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aVincristine dose capped at 2 mg. bGranulocyte colony-stimulating factor.

aVincristine dose capped at 2 mg. bGranulocyte colony-stimulating factor.

exceeding 80%, as compared to 67% in the COPP-ABVD arm.74 On the other hand, in the group of patients with zero to one adverse prognostic factors, OS did not differ among the three arms. Unfortunately, this intensification in chemotherapy resulted in a higher incidence of side effects: bone marrow toxicity, including grade 3 and 4 anemia, throm-bocytopenia, infections, azospermia, and mucositis. At a median follow-up of 7 years, secondary hematologic malignancies were 2.4% in the escalated BEACOPP arm, 1% in the BEACOPP-baseline group, and 0.4% in the COPP-ABVD arm.75 Toxicities seemed to be more significant with advanced age, as a 21% mortality was noted in patients between 66 and 75 years old.76 Studies are currently evaluating a shorter duration of the BEACOPP regimen (14 days) in addition to growth factors.77 Another study is evaluating a "hybrid" regimen of escalated and standard BEACOPP, where patients get four cycles of each chemotherapy regimen in an attempt to reduce toxicity and maintain same cure rates.75 These studies are ongoing.

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