BEACOPP Regimen for Hodgkin Lymphoma
The BEACOPP regimen (Bleomycin, Etoposide, Doxorubicin, Cyclophosphamide, Vincristine, Procarbazine, Prednisone) is an intensified chemotherapy protocol primarily used for advanced-stage Hodgkin lymphoma that offers superior disease control compared to standard ABVD, though with increased toxicity. 1
BEACOPP Regimen Components and Administration
The BEACOPPescalated regimen consists of:
| Drug | Dose (mg/m²) | Administration | Days |
|---|---|---|---|
| Bleomycin | 10 | i.v. | 8 |
| Etoposide | 200 | i.v. | 1-3 |
| Doxorubicin | 35 | i.v. | 1 |
| Cyclophosphamide | 1250 | i.v. | 1 |
| Vincristine | 1.4* | i.v. | 8 |
| Procarbazine | 100 | p.o. | 1-7 |
| Prednisone | 40 | p.o. | 1-14 |
| G-CSF | s.c. | From day 8 |
*Maximum absolute dose is 2 mg of vincristine
The regimen is recycled every 21-22 days 1
Clinical Indications
BEACOPP is primarily indicated for:
- Advanced-stage Hodgkin lymphoma (stages III-IV) in patients ≤60 years old 1
- Intermediate-stage disease with unfavorable risk factors 1
- Positive interim PET after 2 cycles of ABVD (treatment intensification) 1
Efficacy and Outcomes
- Superior tumor control: Several trials comparing ABVD and BEACOPPescalated have shown superior tumor control with BEACOPPescalated 1
- Survival advantage: A network meta-analysis showed a 10% overall survival advantage at 5 years with BEACOPPescalated compared to ABVD 1
- Freedom from treatment failure: Studies show 7-year freedom from first progression of 85% with BEACOPP versus 73% with ABVD 2
- Complete remission rates: Early studies showed CR rates of 93% with BEACOPP 3
Toxicity Profile
BEACOPP has significant toxicity that requires careful monitoring:
- Hematologic toxicity: Grade 3/4 leukopenia in 75%, thrombocytopenia in 23%, anemia in 65% 4
- Infectious complications: Grade 3/4 infections in 12% of patients 4
- Fertility concerns: Higher rates of infertility compared to ABVD 5
- Treatment-related mortality: Increased risk, especially in patients >60 years 1
- G-CSF support: Required to manage myelosuppression 1
Important Considerations and Contraindications
- Age restriction: BEACOPP should NOT be given to patients >60 years due to increased treatment-related mortality 1, 5
- Fertility preservation: Discuss fertility preservation options before starting treatment due to high risk of infertility 5
- Supportive care: Appropriate surveillance and supportive care must be available when using this protocol 1
- High-risk designation: BEACOPP is classified as a chemotherapy regimen with high risk (>20%) for febrile neutropenia 1
Treatment Algorithms
Advanced Hodgkin Lymphoma (Stage III-IV)
For patients ≤60 years:
- Option 1: 6 cycles of BEACOPPescalated
- Option 2: 4 cycles of BEACOPPescalated followed by 4 cycles of BEACOPP baseline
- Followed by radiotherapy to PET-positive residual masses >2.5 cm 1
Intermediate-Stage Disease with Positive Interim PET
- After 2 cycles of ABVD with positive interim PET (Deauville score ≥3):
- Switch to 2 cycles of BEACOPPescalated before involved-site radiotherapy 1
Alternative Time-Intensified Approach
- BEACOPP-14: A 14-day variant with G-CSF support has shown good efficacy with freedom from treatment failure of 90% at 34 months 4
Monitoring and Follow-up
- Interim PET assessment: After 2 cycles to guide treatment decisions 5
- Complete blood counts: Regular monitoring for myelosuppression 5
- Long-term follow-up: Essential due to risk of late effects 5
Pitfalls and Caveats
- Never use in patients >60 years due to prohibitive treatment-related mortality 1, 5
- Always provide G-CSF support from day 8 to prevent prolonged neutropenia 1
- Consider fertility preservation before starting treatment 5
- Monitor for bleomycin pulmonary toxicity, especially in patients with pre-existing lung disease 5
- Ensure appropriate supportive care is available before initiating this intensive regimen 1
BEACOPP represents an effective but intensive treatment option that should be carefully considered against its toxicity profile, with treatment decisions guided by disease stage, patient age, and comorbidities.