ABVD versus BEACOPP for front-line treatment of Hodgkin lymphoma: A systematic review and meta-analysis.

e19039 Background: Hodgkin lymphoma is a curable malignancy, the choice of frontline therapy for advanced-stage disease remains debated. ABVD has been the backbone of treatment for decades because of its reliable efficacy and lower long-term toxicity, while escalated BEACOPP was introduced to improve disease control. Randomized trials show better progression-free survival with BEACOPP but no clear overall survival benefit. BEACOPP carries higher rates of acute toxicity, infertility, and secondary malignancies particularly relevant given patients' young age and long life expectancy. Interpretation of existing literature is limited by differences in study design, patient selection, follow-up duration, and outcome reporting, so many individual trials are underpowered. A systematic review and meta-analysis is needed to define balance between efficacy and toxicity in advanced Hodgkin lymphoma. Methods: A total of 2858 records were retrieved from PubMed, Embase, Scopus, ScienceDirect, and the Cochrane Library from inception January 2026. Eligible randomized controlled trials and comparative observational studies of frontline BEACOPP (standard/escalated) vs ABVD in classical Hodgkin lymphoma reporting overall survival (OS) and progression-free/event-free survival (PFS/EFS), while secondary outcomes included complete or objective response, treatment-related toxicity (including grade 3–4 adverse events), secondary malignancies, and treatment discontinuation due to adverse events, and health-related. Pooled analyses used RevMan random-effects models (p<0.05). Results: Eight studies (n = 5187) assessed the effectiveness of BEACOPP compared to ABVD in patients with classical Hodgkin lymphoma receiving front-line systemic therapy. BEACOPP showed an 18% reduction in the risk of mortality (HR 0.82; 95% CI 0.48–1.41; p = 0.48) and a 38% reduction in the risk of progression (HR 0.62; 95% CI 0.45–0.85; p = 0.003), with moderate heterogeneity (I² = 55%). However, no significant differences were observed in complete response rate (RR 0.99; 95% CI 0.89–1.10; p = 0.82) or overall response rate (RR 1.03; 95% CI 0.95–1.11; p = 0.51) with heterogeneity (I² = 51% and 23%, respectively). BEACOPP was associated with a significantly higher risk of serious adverse events (RR 4.60; 95% CI 2.37–8.93; p = 0.04) and a higher risk of secondary malignancies (RR 1.30; 95% CI 0.47–3.58; p = 0.61), both reported with moderate heterogeneity (I² = 65% and 71%). Additionally, BEACOPP showed a non-significant reduction in the risk of event occurrence (HR 0.36; 95% CI 0.07–1.93; p = 0.23), though this result was limited by high heterogeneity (I² = 97%). Conclusions: BEACOPP improved progression free survival as compared to ABVD but did not significantly improve overall survival and was associated with significantly greater toxicity. This efficacy toxicity trade off must be put into close consideration with regimen choice.