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Response‐adapted therapy for the treatment of children with newly diagnosed high risk Hodgkin lymphoma (AHOD0831): a report from the Children’s Oncology Group
Author(s) -
Kelly Kara M.,
Cole Peter D.,
Pei Qinglin,
Bush Rizvan,
Roberts Kenneth B.,
Hodgson David C.,
McCarten Kathleen M.,
Cho Steve Y.,
Schwartz Cindy
Publication year - 2019
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.16014
Subject(s) - medicine , etoposide , vincristine , ifosfamide , radiation therapy , oncology , chemotherapy , hazard ratio , prednisone , abvd , confidence interval , cyclophosphamide , surgery
Summary 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.