Jurnal Internasional Brentuximab vedotin, doxorubicin, vinblastine, dan dacarbazine untuk limfoma Hodgkin klasik tahap terbatas yang nonbulky

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Jurnal Internasional Brentuximab vedotin, doxorubicin, vinblastine, dan dacarbazine untuk limfoma Hodgkin klasik tahap terbatas yang nonbulky

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Main Points

  • Brentuximab vedotin plus AVD without consolidated radiation is an effective therapy for nonbulky restricted HL stages.

  • Peripheral neuropathy and neutropenic fever appear to be increased with brentuximab-AVD compared with consolidated radiation. Expected toxicity from ABVD only. [19659004] Abstract Abstract

Abstract

Doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) with or without radiation is standard therapy for limited-stage Hodgkin lymphoma (HL) but has risks. Bleomycin-induced lung injury and radiation toxicity. Vedotin Brentuximab is very active in recurring HL and was recently approved with doxorubicin, vinblastine, and dacarbazine (AVD) for stage III / IV HL which were previously untreated. We evaluated brentuximab-AVD for nonbulky HL stage I / II in a phase 2 multicenter study. Patients received an initial cycle of vedotine brentuximab monotherapy on days 1 and 15, followed by exploratory positron emission tomography / computed tomographic scanning. Patients then received brentuximab-AVD for 4 to 6 cycles based on a temporary positron emission tomography / tomographic scan after cycle 2. Thirty-four patients were enrolled with an average age of 36 years (range, 20-75 years). The initial risk is favorable at 62% and unprofitable at 38%. The best complete response rate is 100%. At a median follow-up of 38 months, development-free survival and overall survival were 94% and 97%, respectively. The most common side effects were peripheral sensory neuropathy (79%), neutropenia (76%), fatigue (74%), and nausea (71%). The most common grade 3/4 toxicity is neutropenia (62%), febrile neutropenia (35%), and peripheral sensory neuropathy (24%). One elderly patient died of neutropenic sepsis in the first brentuximab-AVD cycle. Reduction of the Brentuximab dose is needed in 38% of patients, mostly for peripheral neuropathy. In conclusion, brentuximab-AVD without bleomycin or radiation produces a high complete response rate, with most patients only needing 4 total cycles of therapy. Because the toxicity is higher than expected from AVD alone, this method may not be suitable for early stage patients with a very good prognosis. This court was registered at www.clinicaltrials.gov as # NCT01534078 .

  • Submitted 24 April 2019.
  • Received June 1, 2019.

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