Abstract P028

First-line BrECADD in routine clinical practice: excellent treatment deliverability and early efficacy in advanced-stage classical Hodgkin lymphoma

Background: BrECADD became the preferred first-line treatment for advanced-stage (AS) classical Hodgkin lymphoma (cHL) following HD21. However, real-world data remain limited. Aim: To evaluate efficacy, treatment deliverability, and toxicity of first-line BrECADD in routine clinical practice and compare toxicity outcomes with a historical escalated BEACOPP (escBEACOPP) cohort.

Methods: We retrospectively analyzed all patients with AS cHL treated with first-line BrECADD at the University Hospital Centre Zagreb (2023–2025). Toxicity findings were compared with an escBEACOPP cohort treated between 2015 and 2025. Toxicity endpoints included grade ≥3 neutropenia, transfusion requirements, treatment modifications, peripheral neuropathy, and hospitalizations. Multivariable logistic regression adjusted for age, stage, and ECOG performance status was used to evaluate factors associated with transfusion requirements and treatment modifications.

Results: Twenty-one patients received first-line BrECADD. Median age was 27 years (19–60); 86% had stage IV disease and 71% extranodal involvement. Interim PET2 was available in 19 pts, with 18/19 achieving complete metabolic remission (CMR). Most pts received 4 cycles (4 received 6 cycles). At a median follow-up of 15 months, all patients achieved CMR, with progression-free and overall survival rates of 100%.

Treatment modifications occurred in 43% of patients; however, no cycle delays or treatment discontinuations were observed. Grade ≥3 neutropenia occurred in 95% of patients, hospitalization for febrile neutropenia in 33%, red blood cell transfusions in 19%, platelet transfusions in 33%, and peripheral neuropathy in 14%. Compared with escBEACOPP (n=119), BrECADD-treated patients received fewer treatment cycles (median 4 vs 6, p<0.001).

Overall transfusion requirements were lower with BrECADD (48% vs 72%; p=0.039). In multivariable analysis, BrECADD remained independently associated with lower odds of transfusion requirement (OR 0.37, 95% CI 0.14–0.98; p=0.046) and superior treatment deliverability (OR 2.73, 95% CI 1.01–7.41; p=0.048).

Conclusions: In routine clinical practice, first-line BrECADD demonstrated excellent efficacy and tolerability. Despite frequent hematologic toxicity, treatment completion was universal and no treatment delays occurred. Compared with escBEACOPP, BrECADD was associated with reduced transfusion requirements and better preservation of planned treatment intensity.