***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE At present , treatment results for patients with advanced-stage Hodgkin 's disease remain unsatisfactory . St and ard chemotherapy M(C)OPP ( nitrogen mustard ( cyclophosphamide ) . vincristine , procabazine , and prednisone ) . ABVD ( adriamycine , bleomycine , vinblastine , and dacarbacine ) or M(C)OPP/ABVD + /- radiotherapy fail to achieve long-term complete remission in 35 % to 50 % of these patients . The BEACOPP ( bleomycin , etoposide , adriamycine , cyclophosphamide , vincristine , procarbazine , and prednisone ) regimen was developed to improve treatment results by dose intensification achieved by reduced duration of treatment ( time intensification ) and addition of etoposide . PATIENTS AND METHODS Thirty untreated patients with advanced Hodgkin 's disease stage IIB IV according to the Ann Arbor classification were treated with the time intensified BEACOPP regimen . Each patient was scheduled to receive eight cycles of chemotherapy with consolidating radiotherapy to sites of initial bulk disease and to residual tumor remaining after chemotherapy . RESULTS All patients were evaluable for assessment of toxicity , treatment response , freedom from treatment failure ( FFTF ) and survival ( SV ) . Of 30 treated patients , 29 patients received the intended eight cycles of BEACOPP . One patient in clinical CR , terminated the chemotherapy at his own request after six cycles and is at this time , 48 months after the end of treatment , in complete remission . Toxicity was tolerable with WHO grade 3/4 leucopenia in 28 % of chemotherapy cycles and one severe ( WHO grade 3 ) infection . No treatment-related death occurred . Cycles could generally be given on schedule . Complete remission ( CR ) was achieved in all but two patients ( 93 % ) . At present , only one patient has relapsed . At a median follow-up of 40 months , FFTF-rate is 89 % ( lower confidence limit : 80 % ) . One patient died due to progressive disease . CONCLUSION The BEACOPP regimen is feasible at moderate hematopoeitic toxicity . With a FFTF-rate of 89 % at a median follow-up of 40 months , the treatment results are very encouraging . A prospect i ve r and omised trial has been initiated to compare the BEACOPP regimen with the st and ard COPP/ABVD regimen in advanced-stage Hodgkin 's disease BACKGROUND Advanced stage Hodgkin 's lymphoma represents a heterogeneous group of patients with different risk profiles . Data suggests that interim PET assessment during chemotherapy is superior to baseline international prognostic scoring in terms of predicting long-term treatment outcome in patients with Hodgkin 's lymphoma . We therefore hypothesised that early interim PET-imaging after two courses of bleomycin , etoposide , doxorubicin , cyclophosphamide , vincristine , procarbazine , and prednisone ( BEACOPP ) might be suitable for guiding treatment in patients with advanced stage Hodgkin 's lymphoma . We aim ed to assess whether intensifying st and ard chemotherapy ( BEACOPPescalated ) by adding rituximab would improve progression-free survival in patients with positive PET after two courses of chemotherapy . METHODS In this open-label , international , r and omised , phase 3 study , we recruited patients aged 18 - 60 years with newly diagnosed , advanced stage Hodgkin 's lymphoma from 160 hospitals and 77 private practice s in Germany , Switzerl and , Austria , the Netherl and s , and the Czech Republic . Interim PET-imaging was done after two cycles of BEACOPPescalated and central ly assessed by an expert panel . Patients with a positive PET after 2 cycles of BEACOPPescalated chemotherapy ( PET-2 ) were r and omly assigned ( 1:1 ) to receive six additional courses of either BEACOPPescalated ( BEACOPPescalated group ) or BEACOPPescalated plus rituximab ( R-BEACOPPescalated group ) . PET-2 was assessed using a 5-point scale with 18FDG uptake higher than the mediastinal blood pool ( corresponding to Deauville scale 3 ) defined as positive . BEACOPPescalated was given as previously described ; rituximab was given intravenously at a dose of 375 mg/m2 ( maximum total dose 700 mg ) , the first administration starting 24 h before starting the