VAMP and Low-Dose, Involved-Field Radiation for Children and Adolescents With Favorable, Early-Stage Hodgkin’s Disease: Results of a Prospective Clinical Trial

2002 ◽  
Vol 20 (14) ◽  
pp. 3081-3087 ◽  
Author(s):  
Sarah S. Donaldson ◽  
Melissa M. Hudson ◽  
Kathleen R. Lamborn ◽  
Michael P. Link ◽  
Larry Kun ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Low Dose ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Complete Response ◽  
Event Free Survival ◽  
Free Survival ◽  
Clinical Stages ◽  
Field Radiation ◽  
Involved Field

PURPOSE: To evaluate outcome and assess toxicity of children and adolescents with early-stage, favorable Hodgkin’s disease treated with vinblastine, doxorubicin, methotrexate, and prednisone (VAMP) and low-dose, involved-field radiation. PATIENTS AND METHODS: One hundred ten patients with clinical stages I and II, favorable (nonbulky) Hodgkin’s disease were treated with four cycles of VAMP chemotherapy and 15 Gy involved-field radiation for those who achieved a complete response, or 25.5 Gy for those who achieved a partial response to two cycles of VAMP. RESULTS: With a median follow-up of 5.6 years (range, 1.1 to 10.4 years), the 5-year survival and event-free survival were 99% (lower confidence limit [CL], 97.4%) and 93% (lower CL, 88.6%), respectively. Factors associated with event-free survival of 100% were complete response to two cycles of VAMP and histology other than nodular sclerosing Hodgkin’s disease (NSHD). No serious early or late toxicity has been observed. Patients presenting with clinical stages I and IIA, nonbulky disease involving fewer than three nodal sites have a projected survival and event-free survival of 100% and 97% (lower CL, 93%), respectively, at 5 years. CONCLUSION: Risk-adapted, combined-modality therapy using only four cycles of VAMP chemotherapy with 15 to 25.5 Gy of involved-field radiation for patients with early-stage/favorable Hodgkin’s disease is highly effective and without demonstrable late effects. These results indicate that pediatric patients with stages I and II favorable Hodgkin’s disease can be cured with limited therapy that does not include an alkylating agent, bleomycin, etoposide, or high-dose, extended-field radiation therapy.

scholarly journals Involved field radiation therapy for early stage Hodgkin's disease in children.Preliminary results

Cancer ◽  
1976 ◽  
Vol 37 (4) ◽  
pp. 1625-1632 ◽  
Author(s):  
William C. Cham ◽  
Charlotte T. C. Tan ◽  
Alvaro Martinez ◽  
Philip R. Exelby ◽  
Melvin Tefft ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Hodgkin's Disease ◽  
Early Stage ◽  
Hodgkin’S Disease ◽  
Field Radiation ◽  
Involved Field

Localized Childhood Hodgkin’s Disease: Response-Adapted Chemotherapy With Etoposide, Bleomycin, Vinblastine, and Prednisone Before Low-Dose Radiation Therapy—Results of the French Society of Pediatric Oncology Study MDH90

2000 ◽  
Vol 18 (7) ◽  
pp. 1500-1507 ◽  
Author(s):  
J. Landman-Parker ◽  
H. Pacquement ◽  
T. Leblanc ◽  
J.L. Habrand ◽  
M.J. Terrier-Lacombe ◽  
...  
Keyword(s):  
Survival Rate ◽  
Pediatric Oncology ◽  
Hodgkin's Disease ◽  
Low Dose ◽  
Hodgkin’S Disease ◽  
Alkylating Agents ◽  
Poor Responders ◽  
Event Free Survival ◽  
French Society ◽  
Free Survival

