Hodgkin lymphoma (HL) is a hematologic neoplasm with great prognosis, although patients with advanced disease presents worse outcomes. The German Hodgkin Study Group (GHSG) proposed a new approach to treat advanced LH patients with a more intense and aggressive protocol aiming better responses, but most of discussions regards between the benefit of improving response versus the onus of adding more toxicity. The original described escalated BEACOPP (eBEACOPP) had procarbazine as part of the protocol. In 2008, a public health care center in São Paulo (Santa Casa de Misericórdia) started using this protocol with LH patients in stage IIB or more and with IPS equal or above 3. In Brazil, procarbazine is not an available drug, thus the original protocol was modified incorporating dacarbazine (BRECADD) 375 mg/m2 in D8 of each cycle. When the first results of the BRECADD protocol study were published, with dacarbazine 500 mg/m2 (D2,D3), our service decided increase the dose the same as the study, but the impression was the improvement of toxicity without any gain in efficacy.

Compare the two protocol doses (375 mg/m2 versus 500 mg/m2) applied at Santa Casa for HL advanced patients in a similar period.

Retrospective study analyzing data from 31 patients that were followed up at a single center in Brazil from 2019 and 2021. Age at diagnosis, gender, Ann Arbor stage, laboratory characteristics, number of realized cycles, neutropenia in each cycle and responses rates were collected.

Seventeen of the 31 patients received 500 mg/m2 (500-group) and fourteen received 375 mg/m2 (375-group). The responses rates at the end of which protocol were equivalent in both groups (71% in 375 group and 76% in 500 group with CR). When analyzing the number of cycles that patients evolved with febrile neutropenia, the 500-group had 3 times more events (17,9%) than the 375-group (6,09%) with p value of 0,04. This difference was reflected in the need for change the protocol do ABVD in about 47,1% of patients in 500-group due to toxicities.

In this small cohort of a single public center in Brazil using 375 mg/m2 of dacarbazine per protocol of BRECADD turn out to be a safer strategy without losses in responses for HL advanced patients.