EHA 2025 | An analysis of the optimal treatment option for patients with advanced-stage cHL

We are entering a new era for patients with advanced-stage patients with classical Hodgkin lymphoma. We have several treatment options available. Everything starts with the ABVD and the BEACOPP therapies which have been improved with the advent of functional imaging, in particular interim PET assessment which allows the development of PET-adapted ABVD and PET-adapted BEACOPP escalated. The availability of brentuximab vedotin allowed the development of brentuximab AVD and BEACOPP which is PET-adapted indeed. And last but not least the checkpoint inhibitors nivolumab established Nivo-AVD as a new standard treatment for patients with advanced-stage classical Hodgkin lymphoma. So we have several treatments available but which is the most effective one. We were able to retrieve data for more than 7,100 patients with advanced-stage classical Hodgkin lymphoma that were assigned to different treatments, nivo-AVD, rituximab-AVD, BRECADD, BEACOPP-escalated, ABVD-escalated or ABVD without a PET-adaptive treatment. We retrieved data by using the individual patient data extracted from Kaplan-Meier curves of both progression-free survival and overall survival and we compared the outcome of the different treatments. We observed that patients treated with BRECADD had the best three-year progression-free survival which is above 94% as compared to all the other treatments. The differences between BRECADD and rituximab AVD is statistically significant and also between BRECADD and NIVO AVD, suggesting that BRECADD in patients between 18 to 60 years old is able to decrease the rate of relapses in early primary refractory patients. We analyzed also overall survival, yet we were not able to demonstrate a difference in terms of overall survival. The treatment that was associated with the lower overall survival is ABVD without a PET-adaptive strategy. We also compared the adverse events. We observed that BEACOPP and BEACOPP-based treatment were associated with a higher rate of severe cytopenia and febrile neutropenia between 20 to 30% of the patients developed grade 4 thrombocytopenia as compared to ABVD or ABVD-adaptive treatment. Instead, in terms of grade 3 or higher peripheral neuropathies, the rate of this adverse event was more common with brentuximab-AVD as compared to all the other treatments. In patients between 18 to 60 years old, the treatment-related mortality was very low, less than 1% overall in the patients. So in conclusion, we can say we are moving the needle into a personalized treatment approach for patients with advanced-stage classical Hodgkin lymphoma in order to improve the outcome of our patients.

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