Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, China.
J Cancer Res Clin Oncol. 2023 Jul;149(7):3989-4003. doi: 10.1007/s00432-022-04321-6. Epub 2022 Aug 28.
Doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) has been regarded as the standard treatment regimen for classical Hodgkin lymphoma. In recent years, ABVD-like regimens, which emerged due to shortages and the lung toxicity of bleomycin or the emergence of immune checkpoint inhibitors and antibody-drug conjugates, may be favorable, but have not yet been tested.
We compared the outcomes of ABVD with ABVD-like regimens, which include bleomycin was completely or partially omitted; meanwhile, etoposide or PD-1 inhibitors were added.
5-Year progression-free survival (PFS) was higher for ABVD than ABVD-like regimens in young patients (82.1% vs. 67.0%, p = 0.029), patients with serum beta-2 microglobulin (β2-MG) ≥ 1.85 mg/L (75.8% vs. 57.6%, p = 0.046), and advanced-stage patients with IPS score 4-7(63.1%, 18.3%, p = 0.038). For elderly (60.5% vs.76.1%, p = 0.089), patients with β2-MG < 1.85 mg/L (83.1% vs 76.1%, p = 0.282), and advanced-stage patients with IPS score 0-3(84.6% vs. 81.3%, p = 0.476), 5-year PFS for ABVD did not differ from ABVD-like regimens. Elderly patients treated with bleomycin-free regimens showed a better survival trend compared with ABVD (99.3% vs. 61.3%, p = 0.270).
ABVD is superior to ABVD-like regimens in achieving PFS in young patients or patients with poor prognosis including high IPS score and β2-MG level. ABVD-like regimens are as effective as ABVD in elderly or low-risk patients including low IPS score and β2-MG level; elderly patients treated with bleomycin-free regimens exhibit a better survival trend compared with ABVD.
多柔比星、博来霉素、长春碱和达卡巴嗪（ABVD）一直被视为经典霍奇金淋巴瘤的标准治疗方案。近年来，由于博来霉素短缺和肺毒性，或免疫检查点抑制剂和抗体药物偶联物的出现，出现了 ABVD 样方案，这些方案可能更有利，但尚未经过检验。
我们比较了 ABVD 与 ABVD 样方案的结果，ABVD 样方案包括完全或部分省略博来霉素；同时，加用依托泊苷或 PD-1 抑制剂。
在年轻患者（82.1% vs. 67.0%，p=0.029）、β2-微球蛋白（β2-MG）血清水平≥1.85mg/L（75.8% vs. 57.6%，p=0.046）和国际预后评分（IPS）为 4-7 分的晚期患者中，ABVD 比 ABVD 样方案的 5 年无进展生存率（PFS）更高。在老年患者（60.5% vs. 76.1%，p=0.089）、β2-MG<1.85mg/L（83.1% vs. 76.1%，p=0.282）和 IPS 评分 0-3 分的晚期患者中，ABVD 与 ABVD 样方案的 5 年 PFS 没有差异。与 ABVD 相比，接受无博来霉素方案治疗的老年患者有更好的生存趋势（99.3% vs. 61.3%，p=0.270）。
在年轻患者或预后不良（包括 IPS 评分高和β2-MG 水平高）的患者中，ABVD 优于 ABVD 样方案，可实现 PFS；在 IPS 评分低和β2-MG 水平低的老年或低危患者中，ABVD 样方案与 ABVD 同样有效；与 ABVD 相比，接受无博来霉素方案治疗的老年患者有更好的生存趋势。
