Reference: August 2026 | Issue 8 | Vol 12 | Page 37
PET-guided brentuximab vedotin, etoposide, cyclophosphamide, adrip/doxorubicin, dacarbazine, and dexamethasone (BrECADD) is an effective and feasible first-line treatment option for patients above 60 years with advanced-stage classic Hodgkin lymphoma (AS-cHL), according to results from an analysis of data from the German Hodgkin Study Group (GHSG) HD21 trial
HD21 is an international, open-label, randomised phase 3 trial including AS-cHL patients 18-60 years at diagnosis. At EHA 2026, data was presented from a subgroup analysis of patients aged 61-75 years. Eighty-three patients were included. Median age was 67 years.
Endpoints included complete response (CR) at the end of chemotherapy, progression-free survival (PFS), overall survival (OS), time to progression (TTP), secondary malignancies, and late toxicities.
Treatment comprised two cycles of BrECADD followed by centrally reviewed PET (PET2). PET2-negative patients received a total of four cycles. PET2-positive patients received six cycles. Consolidative radiotherapy (30 Gy) to residual PET-positive lesions was recommended.
PET2 was centrally reviewed in 80 patients. Sixty per cent of patients were PET2-negative and received four cycles. Forty per cent were PET2-positive and received six cycles. The target number of cycles was delivered in 89 per cent of patients.
At the end of chemotherapy, CR was achieved in 82 per cent. At three years, PFS was 83 per cent and OS was 85 per cent. Relapse/progression was rare. The three-year event-free rate was 92 per cent. Secondary malignancies occurred in 14 per cent of patients, including one new solid tumour. No cases of acute myeloid leukaemia (AML) or myelodysplastic syndromes (MDS) was observed.
One year after treatment, no grade 4 late toxicities were reported. There was one grade 3 (musculoskeletal) adverse event. Nine patients experienced persistent peripheral neuropathy at last follow-up. Eight cases were grade 1. Efficacy was broadly consistent across frailty groups, while persisting toxicity/organ dysfunction occurred more often among unfit/frail patients.
The data suggest that PET-guided BrECADD is feasible in older patients with AS-cHL and provides high long-term disease control, with very low relapse/progression rates. Severe late toxicity appears to be rare, and no AML/MDS was observed. These results support PET-guided BrECADD as an effective first-line option for patients above 60 years with AS-cHL.
Reference
Ferdinandus J, et al. Final analysis of the GHSG HD21 older cohort: efficacy, survival and late toxicity of PET-guided BRECADD in older patients with advanced-stage classic Hodgkin lymphoma. Abstract S221. European Hematology Association Congress 2026. June 11-14, 2026. Stockholm, Sweden.
