Brentuximab vedotin‐containing regimen time toxicity for front‐line therapy of advanced‐stage classical Hodgkin lymphoma in young adults and adults: Real‐life comparison between condensed BrECADD versus traditional Bv + AVD

We read with great enthusiasm the report by Jaworek et al. published in British Journal of Haematology in August 2026 describing the implementation of a condensed 3-day BrECADD for front-line treatment of advanced-stage (AS) classical Hodgkin lymphoma (cHL) mostly in young adults and adults (YA&A).1 By reducing intravenous treatment from 4 to 3 days per cycle while preserving dose intensity, the authors offer a more convenient and resource-efficient alternative to the original HD21 BrECADD schedule.2 In the report by Jaworek et al.,1 24 patients (80%) required only four BrECADD cycles, whereas the remaining patients received six cycles according to interim PET results. With the condensed 3-day BrECADD, the overage days of infusions were 13.2 with a range of 12–18 days. The 1-year PFS was 100%. The authors underlined that there was about 25% reduction of cytotoxic agent infusion days versus the original BrECADD.1, 2 This may improve convenience and healthcare efficiency while reducing hospital visits and ‘time toxicity’, namely the time patients and caregivers spend interacting with the healthcare system at the expense of personal, professional and social life.3 While focusing on time toxicity is crucial, its evaluation should not be limited to scheduled chemotherapy visits.4 Three points from Jaworek et al. deserve attention: 33% of cycles were inpatient, 37% of patients required unplanned hospitalization (median 6 days; range, 1–16 days) and 20% developed grade ≥3 infections, including four respiratory viral infections and two bacterial bloodstream infections. Although reducing each BrECADD cycle by one administration day decreases planned healthcare contacts, unplanned hospitalizations for severe treatment-related complications may still substantially contribute to overall treatment burden. Similar findings emerged from another recent multicentre real-world BrECADD study of 100 patients (median age, 30 years) with AS cHL.5 In this cohort, 83% of patients received only four cycles, limiting treatment duration to approximately 3 months. However, Porges et al.5 reported hospitalization in 65% of patients, grade ≥3 febrile neutropenia in 55% and intensive-care admission for severe infections in 5%. Thus, significantly reducing the planned treatment period (as compared to the typical 6 months used until now to front-line treat AS cHL) may not necessarily capture the entire healthcare time associated with an intensive regimen. This perspective is pertinent when considering other contemporary Bv-based front-line strategies. In our multicentre real-world series of 150 patients aged 18–59 years with AS cHL,6 six cycles of 1-day Bv + AVD resulted in an average of 12 infusion days. The 2-year PFS was 91%. Grade ≥3 febrile neutropenia occurred in 3%, and 10% required unplanned hospitalization (median stay, 1.5 days). Structured supportive care with primary prophylaxis including long-acting glyco-pegylated G-CSF and antimicrobial drugs, routinely used in our clinical practice (Figure 1), may have contributed to the lower acute healthcare utilization versus real-world BrECADD series utilizations. In conclusion, among brentuximab vedotin-containing regimens, that is, condensed 3-day BrECADD, original 4-day BrECADD and traditional 1-day Bv + AVD, there is an important variability regarding time toxicity and likely financial toxicity.3, 4 These features deserve some thought on the most cost-effective front-line treatment, in real-life, of AS cHL for YA&A. Marco Picardi: Conceptualization; writing – review and editing; writing – original draft; supervision. Annamaria Vincenzi: Methodology; writing – review and editing; writing – original draft; validation; visualization; data curation; investigation. Fabrizio Pane: Writing – review and editing; supervision. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.