Abstract P078

‘ACOPP’ chemotherapy for older and less fit patients with Hodgkin lymphoma – a multicentre, retrospective study

Introduction: Patients (pts) aged ≥60 years comprise 20-30% of classical Hodgkin lymphoma (cHL) diagnoses, but are significantly underrepresented in clinical trials and outcomes for this group have not improved in line with advances seen in younger pts. Whilst anthracycline-containing regimens result in superior outcomes, older pts typically have poor tolerance of the chemotherapy regimens used in younger pts. We modified the BEACOPP regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisolone) by removing bleomycin and etoposide and dose-reducing cyclophosphamide for use in older pts with co-morbidities. Here we present data from the first 41 pts treated with ACOPP across 3 UK centres.

Methods: ACOPP comprises doxorubicin 35mg/m2 and cyclophosphamide 650mg/m2 intravenous (IV) infusion day (D)1, vincristine 1.4mg/m2 IV injection D8, oral procarbazine 100mg/m2 D1-7, prednisolone 40mg/m2 D1-14 and subcutaneous G-CSF D9-13. Each centre retrospectively analysed consecutive patients receiving ACOPP for cHL. Medical co-morbidities were quantified using the Cumulative Illness Rating Scale-Geriatric (CIRS-G). Statistical analysis was performed using SPSS v28.0.

Results: Forty-one pts previously untreated for cHL were included, with median age 74 and median CIRS-G of 5. The majority (78%) had advanced stage disease. Six cycles of ACOPP were planned for 38/41 patients, of whom 68% completed treatment. Nine pts (22%) had dose reductions, most often with vincristine (6/9). Sixty-one percent required hospital admission during treatment, the majority having 1-2 admissions (22/25). Grade 3+ neutropenia was seen in 34%, with a relatively low rate of febrile neutropenia (15%). Neuropathy occurred in 15 patients (37%), all grade 1-2. Six pts died during the study, only 1/41 (2%) had a direct treatment related death. Overall response rate was 39/41 (95%), with CR in 34/41 (83%). With median follow-up of 17 months, estimated 2-year PFS and OS were 74% (95% CI: 58-90) and 87% (95% CI: 75-99) respectively.

Conclusion: The ACOPP regimen can be delivered to older pts with significant co-morbidity, with a relatively favourable toxicity profile and promising efficacy. Treatment of older patients with cHL continues to be an area of unmet need. Whilst treatment in clinical trials should be considered optimal therapy, enrolment in this group remains challenging and the ACOPP regimen offers promising outcomes in a difficult to treat population.