Is OEPA/COPDAC chemotherapy and PET-CT based strategy for Hodgkin
lymphoma appropriate in a developing country? Lessons learned from 143
patients
Abstract
Background: ABVD regimen for Hodgkin lymphoma (HL), disfavoured in
high-income countries, is popular in low-middle-income countries (LMIC).
The feasibility/safety data for ‘non-ABVD’ protocols from LMIC is
limited. Procedure: The retrospective study was conducted in a single
center in India. Euronet-PHL-C1-based protocol was administered during
2010-19. A PET-CT was performed at diagnosis and following
OEPA-course-2. Radiotherapy was administered for inadequate
PET-response. Results: During the 10-year-period, 143 patients with HL
were treated. The mean-age was 7.8±2.5 years. Bulky-disease was observed
in 82 (59%). Treatment-abandonment was recorded in 13 (9.1%). The
median follow-up duration was 46.4 months. An inadequate PET-response
was observed in 41/118 (34.7%). Radiotherapy was administered to 23/41
(56.1%). There was a protocol violation of replacing radiotherapy in 12
(29.3%) patients with 2-courses of COPDAC. Sixty-nine episodes of
febrile-neutropenia were observed in 54 patients. TRM was observed in 7
(5.3%). The majority of episodes of febrile-neutropenia (61%) and TRM
(86%) were following OEPA-course-1. The 4-year overall-survival (OS)
and event-free survival (EFS) were 93.5±2.2% and 86.2±3.4%,
respectively. Nine (6.3%) patients relapsed. The survival compared
favorably with 5-year-EFS (77.7%) of patients who received ABVD/COPP in
the center in the past. Bulky-disease lacked association with inadequate
PET-response (p=0.800) or relapse (p=1.000). Conclusions: OEPA/COPDAC
regimen and response assessment by PET-CT permitted therapy reduction,
including radiotherapy. The survival (4-year OS: 93.5±2.2%) was
excellent, with a low relapse (6.3%). Febrile neutropenia and resultant
TRM (5.3%) are concerning and occurred frequently following
OEPA-course-1. The support system for managing febrile neutropenia
should be optimized for administering OEPA in LMIC.