VEPEMB Compared With ABVD for Older Patients With Hodgkin Lymphoma

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Standard ABVD was associated with a significant improvement in survival in older patients with Hodgkin lymphoma.
Standard ABVD was associated with a significant improvement in survival in older patients with Hodgkin lymphoma.

Standard ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) was associated with a non-statistically significant improvement in progression-free and overall survival compared with reduced intensity VEPEMB (vinblastine, cyclophosphamide, procarbazine, prednisone, etoposide, mitoxantrone, bleomycin) in older patients with Hodgkin lymphoma, a study published in the British Journal of Haematology has shown.1 Both treatments were associated with low toxicity.

Because survival rates for older patients with Hodgkin lymphoma have not improved substantially in recent years, mostly due to limited prospective randomized trials, researchers sough to compare reduced intensity VEPEMB with standard ABVD in a phase 3 trial.

For the study, researchers enrolled 54 previously untreated patients between 65 and 80 years considered “non-frail” per a comprehensive geriatric evaluation. Of those, 17 patients had early stage disease while 37 had advanced stage disease.  Researchers then randomly assigned participants to receive one regimen or the other.

Results showed that after a median follow-up of 76 months, the 5-year progression-free survival rates were 48% with VEPEMB compared with 70% with ABVD (HR, 2.19; 95% CI, 0.94 - 5.10; P = .068). Five-year overall survival rates were 63% and 77%, respectively (HR, 1.67; 95% CI, 0.69 - 4.03; P = .254).

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In regard to safety, researchers found that the overall treatment-related mortality was 4% in both groups combined. A total of 4 patients who received ABVD reported grade 4 cardiac and lung toxicity vs no cases in the VEPEMB treatment arm.

The researchers noted that the low toxicity of both regimens was likely due to the stringent selection of patients that ultimately excluded frail patients.

Reference

  1. Zallio F, Tamiazzo S, Monagheddu C, et al. Reduced intensity VEPEMB regimen compared with standard ABVD in elderly Hodgkin lymphoma patients: results from a randomized trial on behalf of the Fondazione Italiana Linfomi (FIL) [published online ahead of print January 13, 2016]. Brit J Haematol. doi: 10.1111/bjh.13904.

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