PURPOSE: The French Society of Pediatric Oncology MDH82 study demonstrated the effectiveness of 20 Gy irradiation of involved fields after doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) or mechlorethamine, vincristine, procarbazine, and prednisone/ABVD chemotherapy in children with localized Hodgkin’s disease (HD). The response to primary chemotherapy was the only predictor of survival. To reduce long-term treatment complications without compromising efficacy, the MDH90 study was based on a new chemotherapy regimen devoid of both alkylating agents and anthracycline, followed by 20 Gy of radiotherapy (RT) for good responders. PATIENTS AND METHODS: From January 1990 to July 1996, 202 children were enrolled from 30 institutions. Good responders to four cycles of vinblastine, bleomycin, etoposide (VP16), and prednisone (VBVP) were given 20 Gy of RT and no further therapy. Poor responders were given vincristine, procarbazine, prednisone, and doxorubicin. After a second evaluation, good responders were given 20 Gy of RT, and poor responders were given 40 Gy of RT. RESULTS: One hundred seventy-one patients (85%) were good responders to VBVP, 27 (15%) were poor responders, and four did not respond. With a median follow-up of 74 months (range, 25 to 117 months), the 5-year overall survival rate (mean ± SD) is 97.5% ± 2.1%, and the event-free survival rate (mean ± SD) is 91.1% ± 1.8%. Significant predictors of worse event-free survival in multivariate analysis were hemoglobin < 10.5 g/L, “b” biologic class, and nodular sclerosis. CONCLUSION: These results suggest that most children with clinical stage I and II HD can be treated with chemotherapy devoid of alkylating agents and anthracycline, followed by low-dose RT.

Randomized Comparison of Low-Dose Involved-Field Radiotherapy and No Radiotherapy for Children With Hodgkin’s Disease Who Achieve a Complete Response to Chemotherapy

2002 ◽  
Vol 20 (18) ◽  
pp. 3765-3771 ◽  
Author(s):  
James B. Nachman ◽  
Richard Sposto ◽  
Philip Herzog ◽  
Gerald S. Gilchrist ◽  
Suzanne L. Wolden ◽  
...  
Keyword(s):  
Combination Chemotherapy ◽  
Hodgkin's Disease ◽  
Low Dose ◽  
Hodgkin’S Disease ◽  
Complete Response ◽  
Study Entry ◽  
Rank Test ◽  
Log Rank Test ◽  
Involved Field ◽  
To Receive

PURPOSE: Current standard therapy for children and adolescents with Hodgkin’s disease includes combination chemotherapy and low-dose involved-field radiation (LD-IFRT). Because radiation may be associated with adverse late effects, the Children’s Cancer Group (CCG) investigated whether radiation could be omitted in patients achieving a complete response to initial chemotherapy without jeopardizing the excellent outcome obtained with combined-modality therapy. PATIENTS AND METHODS: Between January 1995 and December 1998, 829 eligible patients were enrolled onto CCG 5942. A total of 501 patients who achieved an initial complete response after risk-adapted combination chemotherapy were randomized to receive LD-IFRT or no further treatment. Event-free survival (EFS) and overall survival were assessed from the date of study entry or the date of randomization, as appropriate. RESULTS: The projected 3-year EFS from study entry for the entire cohort was 87% ± 1.2%. Among patients who achieved a complete response to initial chemotherapy, 92% ± 1.9% of those randomized to receive LD-IFRT were alive and disease free 3 years after randomization, versus 87% ± 2.2% for patients randomized to receive no further therapy (stratified log-rank test; P = .057). With an “as-treated” analysis, 3-year EFS after randomization for the radiation cohort was 93% ± 1.7% versus 85% ± 2.3% for patients receiving no further therapy (stratified log-rank test; P = .0024). Three-year survival estimates for patients treated with and without LD-IFRT were 98% ± 1.1% for patients who received radiation and 99% ± 0.5% for patients who did not receive radiation. CONCLUSION: LD-IFRT after an initial complete response to risk-adapted chemotherapy improved EFS. At this time, there is no survival advantage for LD-IFRT, but follow-up remains short.

