Sufficient-dose Brentuximab vedotin improves prognosis in patients with classic Hodgkin lymphoma: a single-center real-world study in China

This is the authors' abstract. We don't add key points for this paper.

Background Classic Hodgkin lymphoma (cHL) is highly curable for most patients with cytotoxic chemotherapy, while targeted agents such as brentuximab vedotin (BV) have been incorporated into frontline regimens. This single-center retrospective study aimed to compare the efficacy and safety of a local ABVD-like regimen and a BV-containing A-AVD-like regimen in Chinese patients with cHL. Methods A total of 243 cHL patients were enrolled, including 192 in ABVD and 51 in A-AVD. Baseline demographics, treatment outcomes, survival, and adverse events were analyzed; the median follow-up was 21.47 months. Subgroup analysis was performed including Ann Arbor stage and dose of Brentuximab Vedotin (BV). Results At baseline, the A-AVD group had a significantly higher proportion of elderly patients (≥60 years) compared to the ABVD group (25.5% vs. 9.4%, p = 0.002). First-evaluation complete response (CR: 69.3% vs. 72.5%, p = 0.549) and overall response rate (ORR: 93.8% vs. 98.0%, p = 0.312) were similar between ABVD and A-AVD. Overall progression-free survival (PFS) and overall survival (OS) showed no significant differences between the two regimens (PFS p=0.489; OS p = 0.230). The 2-year PFS rates were 71.1% for ABVD and 76.7% for A-AVD. However, subgroup analysis revealed that in patients with Ann Arbor stage III-IV, a sufficient dose of BV (≥1.15 mg/kg) significantly improved PFS compared to a reduced dose (<1.15 mg/kg) (2-year PFS 91.7% vs. 58.7%; p=0.036). Regarding safety, the A-AVD group exhibited a higher rate of peripheral neuropathy (47.1% vs. 5.2%, p < 0.001), while pulmonary toxicity events were numerically more frequent in the ABVD group. The incidences of grade 3–4 neutropenia were comparable between the two groups (17.7% in ABVD vs. 19.6% in A-AVD, p = 0.751). Conclusion This is the first real-world study of frontline A-AVD-like therapy for cHL in China. Despite a higher proportion of elderly patients in A-AVD, the regimen still achieved a 2-year PFS rate of 76.7% and showed overall efficacy and survival outcomes comparable to the ABVD-like regimen. Notably, maintaining sufficient BV dose intensity (≥1.15 mg/kg) was significantly associated with superior PFS in patients with advanced-stage (Ann Arbor III-IV) disease. While A-AVD was associated with higher rates of peripheral neuropathy, ABVD showed a trend toward a higher risk of pulmonary toxicity. These findings support careful maintenance of BV dose intensity when clinically feasible, together with proactive toxicity management. Longer follow-up and larger prospective studies are needed to validate survival outcomes and toxicity profiles in Chinese patients.