Dose-dense ABVD First Line Therapy in Early Stage Unfavorable Hodgkin's Lymphoma

Dose-density has been shown to be an important factor for complete remission rate and longterm survival in lymphomas.

The aims of this study were to find out whether intensification of ABVD (dd-ABVD) is feasible and can improve the outcome of patients with early stage Hodgkin Lymphoma. In view of emerging data on the role of early PET in defining prognosis in Hodgkin Lymphoma patients, the percentage of FDG-PET (fluorodeoxyglucose positron emission tomography) negativity after two cycle was chosen as the parameter to evaluate dd-ABVD activity.

Inclusion criteria

• Age 18-70 years
• Histologically confirmed Hodgkin Lymphoma stage I, II unfavorable according to EORTC (European Organisation for Research and Treatment of Cancer) criteria, with exclusion of stage II B bulky.
• Previously untreated
• ECOG (Eastern Cooperative Oncology Group) performance status 0 - 2
• Staging with FDG-PET (fluorodeoxyglucose positron emission tomography)
• Written informed consent
• Adequate liver and renal function (total serum bilirubin < 2.5 x ULN, AST/SGOT and/or ALT/SGPT ≤ 2.5 x upper limit of normal (ULN) or ≤ 5.0 x ULN if the transaminase elevation is due to disease involvement, serum creatinine < 2.5 x ULN)

Exclusion criteria

• Concomitant cardiac, pulmonary, neurologic, psychiatric or metabolic severe disease.
• Uncontrolled diabetes mellitus (with fasting glucose levels above 200mg/dl)
• Other prior malignancies except for adequately treated basal cell carcinoma, squamous cell carcinoma of the skin, carcinoma in situ of the cervix, carcinoma in situ of the breast or other cancer from which the patient has been disease-free for ≥ 3 years
• Patients with a known history of HIV seropositivity
• Active HCV infection (PCR + ; AST> 1.5-2x UN)
• Woman who is pregnant or breast feeding. Fertile patients not willing to use effective contraception during the study and 3 months after the end of treatment. Women of childbearing potential (WOCBP) are defined as sexually mature women who have not undergone a hysterectomy or who have not been naturally postmenopausal for at least 12 consecutive months.
• Negative pregnancy test at baseline is required (serum β HCG).
• Male patient whose sexual partner(s) are WOCBP who are not willing to use a effective contraception during the study and 3 months after the end of treatment
• Nodular lymphocyte prevalence histological subtype