Bleomycin dose modification in Hodgkin disease (HD) treated with ABVD: Patient characteristics, treatment outcomes, and association with mixed cellularity (MC) histology
18525 Background: Bleomycin used in the ABVD regimen is associated with a risk of pulmonary toxicity (10 - 19%). Pts with early signs of suspected bleomycin toxicity are often treated with modifications of the regimen. We conducted a retrospective study of patients with HD at our institution in whom bleomycin dose was modified or discontinued during their course of therapy with ABVD. Their response to modified therapy and possible predisposing factors were analysed. Methods: IRB approval was obtained for this study. Tumor registry data for adult pts diagnosed with HD between 2004 and 2006 were analysed for age, stage, sex, histology, smoking history, reduction in bleomycin dose and outcomes. Results: 38 pts were diagnosed with HD at our institution during this time period. Histology: NS: n=15(39.4%), MC: n=16(42.1%), NLP: n=2(5.2%), LR: n=2(5.2%). Histology NOS: n=4(10.5%). 8 pts with bleomycin dose modifications were identified. Pt. characteristics : Med.age 46 yrs (28- 64 ), M:F3:5; 7 of 8 were newly diagnosed and one pt had recurrent HDs. Stages: Stg I: n = 1; Stg II: n= 3; Stg III: n = 3, Stage IV: n= 1, B symptoms : n = 3. Histology: MC (n = 6), NS (n = 1). Unk n=1. 4 of 8 pts were ex-smokers. One patient never received bleomycin due to initial poor PFTs. 7 pts had bleomycin discontinued due to symptoms and decrease in DLCO during their treatment. One patient was continued on 50% reduced dose bleomycin for 2 cycles prior to discontinuation of bleomycin. The distribution of the number of patients discontinuing bleomycin by cycle of treatment is as follows: C#2: n=1; C#3: n=2; C#4: n=1; C#5: n=2. The complete response rate was 100% in this group despite bleomycin dose modification. There were no relapses after a median follow up of 18 mos (range: 8- 33). One patient treated for recurrent HD had severe pulmonary toxicity and did not receive any further treatments. All other patients completed their intended cycles of treatment. Conclusions: Despite bleomycin modification in this small series of pts treated initially with ABVD, DFS remains excellent with no noted relapses at this early follow up. Majority of pts requiring dose modifications had MC histology. Further trials are needed to evaluate the role of bleomycin in the ABVD regimen. No significant financial relationships to disclose.