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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