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Previous Volume 349:1186-1187 September 18, 2003 Number 12 Next

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To the Editor: In the study by Diehl et al. (June 12 issue),¹ the median duration of chemotherapy from the first to the last day of drug administration in the group assigned to cyclophosphamide, vincristine, procarbazine, and prednisone alternating with doxorubicin, bleomycin, vinblastine, and dacarbazine (COPP-ABVD) was 46.3 weeks, as compared with 24.4 in the group assigned to bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) and 24.7 in the increased-dose BEACOPP group. Since the duration of treatment in the COPP-ABVD group was twice that in the BEACOPP group, all that one can conclude from the study is that the more frequent administration of chemotherapeutic agents resulted in an advantage in terms of freedom from treatment failure, rather than that the doses or the agents in BEACOPP are superior to those in COPP-ABVD. It could well be that the results of COPP-ABVD given at 24-day intervals or at the planned 30-day intervals would be equivalent to those achieved with increased-dose BEACOPP. This question warrants investigation, particularly in view of the 2.5 percent incidence of secondary leukemia in the increased-dose BEACOPP group.

Henry Ekert, A.M., M.D., F.R.A.C.P.
Royal Children's Hospital
Parkville, VIC 3052, Australia
henry.ekert{at}rch.org.au

References

1. Diehl V, Franklin J, Pfreundschuh M, et al. Standard and increase-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin's disease. N Engl J Med 2003;348:2386-2395. [Free Full Text]

Dr. Ekert correctly remarks that the accelerated administration of drugs may have contributed to the increased efficacy of BEACOPP as compared with COPP-ABVD. But the substitution of drugs (etoposide instead of vinblastine and dacarbazine) or synergetic effects between drugs may also have contributed to the difference in efficacy between COPP-ABVD and standard BEACOPP therapy. The relative importance of these factors is not clarified by our results. The further improvement in results from standard to increased-dose BEACOPP therapy can only be due to the escalation of the doses, since other factors were the same in these two treatment groups. Thus, it is clear (from the data in Table 4 of our article) that most of the improvement in terms of freedom from treatment failure with increased-dose BEACOPP therapy as compared with COPP-ABVD therapy is attributable to the doses used.

Volker Diehl, M.D.
Jeremy Franklin, Ph.D.
University of Cologne
50924 Cologne, Germany
v.diehl{at}uni-koeln.de

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