Costa Fortier, Carlos Sergio Chiattone, Talita Maira Bueno da Silveira