The eBEACOPP regimen, consisting of bleomycin, vincristine, procarbazine and prednisone plus escalated doses of etoposide, doxorubicin and cyclophosphamide, is a standard frontline treatment for classical Hodgkin lymphoma (cHL). This intensive regimen confers the highest primary cure rates but also considerable and often persistent treatment-related morbidities. Now, data from the HD21 trial demonstrate the improved risk-to-benefit ratio of a new regimen comprising the antibody–drug conjugate brentuximab vedotin plus etoposide, cyclophosphamide, doxorubicin, dacarbazine and dexamethasone (BrECADD).

In this phase III trial, 1,500 patients of 18–60 years of age with advanced-stage cHL were randomly assigned (1:1) to receive PET-guided treatment with BrECADD versus eBEACOPP, each for 4 cycles if PET-2 negative (Deauville score 1–3 after cycle 2) or 6 cycles if PET-2 positive (Deauville score 4–5). The co-primary end points were improved tolerability, defined by investigator-assessed treatment-related morbidity (acute grade 4 haematological or grade 3–4 non-haematological organ system toxicities), and non-inferior progression-free survival (PFS).

eBEACOPP 方案由博来霉素、长春新碱、丙卡巴肼和泼尼松以及递增剂量的依托泊苷、阿霉素和环磷酰胺组成，是经典霍奇金淋巴瘤 (cHL) 的标准一线治疗方法。这种强化治疗方案可实现最高的初级治愈率，但也带来相当大且通常持续存在的治疗相关发病率。现在，HD21 试验的数据表明，由抗体药物结合物 brentuximab vedotin 加依托泊苷、环磷酰胺、阿霉素、达卡巴嗪和地塞米松 (BrECADD) 组成的新方案提高了风险效益比。

在这项 III 期试验中，1,500 名 18-60 岁的晚期 cHL 患者被随机分配 (1:1) 接受 PET 引导的 BrECADD 治疗与 eBEACOPP 治疗，如果 PET-2 阴性，则各治疗 4 个周期（Deauville）如果 PET-2 呈阳性，则第 2 周期后评分 1-3，或 6 个周期（Deauville 评分 4-5）。共同主要终点是耐受性的改善，由研究者评估的治疗相关发病率（急性 4 级血液学或 3-4 级非血液学器官系统毒性）和非较差的无进展生存期 (PFS) 来定义。