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Research Article: Sufficient-dose Brentuximab vedotin improves prognosis in patients with classic Hodgkin lymphoma: a single-center real-world study in China

Date Published: 2026-07-06

Abstract:
Classic Hodgkin lymphoma (cHL) is highly curable for most patients with cytotoxic chemotherapy, while targeted agents such as brentuximab vedotin (BV) have been incorporated into frontline regimens. This single-center retrospective study aimed to compare the efficacy and safety of a local ABVD-like regimen and a BV-containing A-AVD-like regimen in Chinese patients with cHL. A total of 243 cHL patients were enrolled, including 192 in ABVD and 51 in A-AVD. Baseline demographics, treatment outcomes, survival, and adverse events were analyzed; the median follow-up was 21.47 months. Subgroup analysis was performed including Ann Arbor stage and dose of Brentuximab Vedotin (BV). At baseline, the A-AVD group had a significantly higher proportion of elderly patients (?60 years) compared to the ABVD group (25.5% vs. 9.4%, p = 0.002). First-evaluation complete response (CR: 69.3% vs. 72.5%, p = 0.549) and overall response rate (ORR: 93.8% vs. 98.0%, p = 0.312) were similar between ABVD and A-AVD. Overall progression-free survival (PFS) and overall survival (OS) showed no significant differences between the two regimens (PFS p=0.489; OS p = 0.230). The 2-year PFS rates were 71.1% for ABVD and 76.7% for A-AVD. However, subgroup analysis revealed that in patients with Ann Arbor stage III-IV, a sufficient dose of BV (?1.15 mg/kg) significantly improved PFS compared to a reduced dose (<1.15 mg/kg) (2-year PFS 91.7% vs. 58.7%; p=0.036). Regarding safety, the A-AVD group exhibited a higher rate of peripheral neuropathy (47.1% vs. 5.2%, p < 0.001), while pulmonary toxicity events were numerically more frequent in the ABVD group. The incidences of grade 3–4 neutropenia were comparable between the two groups (17.7% in ABVD vs. 19.6% in A-AVD, p = 0.751). This is the first real-world study of frontline A-AVD-like therapy for cHL in China. Despite a higher proportion of elderly patients in A-AVD, the regimen still achieved a 2-year PFS rate of 76.7% and showed overall efficacy and survival outcomes comparable to the ABVD-like regimen. Notably, maintaining sufficient BV dose intensity (?1.15 mg/kg) was significantly associated with superior PFS in patients with advanced-stage (Ann Arbor III-IV) disease. While A-AVD was associated with higher rates of peripheral neuropathy, ABVD showed a trend toward a higher risk of pulmonary toxicity. These findings support careful maintenance of BV dose intensity when clinically feasible, together with proactive toxicity management. Longer follow-up and larger prospective studies are needed to validate survival outcomes and toxicity profiles in Chinese patients.

Introduction:
Classic Hodgkin lymphoma (cHL) is highly curable for most patients with cytotoxic chemotherapy, while targeted agents such as brentuximab vedotin (BV) have been incorporated into frontline regimens. This single-center retrospective study aimed to compare the efficacy and safety of a local ABVD-like regimen and a BV-containing A-AVD-like regimen in Chinese patients with cHL.

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