For Standard and High-Risk Patients with Hodgkin Lymphoma Six Cycles of Tailored BEACOPP, Based On Interim Scintigraphy, Are Effective and Female Fertility Is Preserved.
Authors: Dann Eldad , Bar-Shalom Rachel , Tamir Ada , Ben-Shachar Menachem , Avivi Irit , Zuckerman Tsila , Haddad Nuhad , Rosenbaum Hanna , Fineman Riva , Goor Odelia , Libster Diana , Blumenfeld Zeev , Rowe Jacob M. , Epelbaum Ron 
Published: October 2019

Abstract
Abstract 1552
Poster Board I-575
This prospective study (124 patients) evaluated the outcome of patients with Hodgkin lymphoma (HL) whose therapy was tailored based on results of scans performed after 2 cycles of chemotherapy, thus reducing the dose for early responders and maximizing the dose for those with subptimal early response or progression. The study was initiated in 1999 for patients with HL aged 18-60 years. Eligibility criteria were: unfavorable HL stages I, II and stage III or IV. Disease was defined according to the International Prognostic Score (IPS). Standard risk patients were treated with 2 cycles of standard BEACOPP (SB) and those with IPS of 3 3 got 2 cycles of escalated BEACOPP (EB): Ga67(on 57 patients prior to 2001) or hybrid PET/CT scan (on all 67 since 2001) were performed at diagnosis and after the 1st or 2nd cycle for all 124 patients. If early interim scan remained positive, additional 4 cycles of EB were used; otherwise, SB was given. Data for 108 patients were previously reported (Blood, 2007); albeit with a median follow-up of only 4 years. Herein is an updated 6- year median follow-up for all previously reported patients who had Ga67 or PET/CT as well as 16 additional patients who underwent interim PET/CT. Furthermore, importantly, the fertility of all young female patients is herein reported. For all 124 patients on study, the 7-year event-free survival (EFS) for patients with IPS 0-2 is 89% and for those with IPS of 3 3 87%. Seven year overall survival (OS) is 90%. Sixty seven patients (39 males and 28 females aged 18-55 [median 33]) were treated after 2001 when hybrid FDG-PET/CT became available. Forty one patients had IPS of 0-2 and 26 ≥3. Complete remission (CR) rate was 96%, 5-y FFS and OS were 92% and 97%, respectively at a median follow-up of 56 months (8-90). 5-y EFS and OS were similar for standard and high risk patients. HL progressed in 2/12 patients with interim positive PET/CT versus 3/55 with negative PET (p<0.02) (Table 1). Ninety four percent of patients with negative interim PET/CT had no disease progression during the follow-up, while 17% of patients with interim positive PET/CT progressed. One patient died from breast cancer. Thirty-eight females < 40 years old who had been treated with tailored BEACOPP since 1998 were assessed for fertility status. This is described in Table 2. Twenty six were co-treated with the GnRH agonist triptorelin, concomitantly with chemotherapy. Nineteen conceived during follow-up. Thirteen delivered 17 healthy babies, 6 terminated their pregnancy.

Conclusion
PET/CT is useful for making an early interim decision about chemotherapy dose on an individual basis, thus reducing unnecessary toxicity and escalating therapy where appropriate based on poor interim prognostic features. The results of 6 cycles of risk-adapted BEACOPP compare favorably with the reported data following 8 cycles of EB. Use of tailored therapy enables reduction of cumulative chemotherapy and preservation of fertility in the majority of young female patients.

Disclosures
Rowe: Teva Pharmaceuticals: Consultancy; EpiCept Corporation: Consultancy.