Treatment of Unfavorable Childhood Hodgkin’s Disease With VEPA and Low-Dose, Involved-Field Radiation

2002 ◽  
Vol 20 (14) ◽  
pp. 3088-3094 ◽  
Author(s):  
Alison M. Friedmann ◽  
Melissa M. Hudson ◽  
Howard J. Weinstein ◽  
Sarah S. Donaldson ◽  
Larry Kun ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Low Dose ◽  
Hodgkin’S Disease ◽  
Combined Modality Therapy ◽  
Stage I ◽  
Stage Iii ◽  
Advanced Stage ◽  
Combined Modality ◽  
Field Radiation ◽  
Involved Field

PURPOSE: Between January 1990 and April 1993, 56 pediatric patients with Hodgkin’s disease were treated on a single-arm trial at three institutions with a regimen designed to maintain high cure rates while minimizing the potential late effects of treatment, such as infertility, second malignant neoplasms, and cardiopulmonary injury. PATIENTS AND METHODS: The regimen used combined-modality therapy with six cycles of vinblastine, etoposide, prednisone, and doxorubicin (VEPA) chemotherapy and low-dose, involved-field radiation. Unfavorable features comprised bulky presentations of localized (stage I or II) disease or advanced (stage III or IV) Hodgkin’s disease. RESULTS: Of 56 patients enrolled, 26 (46%) had unfavorable presentations of stage I/II disease and 30 (54%) had advanced (stage III/IV) disease. Seventy-nine percent of the patients are alive without disease at a median follow-up time of 8.9 years from diagnosis. Nineteen patients had events at a median of 1.5 years (range, 0.4 to 7.9 years) from diagnosis; 17 patients relapsed, one died of cardiomyopathy, and one died of accidental injuries. Survival and event-free survival (EFS) estimates at 5 years for the entire cohort were 81.9% (SE, 5.2%) and 67.8% (SE, 6.3%), respectively. Five-year EFS by stage was 100% for stage I, 79.2% (SE, 8.3%) for stage II, 70% (SE, 14.5%) for stage III, and 49.5% (SE, 11.3%) for stage IV patients. CONCLUSION: Combined-modality therapy with VEPA chemotherapy and low-dose, involved-field radiation is adequate for disease control of early-stage patients with unfavorable features, but it is inferior to other standard regimens for advanced-stage patients.

scholarly journals Hodgkin’s Disease / Hodgkin-PTLD after Solid Organ Transplantation in Children: A Report on 16 Patients Treated According to Subsequent Gpoh-HD Treatment Schedules

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1612-1612
Author(s):  
Johanna Kampers ◽  
Rita Beier ◽  
Manuela A. Orjuela-Grimm ◽  
Tilmann Schober ◽  
Thomas Schulz ◽  
...  
Keyword(s):  
Treatment Group ◽  
Organ Transplantation ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Event Free Survival ◽  
Free Survival ◽  
Involved Field ◽  
Involved Field Radiotherapy

