Abstract P139

Implementation of BrECADD According to HD21 Standards in a Middle-Income Country: Barriers and Feasibility in Mexican Public Hospitals

Background: BrECADD has emerged as a new standard of care for advanced-stage classical Hodgkin lymphoma (cHL). However, little is known about its implementation outside clinical trials. We evaluated the feasibility of delivering BrECADD in Mexico.

Methods: We conducted a multicenter retrospective study of consecutive patients with newly diagnosed cHL treated with BrECADD across four Mexican public institutions. Feasibility was assessed using a predefined HD21-inspired adherence measure, defined by the availability of baseline and interim PET-CT, completion of planned treatment, and the absence of dose reductions or treatment delays >14 days. Potential implementation barriers were evaluated across four predefined domains: diagnostic infrastructure, treatment delivery, supportive care, and safety.

Results: Twenty patients were included. Median age was 33 years (IQR 22–42); 65% had nodular sclerosis subtype and 90% advanced-stage disease. B symptoms were present in 90%, bulky disease in 55%, and ECOG 0–1 in 75%. Baseline and interim PET-CT assessments were available in 65% and 50% of patients, respectively. Treatment was administered in the outpatient setting in 75% of cases, while mesna was used in 30%. Thirty percent received four cycles and 70% six cycles of BrECADD. Ninety percent completed treatment without dose modifications and only 10% experienced delays >14 days due to toxicity or logistical reasons. All patients received primary G-CSF prophylaxis; 70% received Pneumocystis and antifungal prophylaxis.

Febrile neutropenia occurred in 10%, intensive care admission in 5%, and transfusion support in 10%. No treatment-related deaths were observed. The overall response rate was 95%, including 70% complete responses. Radiotherapy consolidation was administered in 30%. Four patients (20%) required subsequent systemic therapy; 12-month progression-free survival was 74.5%, and overall survival was 100%. All patients completed planned treatment; however, full HD21 adherence was achieved in only 7 of 20 patients (35%).

Conclusions: BrECADD can be safely delivered in Mexican public hospitals, with low rates of severe toxicity. Despite a 100% treatment completion rate, full implementation of the HD21 strategy was achieved in only 35% of patients. Barriers were predominantly identified within the diagnostic infrastructure domain, particularly limited access to baseline and interim PET-CT.