‘ACOPP’ chemotherapy for older and less fit patients with Hodgkin lymphoma—a multicentre, retrospective study

Introduction: Patients (pts) aged ≥60 years comprise 20%–30% of classical Hodgkin lymphoma (cHL) diagnoses, but are significantly underrepresented in clinical trials and outcomes for this group have not improved in line with advances seen in younger counterparts. Whilst there is evidence that anthracycline-containing regimens result in superior outcomes, older pts typically have poor tolerance of the chemotherapy regimens used in younger pts. We modified the BEACOPP regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisolone) by removing bleomycin and etoposide and dose-reducing cyclophosphamide for use in older pts with co-morbidities. Here we present data from the first 41 pts treated with ACOPP across 3 UK centres. Methods: The ACOPP regimen comprises doxorubicin 35 mg/m2 and cyclophosphamide 650 mg/m2 intravenous infusion day (D) 1, vincristine 1.4 mg/m2 intravenous injection D8, oral procarbazine 100 mg/m2 D1-7, prednisolone 40 mg/m2 D1-14 and subcutaneous G-CSF D9-13. Each centre retrospectively analysed consecutive patients receiving ACOPP for cHL with data recorded in a secure, anonymised database. Medical co-morbidities were quantified using the Cumulative Illness Rating Scale-Geriatric (CIRS-G). Lymphoma diagnosis was not included in the score. Interim assessment after 2 cycles with either computed tomography (CT) or positive emission tomography (PET-CT) was recommended. Statistical analysis was performed using SPSS v28.0. Results: Forty-one pts previously untreated for cHL were included, with median age 74 and median CIRS-G of 5. The majority (78%) had advanced stage disease. Six cycles of ACOPP were planned for 38/41 patients, of whom 68% completed treatment. Nine pts (22%) had dose reductions, most commonly with vincristine (6/9). Sixty-one percent required hospital admission during treatment, the majority having 1–2 admissions (22/25). Grade 3+ neutropenia was seen in 34%, with a relatively low rate of febrile neutropenia (15%). Neuropathy was seen in 15 patients (37%), all grade 1–2. Six pts died during the study, only 1/41 (2%) had a direct treatment related death. Overall response rate was 39/41 (95%), with 34/41 (83%) achieving CR. With median follow-up of 17 months, estimated 2-year PFS and OS were 74% (95% CI: 58–90) and 87% (95% CI: 75–99) respectively. Keywords: Chemotherapy, Hodgkin lymphoma Conflicts of interests pertinent to the abstract. M. R. Wilson Consultant or advisory role: Veriton Honoraria: Kite/Gilead, Janssen, Takeda Educational grants: Janssen, Takeda, Kite/Gilead K. Parsons Honoraria: Abbvie Educational grants: Abbvie W. Osborne Consultant or advisory role: MSD, Kite Gilead, Roche, Takeda, Servier, Novartis, Beigene, Autolus, Kyowa Kirin, Incyte, Sobi, Janssen, Syneos Honoraria: Roche, Takeda, Pfizer, Kite Gilead, Astra Zeneca, Novartis, Kyowa Kirin, Incyte, Janssen Other remuneration: Support for medical education: Novartis, Takeda, Roche M. Leach Consultant or advisory role: Abbvie, Janssen, Roche P. McKay Consultant or advisory role: Abbvie, AstraZeneca, Beigene, Celgene/BMS, Epizyme, Gilead/Kite, Incyte, Janssen, Roche, Takeda Honoraria: Gilead/Kite, Incyte, Janssen Educational grants: Takeda, Janssen