G-CSF is not necessary to maintain over 99% dose-intensity with ABVD in the treatment of Hodgkin lymphoma: Low toxicity and excellent outcomes in a 10-year analysis

Andrew M. Evens, Jeffrey Cilley, Taylor Ortiz, Mrinal Gounder, Nanjiang Hou, Alfred Rademaker, Sarah Miyata, Kara Catsaros, Connie Augustyniak, Charles L. Bennett, Martin S. Tallman, Daina Variakojis, Jane N. Winter, Leo I. Gordon

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Abstract

Dose-intensity of chemotherapy is important in the treatment of Hodgkin lymphoma (HL) and granulocyte-colony stimulating factor (G-CSF) is commonly used to maintain it. We reviewed all newly diagnosed HL patients who were treated at our institution between 1996 and 2005. Fifty-nine patients received adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy with no dose reductions, treatment delays, and without G-CSF, regardless of absolute neutrophil count (ANC). The median ANC on all ABVD treatment days (n = 658) was 0.925 × 109/l, and was <0.5 × 109/l on 26% of treatment days. Median normalised ABVD dose-intensity was 99.1% (range, 93-100%) and median cycle duration was 28.2 d. Incidence of bleomycin lung toxicity was 1.6%, 0.44% treatments were complicated by febrile neutropenia, and no secondary malignancies have occurred (median follow-up 48 months; range, 11-130 months). Five-year event-free (EFS) and overall survival (OS) were 92.9% and 97.4% respectively. Furthermore, the 5-year EFS and OS (87.4% and 94.1% respectively) for advanced stage patients compared favourably with a similar ABVD patient group who received routine prophylactic G-CSF (n = 23) with EFS 80.0% and OS 91.3% (P = 0.46 and 0.67 respectively). Our experience suggests that ABVD may be safely and effectively administered at >99% dose-intensity without G-CSF support, regardless of the ANC.

Original languageEnglish (US)
Pages (from-to)545-552
Number of pages8
JournalBritish Journal of Haematology
Volume137
Issue number6
DOIs
StatePublished - Jun 1 2007
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Hematology

Keywords

  • Bleomycin lung toxicity
  • Chemotherapy
  • Dose-intensity
  • Granulocyte-colony stimulating factor
  • Hodgkin lymphoma

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    Evens, A. M., Cilley, J., Ortiz, T., Gounder, M., Hou, N., Rademaker, A., Miyata, S., Catsaros, K., Augustyniak, C., Bennett, C. L., Tallman, M. S., Variakojis, D., Winter, J. N., & Gordon, L. I. (2007). G-CSF is not necessary to maintain over 99% dose-intensity with ABVD in the treatment of Hodgkin lymphoma: Low toxicity and excellent outcomes in a 10-year analysis. British Journal of Haematology, 137(6), 545-552. https://doi.org/10.1111/j.1365-2141.2007.06598.x