Long-term follow-up of the Response-Adjusted Therapy for Advanced Hodgkin Lymphoma trial

The Response-Adjusted Therapy for Advanced Hodgkin Lymphoma trial (RATHL) aimed to confirm noninferiority of treatment de-escalation by omission of bleomyin from doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) for interim fluorodeoxyglucose positron emission tomography (iPET)-negative patients and assess efficacicy and safety for iPET-positive patients who underwent treatment intensification with escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone (BEACOPP/BEACOPP14). At median follow-up of 7.3 years, for all patients the 7-year progression-free survival is 78.2% and 91,6%, respectively. The 1.3% difference in 3-year PFS between ABVD and AVD now falls within the predefined non-inferiority margin. Among patients with positive iPET, the 7-year PFS and OS were 65.9% and 83.2%, respectively. The cumulative incidence of second malignancies at 7 years was 5.5% for those receiving ABVD/AVD and 2.5% for those escalated to BEACOPP The authors conclude that with extended follow-up, these results confirm noninferiority of treatment de-escalation after a negative iPET. Escalation with BEACOPP for iPET-positive patients is effective and safe, with no increasse in second maligancies.