P036 | A-AVD VERSUS ABVD IN FIRST-LINE STAGE IV CLASSICAL HODGKIN LYMPHOMA: EFFICACY AND TOXICITY IN A SINGLE CENTER EXPERIENCE

Brentuximab Vedotin combined with AVD (A-AVD) is the new standard for first-line advanced-stage Hodgkin Lymphoma (HL). The ECHELON-1 trial showed improved 7-year PFS (82.3% vs 74.5%) and OS (93.5% vs 88.8%) with A-AVD compared to ABVD. Nevertheless, the enhanced survival outcomes may be accompanied by an increased incidence of toxicities, notably peripheral neuropathy and neutropenia, and a more challenging management of treatment-related complications. Furthermore, in Italy, its use is restricted to stage IV disease. We reviewed our single-center experience with A-AVD and compared it to ABVD-treated HL cases. Since 2022, we treated 13 patients (pts) with A-AVD. We selected all consecutive stage-IV HL pts treated with an ABVD-like regimen (including ABVD and MBVD), from 2010 onward, for a total of 34 pts. Among the 47 pts, the median age was 41 years (17-82), with 28 male pts (60%). With a median follow-up of 41 months (range: 4–122 months), the PFS and OS for the entire cohort were 89% [95% CI: 75–95] and 93% [CI: 79–98], respectively. In the A-AVD cohort specifically, the median PFS was 92% [CI: 57–99], with a single case of disease progression, while the median OS was 97% [CI: 81–99], with one recorded death. The ABVD cohort presented comparable survival outcomes, with a median PFS of 84% [CI: 65–93], corresponding to 7 cases of progression, and a median OS of 90% [CI: 70–97], with 3 deaths reported. Statistical comparison of the cohorts utilizing the Kaplan-Meier method revealed no significant differences. The p-values for PFS and OS were 0.89 and 0.57, respectively. Regarding toxicity and management, the registration trial showed higher neurological complications in the A-AVD group (19% vs 9%), confirmed by our clinical data (8% vs 3%). Supportive therapies and doses adjustment mitigate these adverse effects, improving treatment consistency and pts quality of life. PET2 analysis revealed deeper responses in A-AVD (CR: 92% vs 65%), though sample size limited statistical significance. In conclusion, A-AVD demonstrated therapeutic efficacy comparable to ABVD at end-of-treatment (EoT) evaluation. A-AVD is associated with a less favorable toxicity profile; therefore, supportive care and dose modification play a crucial role in mitigating its impact. Responses with A-AVD appear deeper and more rapid. This does not result in a difference in survival between the two cohorts; however, an increased sample size could reveal a survival benefit with A-AVD regimen.