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The efficacy and tolerability of adriamycin, bleomycin, vinblastine, dacarbazine and S tanford V in older H odgkin lymphoma patients: a comprehensive analysis from the N orth A merican intergroup trial E 2496
Author(s) -
Evens Andrew M.,
Hong Fangxin,
Gordon Leo I.,
Fisher Richard I.,
Bartlett Nancy L.,
Connors Joseph M.,
Gascoyne Randy D.,
Wagner Henry,
Gospodarowicz Mary,
Cheson Bruce D.,
Stiff Patrick J.,
Advani Ranjana,
Miller Thomas P.,
Hoppe Richard T.,
Kahl Brad S.,
Horning Sandra J.
Publication year - 2013
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.12222
Subject(s) - dacarbazine , vinblastine , medicine , abvd , bleomycin , vincristine , tolerability , gastroenterology , hodgkin's lymphoma , chemotherapy , etoposide , oncology , surgery , adverse effect , cyclophosphamide
Summary There is a lack of contemporary prospective data examining the adriamycin, bleomycin, vinblastine, dacarbazine ( ABVD ) and Stanford V ( SV ; doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, prednisone) regimens in older Hodgkin lymphoma ( HL ) patients. Forty‐four advanced‐stage, older HL patients (aged ≥60 years) were treated on the randomized study, E2496. Toxicities were mostly similar between chemotherapy regimens, although 24% of older patients developed bleomycin lung toxicity ( BLT ), which occurred mainly with ABVD (91%). Further, the BLT ‐related mortality rate was 18%. The overall treatment‐related mortality for older HL patients was 9% vs. 0·3% for patients aged <60 years ( P < 0·001). Among older patients, there were no survival differences between ABVD and SV . According to age, outcomes were significantly inferior for older versus younger patients (5‐year failure‐free survival: 48% vs. 74%, respectively, P = 0·002; 5‐year overall survival: 58% and 90%, respectively, P < 0·0001), although time‐to‐progression ( TTP ) was not significantly different (5‐year TTP : 68% vs. 78%, respectively, P = 0·37). Furthermore, considering progression and death without progression as competing risks , the risk of progression was not different between older and younger HL patients (5 years: 30% and 23%, respectively, P = 0·30); however, the incidence of death without progression was significantly increased for older HL patients (22% vs. 9%, respectively, P < 0·0001). Altogether, the marked HL age‐dependent survival differences appeared attributable primarily to non‐ HL events.