{"entity":{"id":"paper-rathl-interim-pet-adapted-abvd-advanced-hodgkin-nejm-2016","kind":"paper","name":"RATHL: adapted treatment guided by interim PET-CT in advanced Hodgkin lymphoma","aka":[],"tldr":"Using a PET scan after two cycles to decide the rest of treatment let patients with a clear scan drop bleomycin, sparing their lungs without losing cure, while those with a positive scan were escalated to stronger chemotherapy.","summary":"International randomised trial of 1,214 patients with advanced Hodgkin lymphoma who had an interim PET-CT after two cycles of ABVD; PET-negative patients were randomised to continue ABVD or switch to AVD (omitting bleomycin), and PET-positive patients were escalated to BEACOPP.\n\nThree-year progression-free survival was 85.7 percent with ABVD and 84.4 percent with AVD, with fewer pulmonary adverse events after bleomycin was dropped; PET-positive patients escalated to BEACOPP had a three-year progression-free survival of 67.5 percent, better than expected. PET-adapted therapy became standard.","asOf":"2026-09-18","links":[{"label":"N Engl J Med 2016","url":"https://doi.org/10.1056/NEJMoa1510093"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/27332902/"}],"tags":[],"related":[],"indications":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["rathl"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2016,"doi":"10.1056/NEJMoa1510093","pmid":"27332902","authors":"Johnson P, Federico M, Kirkwood A, et al.","paperType":"rct","findings":["Three-year progression-free survival 85.7 percent with continued ABVD versus 84.4 percent with AVD after a negative interim PET.","Fewer pulmonary and other toxic effects without bleomycin; PET-positive patients escalated to BEACOPP had 67.5 percent three-year progression-free survival."],"whatItMeans":"An interim PET scan after two cycles guides treatment of advanced Hodgkin lymphoma: drop bleomycin if negative, intensify if positive.","caveats":["The non-inferiority margin for AVD was not formally met in the intention-to-treat analysis, though the difference was small.","Predates brentuximab vedotin and nivolumab combinations, which now often replace ABVD."],"changedPractice":true,"participants":1214},"route":"/key-papers/paper-rathl-interim-pet-adapted-abvd-advanced-hodgkin-nejm-2016/","neighbours":{"trial":[{"id":"rathl","kind":"trial","name":"RATHL","route":"/trials/rathl/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}],"pairing":[{"id":"fdg-pet-response-adapted-therapy","kind":"pairing","name":"FDG PET then response-adapted chemotherapy","route":"/pairings/fdg-pet-response-adapted-therapy/"}]}}