Treatment-Related Mortality in Patients With Advanced-Stage Hodgkin Lymphoma: An Analysis of the German Hodgkin Study Group

Authors:
  • MFMichael Fuchs
    Michael Fuchs
  • APAnnette Plütschow
    Annette Plütschow
  • BKBeate Klimm
    Beate Klimm
  • BHBernd Hertenstein
    Bernd Hertenstein
  • GMGeorg Maschmeyer
    Georg Maschmeyer
  • TVTom Vieler
    Tom Vieler
  • UDUlrich Dührsen
    Ulrich Dührsen
  • WLWalter Lindemann
    Walter Lindemann
  • WAWalter Aulitzky
    Walter Aulitzky
  • VDVolker Diehl
    Volker Diehl
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Abstract
Purpose: The introduction of BEACOPPescalated (escalated-dose bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) has significantly improved tumor control and overall survival in patients with advanced-stage Hodgkin lymphoma. However, this regimen has also been associated with higher treatment-related mortality (TRM). Thus, we analyzed clinical course and risk factors associated with TRM during treatment with BEACOPPescalated. Patients and Methods: In this retrospective analysis, we investigated incidence, clinical features, and risk factors for BEACOPPescalated-associated TRM in the German Hodgkin Study Group trials HD9, HD12, and HD15. Results: Among a total of 3,402 patients, TRM of 1.9% (64 of 3,402) was mainly related to neutropenic infections (n = 56; 87.5%). Twenty of 64 events occurred during the first course of BEACOPPescalated (31.3%). Higher risk of TRM was seen in patients age ≥ 40 years with poor performance status (PS) and in patients age ≥ 50 years. PS and age were then used to construct a new risk score; those with a score ≥ 2 had TRM of 7.1%, whereas patients who scored 0 or 1 had TRM of 0.9%. Conclusion: The individual risk of TRM associated with BEACOPPescalated can be predicted by a simple algorithm based on age and PS. High-risk patients should receive special clinical attention.

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