{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T00:07:04Z","timestamp":1758931624197,"version":"3.44.0"},"reference-count":8,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Classical Hodgkin lymphoma (cHL) demonstrates high survival rates with the ABVD regimen (doxorubicin, bleomycin, vinblastine, dacarbazine); however, the use of bleomycin is associated with a significant risk of pulmonary toxicity. The Risk-Adapted Treatment of HL (RATHL) trial demonstrated that omitting bleomycin in patients with favorable interim Positron Emission Tomography (PET-CT) results did not adversely affect survival outcomes. In this study, we present real-world data from advanced-stage HL patients treated according to the RATHL protocol. Methods: This multicenter, retrospective study included newly diagnosed cHL patients with Ann Arbor stage IIB\u2013IV disease or stage IIA disease with bulky disease or with involvement of three or more sites, enrolled from 29 centers across T\u00fcrkiye. The analysis focused on patients whose initial treatment was de-escalated from ABVD to AVD (bleomycin was omitted). Data were collected on demographic and clinical prognostic characteristics, interim PET-CT findings (evaluated using the Deauville score), progression-free survival (PFS) and overall survival (OS). Survival outcomes were assessed using Kaplan\u2013Meier analysis. Results: A total of 379 patients were included, with a median age of 34 years (range: 18\u201378). Following interim PET-CT assessments (After 2 cycles of ABVD), Deauville scores were 1 in 39.8% of patients, 2 in 39.1%, and 3 in 21.1%. Based on these results, bleomycin was omitted immediately after interim PET-CT in 73.9% of patients, after one additional ABVD cycle in 12.1%, and after two additional cycles in 14%. The median follow-up duration was 28 months (range: 6\u201396). The 3-year PFS and OS rates were 86.0% and 96.1%, respectively. Patients with Deauville scores of 1\u20132 had a 3-year PFS rate of 87.6%, compared to 79.8% in those with a score of 3 (p = 0.087). Increased age, poor Eastern Cooperative Oncology Group Scale (ECOG) performance status, bulky disease, and higher International Prognostic Scores (IPS) were significantly associated with inferior OS (p &lt; 0.05). There were no significant differences in OS among patients who received 2, 3, or 4 cycles of ABVD. However, among patients treated with 2 cycles of ABVD, both extranodal involvement (p = 0.039) and higher IPS (p = 0.002) were significantly associated with decreased PFS. Conclusions: Our findings demonstrate that PET-guided de-escalation of bleomycin after two cycles of ABVD is feasible, effective, and safe in real-world multicenter practice in T\u00fcrkiye. The survival outcomes are comparable to those reported in the RATHL study, reinforcing the role of interim PET-CT in guiding individualized therapy. However, patients with high IPS or extranodal involvement may require more tailored management strategies.<\/jats:p>","DOI":"10.3390\/jcm14196813","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T10:39:37Z","timestamp":1758883177000},"page":"6813","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-Life Retrospective Turkiye Data of the De-Escalation of ABVD to AVD in Hodgkin Lymphoma: On Behalf of the TSH Turkish Lymphoma Study Group"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1424-4706","authenticated-orcid":false,"given":"Emel","family":"Isleyen","sequence":"first","affiliation":[{"name":"Ankara Bilkent City Hospital Hematology Clinic, Ankara 06800, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nurcan","family":"Alhan","sequence":"additional","affiliation":[{"name":"Education and Research Hospital Hematology Clinic, Alanya Alaaddin Keykubat University, Antalya 07425, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7083-9379","authenticated-orcid":false,"given":"Esra","family":"Terzi Demirsoy","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Hematology Clinic, Kocaeli University, Kocaeli 41380, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9556-8915","authenticated-orcid":false,"given":"Ayfer","family":"Geduk","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Hematology Clinic, Kocaeli University, Kocaeli 41380, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Duygu Nurdan","family":"Avci","sequence":"additional","affiliation":[{"name":"Adana Dr. Turgut Noyan Practice and Research Center Hematology Clinic, Ba\u015fkent University, Adana 01250, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahmut","family":"Yeral","sequence":"additional","affiliation":[{"name":"Adana Dr. Turgut Noyan Practice and Research Center Hematology Clinic, Ba\u015fkent University, Adana 01250, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmet Burhan","family":"Ferhanoglu","sequence":"additional","affiliation":[{"name":"Hematology Clinic, American Hospital, Istanbul 34365, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7628-1712","authenticated-orcid":false,"given":"Ebru","family":"Pekguc","sequence":"additional","affiliation":[{"name":"Hematology Clinic, American Hospital, Istanbul 34365, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eren","family":"Gunduz","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Hematology Clinic, Eski\u015fehir Osmangazi University, Eskisehir 26480, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hava Uskudar","family":"Teke","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Hematology Clinic, Eski\u015fehir Osmangazi University, Eskisehir 26480, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9665-5671","authenticated-orcid":false,"given":"Nihan","family":"Alkis","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Bursa City Hospital, Bursa 16250, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9021-9844","authenticated-orcid":false,"given":"Zafer