Abstract Post-transplant lymphoproliferative diseases (PTLD) are severe complications of immunosuppressive therapy after solid organ transplantation (SOT) in children. Among those, Hodgkin’s disease (HD) or Hodgkin(-like) PTLD is a rare entity, and systematic data on pathogenesis, treatment, and prognosis are lacking. Here, we report on 16 children and adolescents who were treated according to standard treatment guidelines from the German HD (GPOH-HD) study cente. All patients with HD after SOT reported to the German pediatric PTLD (Ped-PTLD) registry between 1999 and 2013 were included in this analysis (14 of 182 patients = 7.7% of pediatric PTLDs). Data were supplemented by information recorded in the GPOH-HD registry. In addition, 2 U.S. patients treated according to the respective GPOH-HD guidelines were included. Central pathology review was performed in 12/16 cases. Epstein-Barr virus (EBV) in tumor tissue was evaluated by EBER in situ hybridization, immunohistochemistry for LMP-1 or EBNA-2, and/or EBV-PCR. All patients were treated with chemotherapy according to the respective GPOH-HD recommendations (treatment group (TG)-1: 2xOEPA; TG-2: 2xOEPA+2xCOPP/COPDAC; TG-3: 2xOEPA+4xCOPP/COPDAC) tailored according to stage and LDH. Indication for involved field radiotherapy was based on the current study recommendations. Six patients had additional rituximab treatment, two as upfront monotherapy and four as addition to chemotherapy. Events recorded included disease progression, relapse, second malignancy, and death of any cause. Overall and event-free survival was calculated using log-rank test. 16 predominantly male (13/16) patients developed HD after SOT, among them 7 renal, 4 liver, and 5 heart transplant recipients. Median age at diagnosis of HD was 13.9 [range 4.3 – 19.4] years with a median duration from SOT to HD of 7.4 [0.75 – 14.3] years. Histopathology review was classified as classical Hodgkin’s disease in 10 patients (nodular sclerosis =1, mixed type =5, epitheloid-cell predominant =2, not further specified =2) and Hodgkin-PTLD in 6 patients. 8 of 10 patients with data evaluable had a negative EBV-serology at transplantation, while antibodies against EBV were detected in 15/15 patients at the time of HD diagnosis. Fifteen of sixteen tumors proved positive for EBV and/or EBV-gene products. As expected, all tumors expressed CD30 and 7 of 16 tumors demonstrated moderate to strong expression of CD20. Staging revealed 1 patient with stage I disease, 8 with stage II, 5 with stage III, and 2 patients with stage IV disease. Four patients presented with extranodal involvement, among them one with graft organ involvement, and three patients with involvement of the gastrointestinal tract. None of the patients had CNS disease. Patients were treated in TG-1 (6 patients), TG-2 (5 patients), TG-3 (4 patients), respectively. One patient received an individualized treatment scheme, and 2 of 16 patients (both TG-2) were assigned to consolidating involved field radiotherapy. Median follow up was 4.1 [0.3 – 9.2] years. One patient in TG-3 died of infection during COPDAC treatment; all others are alive at the time of abstract preparation. Overall survival (OS) at 2 and 5 years was 93%. In addition to the treatment-related death two patients experienced events, 1 relapse after 9 months and 1 secondary malignancy (polymorphic PTLD) after 1.2 years. Event-free survival after HD chemotherapy at 2 and 5 years was 79%. Rituximab monotherapy did not result in long-term remission, both patients relapsed after 0.4 and 2.7 years, respectively. None of the parameters examined (organ graft, stage, treatment group) was significantly associated with overall or event-free survival. In conclusion, HD is a rare type of PTLD in children arising late after SOT, which may lead to underrepresentation in the pediatric patient population. The analysis of 16 patients treated according to a uniform concept represents the largest series reported to date. Almost all cases were EBV-associated. Although tumors often express CD20 rituximab monotherapy does not seem to establish long-lasting remissions. In contrast, the chemotherapy regimens based on the German protocols for de novo Hodgkin’s disease present well tolerated and effective treatment strategies for HD after SOT in children. International efforts are warranted to improve understanding and treatment for this rare disease. Disclosures No relevant conflicts of interest to declare.

Extended versus involved fields irradiation combined with MOPP chemotherapy in early clinical stages of Hodgkin's disease.

1985 ◽  
Vol 3 (2) ◽  
pp. 207-214 ◽  
Author(s):  
R Zittoun ◽  
A Audebert ◽  
B Hoerni ◽  
A Bernadou ◽  
M Krulik ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Nitrogen Mustard ◽  
Hodgkin’S Disease ◽  
Disease Free Survival ◽  
Free Survival ◽  
Significant Difference ◽  
Clinical Stages ◽  
Extended Field ◽  
Involved Field ◽  
Disease Free

From 1976 to 1981, 335 patients with untreated Hodgkin's disease, clinical stages I, II, and IIIA, have been treated by MOPP (nitrogen mustard, vincristine, procarbazine, prednisone) chemotherapy, three to six cycles according to the prognostic factors, combined with radiotherapy. Irradiation was always performed after the first three cycles of chemotherapy, and was randomized between extensive radiotherapy, ie, mantle and paraaortic areas for supradiaphragmatic presentations, and radiotherapy restricted to the involved areas. No significant difference was observed between the two randomized branches for the disease-free survival (86% after six years in the involved field branch v 90% in the extended field branch), and none for the overall survival. Most of the relapses occurred in nonirradiated areas in the first group, and in irradiated areas in the second. Relapses were especially frequent in the IIE stages with pulmonary extension; extranodal relapses occurred with osseous and cutaneous localizations. Two cases of secondary leukemia were observed after three- or six-cycle MOPP plus radiotherapy limited to the involved areas.

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