fourth cycle of BEACOPPescalated ( day 0 and day 3 in cycle 4 , day 1 in cycles 5 - 8 ) . R and omisation was done central ly and used the minimisation method including a r and om component , stratified according to centre , age , stage , international prognostic score , and sex . The primary efficacy endpoint was 5 year progression-free survival , analysed in the intention-to-treat population . We are reporting this second planned interim analysis as the final report of the trial . The trial is registered with Clinical Trials.gov , number NCT00515554 . FINDINGS Between May 14 , 2008 , and May 31 , 2011 , we enrolled 1100 patients . 440 patients had a positive PET-2 and were r and omly assigned to either the BEACOPPescalated group ( n=220 ) or the R-BEACOPPescalated group ( n=220 ) . With a median follow-up of 33 months ( IQR 25 - 42 ) for progression-free survival , estimated 3 year progression-free survival was 91·4 % ( 95 % CI 87·0 - 95·7 ) for patients in the BEACOPPescalated group and 93·0 % ( 89·4 - 96·6 ) for those in the R-BEACOPPescalated group ( difference 1·6 % , 95 % CI -4·0 to 7·3 ; log rank p=0·99 ) . Common grade 3 - 4 adverse events were leucopenia ( 207 [ 95 % ] of 218 patients in the BEACOPPescalated group vs 211 [ 96 % ] of 220 patients in the R-BEACOPPescalated group ) , and severe infections ( 51 [ 23 % ] vs 43 [ 20 % ] patients ) . Based on a futility analysis , the independent data monitoring committee recommended publication of this second planned interim analysis as the final result . Six ( 3 % ) of 219 patients in the BEACOPPescalated group and ten ( 5 % ) of 220 in the R-BEACOPPescalated group died ; fatal treatment-related toxic effects occurred in one ( < 1 % ) patient in the BEACOPPescalated group and three ( 1 % ) in the R-BEACOPPescalated group , all of them due to infection . INTERPRETATION The addition of rituximab to BEACOPPescalated did not improve the progression-free survival of PET-2 positive patients with advanced stage Hodgkin 's lymphoma . However , progression-free survival for PET-2 positive patients was much better than expected , exceeding even the outcome of PET-2-unselected patients in the previous HD15 trial . Thus , PET-2 can not identify patients at high-risk for treatment failure in the context of the very effective German Hodgkin Study Group st and ard treatment for advanced stage Hodgkin 's lymphoma . FUNDING Deutsche Krebshilfe ; Swiss State Secretariat for Education , Research and Innovation ( SERI ) ; and Roche Pharma In contrast to younger patients , the prognosis of elderly patients with advanced Hodgkin 's disease ( HD ) has not improved substantially over the last 20 years . We thus carried out a prospect ively r and omized study ( HD9(elderly ) ) to compare the BEACOPP regimen in this setting against st and ard COPP-ABVD .  Between February 1993 and 1998 , 75 patients aged 66 - 75 years with newly diagnosed HD in advanced stages were recruited into the HD9 trial as a separate stratum ( HD9(elderly ) ) . Patients were assigned to eight alternating cycles of COPP and ABVD or eight cycles of BEACOPP in baseline doses . Radiotherapy was given to initial bulky or residual disease . In total , 68 of 75 registered patients were assessable : 26 were treated with COPP-ABVD and 42 with BEACOPP  baseline . There were no significant differences between COPP-ABVD and BEACOPP in terms of complete remission ( 76 % ) , overall survival ( 50 % ) and freedom from treatment failure ( FFTF ) ( 46 % ) at 5 years . At a median follow-up of 80 months , a total of 37 patients died : 14/26 patients ( 54 % ) treated with COPP-ABVD and 23/42 patients ( 55 % ) with BEACOPP . Two patients ( 8 % ) treated with COPP-ABVD and nine patients ( 21 % ) treated with BEACOPP  died of acute toxicity . Hodgkin-specific FFTF at 5 years was 55 % after COPP-ABVD and 74 % after BEACOPP ( P=0.13 ) . Thus , there are no differences in survival between these regimens in elderly patients BACKGROUND Treatment with escalated BEACOPP achieved a superior time to treatment failure over ABVD in patients with disseminated Hodgkin lymphoma . However , recent clinical trials have failed to confirm BEACOPP  overall survival ( OS ) superiority over ABVD . In addition , the gain in low-risk patients is still a matter of debate . PATIENTS AND METHODS We r and omly compared ABVD ( 8 cycles ) with BEACOPP ( escalated 4 cycles ≥ baseline 4 cycles ) in low-risk patients with an International Prognostic Score ( IPS ) of 0 - 2 . The primary end point was event-free survival ( EFS ) . This parallel group , open-label phase 3 trial was registered under # RECF0219 at French National Cancer Institute . RESULTS One hundred and fifty patients were r and omized in this trial ( ABVD 80 , BEACOPP 70 ) : 28 years was the median age , 50 % were male and IPS was 0 - 1 for 64 % . Complete remission rate was 85 % for ABVD and 90 % for BEACOPP  . Progression or relapses were more frequent in the ABVD patients than in the BEACOPP patients ( 17 versus 5 patients ) . With a median follow-up period of 5.5 years , seven patients died : six in the ABVD arm and one in the BEACOPP arm ( HL 3 and 0 , 2nd cancer 2 and 1 , accident 1 and 0 ) . The EFS at 5 years was estimated at 62 % for ABVD versus 77 % , for BEACOPP [ hazards ratio ( HR ) = 0.6 , P = 0.07 ] . The progression-free survival ( PFS ) at 5 years was 75 % versus 93 % ( HR = 0.3 , P = 0.007 ) . The OS at 5 years was 92 % versus 99 % ( HR = 0.18 , P = 0.06 ) . CONCLUSION Fewer progressions/relapses were observed with BEACOPP , demonstrating the high efficacy of the more intensive regimen , even in low-risk patients . However , additional considerations , balancing treatment-related toxicity and late morbidity due to salvage may help with decision-making with regard to treatment with ABVD or BEACOPP BACKGROUND Data on factors influencing inclusion of Hodgkin 's lymphoma ( HL ) patients in r and omized clinical trials ( RCT ) are limited and , for the present study they were analyzed in a RCT for III/IV HL . PATIENTS AND METHODS All patients with stage III/IV HL referred to the Saint-Louis Hospital between January 2003 and May 2007 were studied . A Groupe d'Etudes des Lymphomes de l'Adulte/European Organisation for Research and Treatment of Cancer RCT , to compare ABVD ( doxorubicin , bleomycin , vinblastine , dacarbazine ) with increased-dose BEACOPP ( bleomycin , etoposide , doxorubicin , cyclophosphamide , vincristine , procarbazine , prednisone ) , was open for recruitment . Non inclusion criteria and physician 's reasons for non-recruitment were prospect ively recorded . The reasons for patient 's refusal were collected retrospectively . Logistic regression analyses were carried out in order to identify factors predicting inclusion . RESULTS A total of 102 patients were diagnosed , among whom 51 % were included . Seven patients were ineligible , 22 refused to participate , and 21 were not enrolled due to the physician 's decision . Main reasons for patients ' refusal were st and ard treatment preference and concerns about experimental arm toxicity , mainly infertility risk . Conditions that could hamper accurate follow-up and toxicity concerns accounted for most of the physicians ' reasons . Adverse prognostic factors [ B symptoms ( odds ratio , OR = 5.35 ) and international prognostic score > or =3 ( OR = 2.69 ) ] were independently associated with inclusion . CONCLUSION Despite an attractive protocol , only 51 % of patients were included . It highlights concerns about selection of patients and the difficulty to obtain informed consent with better prognostic profile patients BACKGROUND BEACOPP 
    Output:
    
This meta- analysis provides moderate- to high- quality evidence that adult patients between 16 and 60 years of age with early unfavourable and advanced stage HL benefit regarding OS and PFS from first-line chemotherapy including escalated BEACOPP .
Furthermore , there is only low- quality evidence of a difference in the total number of secondary malignancies , as the follow-up period might be too short to detect meaningful differences .
Low- quality evidence also suggests that people treated with escalated BEACOPP may have a higher risk to develop secondary AML or MDS .
Due to the availability of only very low- quality evidence available , we are unable to come to a conclusion in terms of infertility .
This review does for the first time suggest a survival benefit .