Efficacy and Tolerability of the PET-Guided Program BrECADD for Advanced Stages of Classical Hodgkin Lymphoma: Data from the Real-World Setting in Russia

BACKGROUND. In 2024, the German Hodgkin Study Group (GHSG) published the unprecedented results of the HD21 trial on PET-guided program BrECADD for patients with advanced stages of classical Hodgkin lymphoma (cHL) showing the highest cure probability with the best tolerability. AIM. To review and analyze the first experience in Russia with BrECADD administered to patients with advanced stages of cHL in a real-world setting. MATERIALS & METHODS. Clinical data from 20 BrECADD recipients with advanced stages of newly diagnosed cHL were provided by 5 medical institutions from 3 cities in Russia. The median age was 31.5 years (range 19–43 years), there were 13 (65 %) female patients. PET/CT after 2 cycles (PET-2) was performed in 9 patients, 6 (66.6 %) of them showed complete metabolic response, which is similar to the results of the HD21 trial (64 %). PET-guided therapy was administered to only 5 patients (25 %), while in the rest of them the number of BrECADD cycles was determined by the attending physician regardless of whether an interim PET-2 was performed and irrespective of its results: 16 patients received 4 and 4 patients received 6 BrECADD cycles. Consolidating radiotherapy was administered to 4 cHL patients. RESULTS. After the chemotherapy stage, complete metabolic response was achieved in 16 (84 %) out of 19 patients (1 patient in clinical remission refused PET after chemotherapy completion), which is similar to the results of the HD21 trial (82 %), partial remission was identified in 1 and disease progression was observed in 2 patients. With the follow-up of 17.5 months, all patients were alive, progression-free survival was 90 % by that time. There were no cases of cycle or dose reduction due to adverse events. Increasing the intervals between cycles in 1/3 patients did not affect general therapy outcomes. CONCLUSION. The analysis of the first findings on BrECADD demonstrated its high efficacy, moderate toxicity, and feasibility in a real-world setting in Russia. The main issue appeared to be non-compliance with the HD21 recommendations in the majority of cases, that requires further standardization in the implementation of the program with a view to establishing best practices and identifying lessons learned with BrECADD administration in the routine practice of treating advanced cHL stages.