Evaluating the Use of Vincristine as a Substitute in Hodgkin Lymphoma Treatment

TL;DR

This study compares the ABOD and ABVD chemotherapy regimens for treating Hodgkin lymphoma and finds that ABOD may be more effective for older patients.

Contribution

The study evaluates the ABOD regimen as a potential alternative to ABVD in classical Hodgkin lymphoma treatment.

Findings

Older patients showed better treatment response after the second cycle of ABOD.

Younger patients required dose escalation more frequently.

ABOD may be more suitable for older patients due to favorable response rates and manageable toxicity.

Abstract

Introduction

Classical Hodgkin lymphoma (HL) is a type of cancer originating from B lymphocytes, characterized by a high annual incidence globally. While the ABVD regimen (adriamycin, bleomycin, vinblastine, and dacarbazine) is the standard treatment, this study aims to evaluate the efficacy of the ABOD regimen (adriamycin, bleomycin, vincristine, and dacarbazine) in treating classical HL. The study also aimed to identify factors influencing treatment response, relapse risk, and the indication for alternative treatments such as escalation therapy, salvage therapy, immunotherapy, and transplantation.

Methods

This ambispective study included 81 patients with classical HL treated with the ABOD regimen containing vincristine at the Military Cancer Center (MCAC) in Amman, Jordan, between January 2017 and January 2022, with follow-up until February 2023. Patients aged 14 to 71 years, with disease stages 2a to 4b and performance status scores of 0 to 2, were included. Exclusion criteria were age below 14, loss to follow-up, stage 1a disease, or performance score >2. Data were primarily collected from electronic records and clinical notes. Treatment response after the second and sixth chemotherapy cycles, and the need for escalation, salvage therapy, or bone marrow transplantation were assessed. Statistical analysis included Chi-square tests for categorical variables and ANOVA and t-tests for continuous variables, followed by logistic regression for significant predictors. Ethical approval was obtained from the IRB of the Jordanian Royal Medical Services.

Results

The study included 81 patients (n = 81), with a mean age of 34.79 years and a predominance of females (n = 49, 60.5%) compared to males (n = 32, 39.5%). The most common histological subtype was nodular sclerosis (n = 67, 82.7%), and the most prevalent stage was stage 4 (n = 31, 38.3%). Treatment response after the second cycle of ABOD was significantly better in older patients. There was no significant association between bulky disease (n = 20, 24.7%) and treatment response or relapse risk (n = 27, 33.3%). Younger patients required dose escalation more frequently (n = 24, 29.6%), suggesting that the ABOD regimen might be more suitable for older patients. Gender, histological subtype, and disease stage were not significantly associated with treatment response or relapse risk.

Conclusion

The ABOD regimen, using vincristine instead of vinblastine, presents a viable alternative to the ABVD regimen for classical HL treatment, particularly benefiting older patients due to favorable response rates and manageable toxicity. The findings highlight the need for further research to optimize treatment strategies for different patient subgroups and confirm the benefits of the ABOD regimen.