Moderate dose escalation for advanced stage Hodgkin's disease using the bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone scheme and adjuvant radiotherapy: A study of the German Hodgkin's Lymphoma Study Group

The BEACOPP (bleomycin, etoposide; adriamycin, cyclophosphamide, vincristin e, procarbazine, and prednisone) regimen, a rearranged and accelerated vers ion of the standard COPP/adriamycin, bleomycin, vinblastine, and dacarbazin e (ABVD) chemotherapy, has been shown to be effective and safe in a previou s pilot study for advanced stage Hodgkin's disease (HD). The present study aimed to determine a maximum practicable dose of three drugs, ie, etoposide , adriamycin, and cyclophosphamide, for which acute toxicities were accepta ble and to assess the feasibility of the escalated scheme. Sixty untreated patients with advanced stage HD were enrolled in this study. Radiotherapy w as given in 44 patients (73%) after chemotherapy to initial bulk lesions an d residual disease. Granulocyte-colony stimulating factor (G-CSF) was given from day 8 to prevent prolonged neutrocytopenia and severe infections. The intended doses of adriamycin, etoposide, and cyclophosphamide in the BEACO PP schedule could be substantially escalated: adriamycin from 25 to 35, cyc lophosphamide from 650 to 1,200, and etoposide from 100 to 200 mg/m(2). The major toxicities were leukocytopenia and thrombocytopenia with considerabl e heterogeneity between individual patients. Of 60 patients, 56 (93%) achie ved a complete remission (CR). At a median observation of 32 months, the ra tes of survival and freedom from treatment failure (FFTF) were estimated to be 91% (95% confidence interval 83% to 99%) and 90% (82% to 98%). These re sults show that a moderate dose escalation of adriamycin, cyclophosphamide, and etoposide of the baseline BEACOPP regimen is feasible. The escalated B EACOPP regimen shows very encouraging results in advanced stage HD and is n ow being compared in a randomized phase III study with BEACOPP at baseline dose level. (C) 1998 by The American Society of Hematology.