Treatment of advanced Hodgkin lymphomas in adolescents and young adults: efficacy and toxicity issues

Hodgkin’s lymphoma (HL) is highly sensitive to chemo- and radiotherapy. Long-term tumor-free survival in patients with early stages is close to 95–98 %. Therapy results in patients with advanced stages is worse that requires an intensification of treatment and creates the issues
of late toxicity prevention. These problems are especially relevant in young adults with a life expectancy of 40 years or more. Escalated BEACOPP protocol developed by the German study group allows to achieve cure the majority of patients with advanced-stage Hodgkin’s lymphoma, but this regime has significant toxicity. It causes infertility in almost all patients. BEACOPP-14 with comparable activity contains less cumulative doses of potentially gonadotoxic alkylating agents. Efficacy and toxicity of this regime has been analyzed in 29 patients with prognostically unfavorable stages of HL (m – 13, f – 16) received 8 courses BEACOPP-14 without a dose reduction of cytostatics. The median age of patients was 24 (20–35) years. With a median follow-up of 32.8 (4–66) months, event-free survival was 92.8 %, disease-free – 96.2 %, and overall survival – 95.2 %. Of the 16 women included in the study, the menstrual cycle was restored in 14 patients during 3–6 months. 2 patients were not evaluated because of switch to more intensive chemotherapy in the early stages of treatment. Of the remaining 14 patients pregnancy occurred in 3 (18.7 %), delivery – in 2, abortion – in 1. Delivery was term, children born healthy. Most of the patients according to the doctors’ recommendations protects and continues to avoid pregnancy for 2 years after treatment. The data indicate a potentially less reproductive damaging of BEACOPP-14 in females retaining high anti-tumor efficacy.