Serenli","family":"Yegen","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Private Doruk Nil\u00fcfer Hospital, Bursa 16110, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9710-134X","authenticated-orcid":false,"given":"Fahir","family":"Ozkalemkas","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5419-3221","authenticated-orcid":false,"given":"Tuba","family":"Ersal","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Bursa Uluda\u011f University, Bursa 16059, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Volkan","family":"Karakus","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Antalya Education and Research Hospital, Antalya 07100, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatma","family":"Aykas","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Antalya Education 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Marmara University, Istanbul 34899, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4303-9488","authenticated-orcid":false,"given":"Meral Ulukoylu","family":"Menguc","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Hematology Clinic, Marmara University, Istanbul 34899, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatma","family":"Arikan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Hematology Clinic, Marmara University, Istanbul 34899, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatma","family":"Keklik Karadag","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Izmir Tepecik Training and Research Hospital, Izmir 35020, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hale","family":"Bulbul","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Izmir Tepecik Training and Research Hospital, Izmir 35020, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5281-5955","authenticated-orcid":false,"given":"Aysun","family":"Senturk Yikilmaz","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Denizli State Hospital, Denizli 20010, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ekin","family":"Kircali","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Medicana International Ankara Hospital, Ankara 06510, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9956-1569","authenticated-orcid":false,"given":"Selin Merih","family":"Urlu","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Medicana International Ankara Hospital, Ankara 06510, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deniz","family":"Goren","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Istanbul Florence Nightingale Hospital, Istanbul 34381, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elif Birtas","family":"Atesoglu","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Yeditepe University Hospital, Istanbul 34752, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9636-4113","authenticated-orcid":false,"given":"Omur Gokmen","family":"Sevindik","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Demiro\u011flu Science University, Istanbul 34394, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3947-0355","authenticated-orcid":false,"given":"Fatos Dilan","family":"Koseoglu","sequence":"additional","affiliation":[{"name":"Hematology Clinic, \u00c7i\u011fli Training and Research Hospital, Izmir Bak\u0131r\u00e7ay University, Izmir 35620, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4013-4647","authenticated-orcid":false,"given":"Taha Ulutan","family":"Kars","sequence":"additional","affiliation":[{"name":"Hematology Clinic, Konya City Hospital, Konya 42020, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atakan","family":"Tekinalp","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Hematology Clinic, Necmettin Erbakan University, Konya 42080, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8933-1081","authenticated-orcid":false,"given":"Serkan","family":"Guven","sequence":"additional","affiliation":[{"name":"Hematology Clinic, \u00c7anakkale Mehmet Akif Ersoy State Hospital, \u00c7anakkale 17000, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ozgur","family":"Mehtap","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Hematology Clinic, Kocaeli University, Kocaeli 41380, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"ref_1","first-page":"116","article-title":"Hodgkin Lymphoma: A Review and Update on Recent Progress","volume":"68","author":"Shanbhag","year":"2018","journal-title":"CA Cancer J. 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Haematol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2419","DOI":"10.1056\/NEJMoa1510093","article-title":"Adapted Treatment Guided by Interim PET-CT scan in Advanced Hodgkin\u2019s Lymphoma","volume":"374","author":"Johnson","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1200\/JCO.23.01177","article-title":"Long-Term Follow-Up of the Response-Adjusted Therapy for Advanced Hodgkin Lymphoma Trial","volume":"42","author":"Luminari","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1182\/blood-2015-11-679407","article-title":"PET-CT for Staging and Early Response: Results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma Study","volume":"127","author":"Barrington","year":"2016","journal-title":"Blood"},{"key":"ref_8","first-page":"e83836","article-title":"Real-World Outcomes of PET-Adapted Treatment for Classic Hodgkin\u2019s Lymphoma: A Study from a Single Tertiary Care Center","volume":"17","author":"Iftikhar","year":"2025","journal-title":"Cureus"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6813\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T10:54:51Z","timestamp":1758884091000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6813"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,26]]},"references-count":8,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcm14196813"],"URL":"https:\/\/doi.org\/10.3390\/jcm14196813","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,26]]}}}