Abstract P045

Frontline BV-AVD in Classical Hodgkin Lymphoma: A Multicenter Real-World Comparison with the ABVD Regimen

Background: For decades, the ABVD regimen remained the global gold standard for advanced-stage classical Hodgkin lymphoma (cHL).In the ECHELON-1 trial, brentuximab vedotin (BV) combined with AVD (BV + AVD) showed higher progression-free survival (PFS) and overall survival (OS) rates in patients with advanced stage compared to the standard ABVD regimen. We evaluated the clinical outcomes of a multicenter cohort treated with first-line BV-AVD and compared them against the long-term historical outcomes of patients treated with the ABVD regimen.

Methods: This multicenter, retrospective cohort study enrolled adult patients with newly diagnosed cHL across 20 centers in Turkey receiving first-line BV+AVD, with ABVD-treated patients as the internal control cohort from Ege University and external validation cohort of advanced-stage from different center.Survival outcomes were estimated using the Kaplan-Meier method and compared with the log-rank test, with Cox regression tests used for multivariate analyses.

Results: A total of 275 patients were analyzed: 123 in the BV-AVD group (median age 46, range 18-83) and 152 in the ABVD group (median age 39, range 18-81). The BV-AVD cohort exhibited a significantly higher risk profile, with a greater prevalence of advanced-stage disease (90% vs. 68%; p<0.001), B symptoms (59% vs. 44.7%; p=0.019), and bone marrow involvement (24% vs. 12%; p=0.006). Median follow-up was 1.4 years for BV-AVD and 4.9 years for ABVD. In the overall cohort, the 2-year PFS and OS rates were higher in the BV-AVD group, though the difference did not reach statistical significance (PFS: 83.5% vs. 78.4%, p=0.7; OS: 96.7% vs. 89.1%, p=0.1). However, in a subgroup analysis of advanced-stage patients, while 2-year PFS remained comparable (81.8% vs. 66.7%; p=0.08), the 2-year OS was significantly superior in the BV-AVD arm (95.6% vs. 81.8%; HR: 3.97, 95% CI: 1.3-12.1, p=0.015). Regarding safety, neuropathy and grade 3-4 hematological toxicities were more frequent in the BV-AVD group. Consequently, the utilization of G-CSF was significantly higher in the BV-AVD cohort (77.2% vs. 41.1%; p<0.001).

Conclusion: Our data suggests that BV-AVD is a robust and effective frontline regimen for advanced-stage HL in a real-world setting. By successfully managing a higher-risk patient population and providing a superior survival advantage in advanced stages, BV-AVD justifies its position as the new standard of care, provided that hematological toxicities are managed.