Response-adapted therapy for the treatment of children with newly diagnosed high risk Hodgkin lymphoma (AHOD0831): a report from the Children's Oncology Group.
Kara M KellyPeter D ColeQinglin PeiRizvan BushKenneth B RobertsDavid C HodgsonKathleen M McCartenSteve Y ChoCindy SchwartzPublished in: British journal of haematology (2019)
The AHOD0831 study for paediatric patients with high risk Hodgkin lymphoma tested a response-based approach designed to limit cumulative alkylator exposure and reduce radiation volumes. Patients (Stage IIIB/IVB) received two cycles of ABVE-PC (doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide). Rapid early responders [RER, no positron emission tomography (PET) activity above mediastinal blood pool] were consolidated with 2 cycles of ABVE-PC. Slow early responders (SER) received 2 cycles of ifosfamide/vinorelbine and 2 cycles of ABVE-PC. Radiotherapy was administered to sites of initial bulk and/or SER. By intent-to-treat analysis, 4-year second event-free survival (EFS; freedom from second relapse or malignancy) was 91·9% [95% confidence interval (CI): 86·1-95·3%], below the projected baseline of 95% (P = 0·038). Five-year first EFS and overall survival (OS) rates are 79·1% (95% CI: 71·5-84·8%) and 95% (95% CI: 88·8-97·8%). Eight of 11 SER patients with persistent PET positive lesions at the end of chemotherapy had clinical evidence of active disease (3 biopsy-proven, 5 with progressive disease or later relapses). Although this response-directed approach did not reach the ambitiously high pre-specified target for second EFS, EFS and OS rates are comparable with results of recent trials despite the reduction in radiotherapy volumes from historical involved fields. Persistent PET at end of chemotherapy identifies a cohort at an especially high risk for relapse/early progression.
Keyphrases
- positron emission tomography
- hodgkin lymphoma
- free survival
- newly diagnosed
- computed tomography
- pet ct
- locally advanced
- pet imaging
- end stage renal disease
- young adults
- early stage
- radiation therapy
- radiation induced
- multiple sclerosis
- chronic kidney disease
- drug delivery
- intensive care unit
- low dose
- peritoneal dialysis
- palliative care
- squamous cell carcinoma
- ejection fraction
- randomized controlled trial
- lymph node
- phase ii study
- dna methylation
- cancer therapy
- prognostic factors
- high dose
- quantum dots
- patient reported
- patient reported outcomes
- open label
- replacement therapy
- double blind