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We performed a retrospective, multicentre analysis of 221 non-trial (\u201creal-world\u201d) patients, aged 16\u201359 years, diagnosed with advanced-stage HL in the Anglia Cancer Network between 2004 and 2014, treated with ABVD or eBEACOPP, and compared outcomes with 1088 patients in the Response-Adjusted Therapy for Advanced Hodgkin Lymphoma (RATHL) trial, aged 18\u201359 years, with median follow-up of 87.0 and 69.5 months, respectively. Real-world ABVD patients (<jats:italic>n<\/jats:italic>=177) had highly similar 5-year progression-free survival (PFS) and overall survival (OS) compared with RATHL (PFS 79.2% vs 81.4%; OS 92.9% vs 95.2%), despite interim positron-emission tomography-computed tomography (PET\/CT)-guided dose-escalation being predominantly restricted to trial patients. Real-world eBEACOPP patients (<jats:italic>n<\/jats:italic>=44) had superior PFS (95.5%) compared with real-world ABVD (HR 0.20, <jats:italic>p<\/jats:italic>=0.027) and RATHL (HR 0.21, <jats:italic>p<\/jats:italic>=0.015), and superior OS for higher-risk (international prognostic score \u22653 [IPS 3+]) patients compared with real-world IPS 3+ ABVD (100% vs 84.5%, <jats:italic>p<\/jats:italic>=0.045), but not IPS 3+ RATHL patients. Our data support a PFS, but not OS, advantage for patients with advanced-stage HL treated with eBEACOPP compared with ABVD and suggest higher-risk patients may benefit disproportionately from more intensive therapy. However, increased access to effective salvage therapies might minimise any OS benefit from reduced relapse rates after frontline therapy.<\/jats:p>","DOI":"10.1007\/s00277-021-04460-9","type":"journal-article","created":{"date-parts":[[2021,2,27]],"date-time":"2021-02-27T23:04:02Z","timestamp":1614467042000},"page":"1049-1058","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Advanced Hodgkin lymphoma in the East of England: a 10-year comparative analysis of outcomes for real-world patients treated with ABVD or escalated-BEACOPP, aged less than 60 years, compared with 5-year extended follow-up from the RATHL trial"],"prefix":"10.1007","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9431-8428","authenticated-orcid":false,"given":"James","family":"Russell","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Collins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Fowler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamatha","family":"Karanth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandan","family":"Saha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Docherty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Padayatty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyaw","family":"Maw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Lentell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Cooke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Hodson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nimish","family":"Shah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalal","family":"Sadullah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Grigoropoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendi","family":"Qian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy A.","family":"Kirkwood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin J.","family":"Uttenthal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8489-0762","authenticated-orcid":false,"given":"George A.","family":"Follows","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,2,27]]},"reference":[{"key":"4460_CR1","doi-asserted-by":"publisher","first-page":"4548","DOI":"10.1200\/JCO.2008.19.8820","volume":"27","author":"A Engert","year":"2009","unstructured":"Engert A, Diehl V, Franklin J, Lohri A, D\u00f6rken B, Ludwig WD, Koch P, H\u00e4nel M, Pfreundschuh M, Wilhelm M, Tr\u00fcmper L, Aulitzky WE, Bentz M, Rummel M, Sezer O, M\u00fcller-Hermelink HK, Hasenclever D, L\u00f6ffler M (2009) Escalated-dose BEACOPP in the treatment of patients with advanced-stage Hodgkin\u2019s lymphoma: 10 Years of follow-up of the GHSG HD9 study. 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