Standards of Care in Hodgkin Lymphoma

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The standard of care in the United States for advanced stage Hodgkin lymphoma is 6 cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine). Robert W. Chen, MD, explains that the standard of care in Europe is a more intense regimen, known as BEACOPP (bleomycin, etoposide, doxorubicin cyclophosphamide, vincristine, procarbazine, and prednisone) or escalated BEACOPP.

The debate between US and European oncologists on which regimen is superior, ABVD or BEACOPP, is ongoing. There is a small progression-free survival benefit associated with the use of escalated BEACOPP when compared with ABVD, suggests John Sweetenham, MD. Although ABVD is marginally less effective than BEACOPP with regard to achieving complete remission, toxicities associated with BEACOPP are higher, including treatment mortality and risk of secondary cancers.

In many cases, individuals exposed to BEACOPP are subjected to a toxic regimen that will affect their fertility. When utilizing a chemotherapy regimen, there is an important balance between disease control and side effects, Sweetenham states.