Standard BEACOPP Chemotherapy Standard BEACOPP Chemotherapy Compared with COPP-ABVD for Compared with COPP-ABVD for Advanced Hodgkin's DiseaseAdvanced Hodgkin's Disease

Moscow State UniversityMoscow State UniversityFaculty of Fundamental MedicineFaculty of Fundamental MedicineN.N.Blokhin Cancer Research Center

Presented By : Dr .Sa Thi Ha (M.B;B.S)Supervisor : Prof Dr.B.I.Polyakov Dr.D.A.Bykov17th may 2010

Introduction Hodgkin lymphoma is characterized by the

presence of a special type of lymphatic cell called a Reed-Sternberg (RS) cell.

look like "owl's eyes.

more common in young adults and elderly patients.

Reed-Sternberg cell

population8510 new cases (2009)

4640males and 3870 females

1290 died (800 males and 490 females in 2009)

Risk factors Age Family history SexPast Epstein-Barr infectionCompromised immune systemGeography Socioeconomic status

Signs and symptom (+) of B symptomsAlcohol-induced pain in the enlarged nodes Enlarged lymph nodes (firm and rubbery)Hepatosplenomegaly Back pain Petechiae

Diagnosis History taking and physical examination Investigation Blood cell count (ESR) MRI PET scan Biopsy BM examination

Treatment Chemotherapy RadiotherapyStem cell transplantSurgery Target therapy Immunotherapy

Chemotherapy ABVD(Adriamycin, bleomycin, vinblastine

and dacarbazine).BEACOPP(bleomycin, etoposide,

doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone).

Stanford V( doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin and prednisone).

COPP/ABVD(cyclophosphamide, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, vinblastine and dacarbazine)

MOPP( mechlorethamine, vincristine, procarbazine and prednisone)

The studied prognostic factors Age >45 year versus <45 Gender Type of disease: early disease versus advanced

disease Presence of B symptoms ESR > 50 or > 30 plus B symptoms versus neither LDH > 500 IU/L versus < 500 IU /L Extranodal involvement Mediastinal involvement Pathological subtypes Type of chemotherapy

Aim of study

To identify various methods of combination therapy in advanced Hodgkin’s lymphoma and which is best and less toxicity.

Research objective To evaluate rate of freedom from treatment failure

at 5 years in treatment of standard BEACOPP and ABVD-COPP

To identify outcome and 5 years survival rates in standard BEACOPP and ABVD-COPP

To determine the toxicity of long term chemotherapy

Methods and materials Study method … retrospective method No of patients …49 patients(25-BEACOPP

and 24-COPP-ABVD)Duration of study …January 2005 to

December 2009.Staging …Ann Arbor clinical stage IIB or IIIA

and above stage with a large mediastinal mass Work-up - chest x-ray, CT of the abdomen and

pelvis, and complete blood count and ESR with metabolic profile

55 patients recruited

28 Assigned to BEACOPP27 Assigned to COPP-ABVD

2 Excluded 2 did not have Hodgkin’s disease

2 Excluded 2 did not have Hodgkin’s disease

26 Eligible 1 lost to follow up 25 Elgible 1 lost to follow up

25 Included in the analysis 23 received full course 2 received partial course

24 Included in the analysis 20 received full course 4 received partial course

Numbers of patients included in this analysis

Characteristics of patients

Chacteristics of patients by stage

Acute Adverse Effects of Chemotherapy

Kaplan–Meier Analysis of the Probability of Freedom from Treatment Failure (Panel A) and Overall Survival (Panel B)

Rate of the early progression and Five year Kaplain-Meier estimates of

the rate of free from treatment failure according to the International

Prognostic Index.

International Prognostic IndexCOPP-ABVD

(%)

Standard

BEACOPP(%)Early progression Good (0-1)Fair (2-3)Poor (4-7)Freedom from treatment failure at 5 yearsGood (0-1)Fair (2-3)Poor (4-7)Overall survival at 5 years Good (0-1)Fair (2-3)Poor (4-7)

101118

796759

928467

699

817274

938681

Outcome of Treatment and Five-Year Survival Rates.

Variable

COPP-ABVD(N=24)

Standard BEACOPP(N=25) percent

Complete remission 85(80-89) 88(85-91)

Early progression 10(7-15) 8(5-10)

Freedom from treatment failure at 5 yr

69(63-75) 76(72-80)

Overall survival at 5 yr 83(78-87) 88(85-91)

Conclusion The rate of freedom from treatment failure at five years

was 69 percent in the COPP-ABVD group, 76 percent in the BEACOPP group.

The five-year rates of overall survival were 83percent COPP-ABVD, the comparison with 88 percent of BEACOPP group. Standard BEACOPP results in better tumor control and overall survival than did COPP-ABVD.

The incidence of acute toxicity increases with BEACOPP; grade 4 leukopenia occurred in one or more cycles.

Thank you for attention