A positron emission tomography (PET)-adapted de-escalation regimen starting with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) and de-escalating to doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) may be the preferred treatment strategy for patients with newly diagnosed advanced-stage Hodgkin lymphoma (HL), according to findings published in The Lancet Haematology. When taking into account costs, effectiveness, and short-term and long-term toxicities, researchers found that this PET-adapted de-escalation approach may maximize both potential life-years and quality-adjusted life-years (QALYs), as well save on costs over a 20-year time period.

The researchers conducted a literature search using PubMed for articles published since January 1, 2000, and they identified 4255 patients from randomized groups of interest who were treated between April 2000 and January 2016. A Markov decision modeling approach was used to assess the QALYs and direct costs of 5 common treatment approaches in HL. The researchers modeled complications of treatment and assessed costs in the relapsed or refractory setting.

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Of the 5 treatment regimens assessed, the PET-adapted de-escalation regimen was found to be the most cost-effective in 87% of cases when the willingness-to-pay threshold was set at $50,000 CAN. This approach was also associated with the greatest increase in QALYs and decrease in direct costs compared with ABVD.

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After accounting for increased rates of febrile neutropenia, infertility, and secondary malignancy related to BEACOPP exposure, the threshold value for treatment-related mortality secondary to BEACOPP was found to be 7.5%. This percentage was “higher than the maximal value reported using BEACOPP in previous randomized controlled trials in this patient population,” the researchers noted.

“Although our findings do not provide an absolute best treatment approach for clinicians to follow for all patients, they can contribute to shared decision making between patients and treating physicians,” the researchers concluded.

Disclosures: Some authors have declared affiliations with the pharmaceutical industry. Please refer to the original study for a full list of disclosures.


  1. Vijenthira A, Chan K, Cheung MC, Prica A. Cost-effectiveness of first-line treatment options for patients with advanced-stage Hodgkin lymphoma: a modelling study [published online January 13, 2020]. Lancet Haematol. doi:10.1016/S2352-3026(19)30218-2