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Shorter bleomycin regimen demonstrates acceptable toxicity profile in older patients with Hodgkin lymphoma
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Four chemotherapy cycles with bleomycin appeared too toxic for elderly patients with early-stage Hodgkin lymphoma, according to an analysis of two trials conducted by the German Hodgkin Study Group.
However, receipt of no more than two cycles of bleomycin-containing regimens demonstrated an acceptable toxicity profile for this cohort, results showed.
Due to a lack of randomized trials of older patients with Hodgkin lymphoma, no well-established chemotherapy regimen exists for these patients, according to study background.
Doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) is considered standard of care; however, bleomycin-induced lung toxicity is a major concern.
Boris Böll, MD, of University Hospital Cologne in Germany, and colleagues sought to evaluate the feasibility, efficacy and toxicity associated with the addition of bleomycin to doxorubicin, vinblastine and dacarbazine (AVD) chemotherapy in older patients with early-stage Hodgkin lymphoma.
Researchers evaluated data from 287 patients (median age, 65 years; range, 60-75) in the German Hodgkin Study Group HD10 and HD13 trials.
The researchers randomly assigned patients to two cycles of ABVD (n = 137), two cycles of AVD (n = 82), or four cycles of ABVD (n = 68). All patients then underwent involved-field radiation therapy.
Similar rates of grade 3 or higher adverse events occurred among patients treated with two chemotherapy cycles, with or without bleomycin (40% vs. 39%). Two patients assigned bleomycin developed bleomycin-induced lung toxicity.
However, 65% of patients assigned four cycles of chemotherapy with bleomycin had a grade 3 or higher adverse event. Seven patients in this treatment arm developed bleomycin-induced lung toxicity, which resulted in three deaths.
Rates of complete remission ranged from 96% to 99% in patients treated with two chemotherapy cycles. For patients treated with four cycles, the complete remission rate was 88%.
Study limitations identified by the researchers included the small cohort and the lack of a comprehensive geriatric assessment.
“In older early-stage favorable patients, combined-modality treatment should be favored over three or four cycles of chemotherapy alone,” Böll and colleagues wrote. “In early-stage unfavorable and advanced-stage patients requiring more than two cycles of ABVD, bleomycin might be omitted in subsequent cycles. In addition, caution is warranted in the use of bleomycin for older patients with risk factors for bleomycin-induced lung toxicity, such as renal insufficiency, pulmonary radiation, underlying lung disease, tobacco history and concomitant use of granulate colony–stimulating factor.” – by Cameron Kelsall
Reference:
Böll B, et al. Blood. 2016;doi:10.1182/blood-2015-11-681064.
Disclosure: The researchers report no relevant financial disclosures.