Abstract P010

Frontline Escalation to BrECADD in Advanced Hodgkin Lymphoma: Multicenter Real-World Experience

Background: Response-adapted treatment escalation is an established strategy in advanced classical Hodgkin lymphoma for patients with inadequate early response to initial lower-intensity therapy. However, the published evidence for PET2-adapted escalation is based largely on escalation to escalated BEACOPP with The RATHL study and SWOG S0816 support escalation with 3- and 2-year progression-free survival of 67.5% and 64% respectively. BrECADD protocol has mainly been studied as an upfront intensive regimen and showed lower treatment-related morbidity than escalated BEACOPP with at least noninferior efficacy and a 4-year progression-free survival of 94.3 percent. Data on BrECADD as an escalation strategy in routine practice remain limited.

Methods: We conducted a multicenter retrospective real-world analysis of adults treated with BrECADD between July 1, 2023, and October 1, 2025, data cut off was 1.12.25. Within this cohort, we identified nine patients with advanced Hodgkin lymphoma who underwent escalation to BrECADD during frontline therapy. Most patients escalated because of inadequate response to initial lower-intensity treatment. This subgroup was analyzed descriptively for treatment delivery, response, survival outcomes, and safety.

Results: Nine patients with advanced Hodgkin lymphoma underwent escalation to BrECADD after other regimen: ABVD in 6 patients, AAVD in 2, and CHOP in 1. Escalation was triggered by partial response in 7 patients, toxicity in 1, and revised diagnosis in 1. The median age was 25 and stage 4 disease was reported in 4 patients. Patients received a median of 4 BrECADD cycles, with 8 of 9 completing planned treatment and 2 requiring dose reduction. All 9 patients achieved complete metabolic response after BrECADD, 7 of them after 2 cycles. After a median follow-up of 15.7 months (range, 5.1–30.7), 2 patients had relapsed, and all patients were alive at last follow-up. Grade 4 hematologic adverse events were recorded in 6 patients with only one patient with Grade 3-4 non hematologic toxicity. No ICU admission or neurologic toxicity was reported.

Conclusions: In this multicenter real-world series, frontline escalation to BrECADD was feasible and induced complete metabolic response in all patients. Although 2 relapses occurred during follow-up, there were no recorded death which bring the overall survival to 100%. These findings extend the limited literature on BrECADD beyond its use as upfront