Early Response to Dose-Intensive Chemotherapy Can Be Used to Tailor Subsequent Therapy in Pediatric Intermediate-Risk Hodgkin Lymphoma


Key Points

  • Early response assessment supported omitting involved-field radiotherapy in rapid early responders with a complete response.
  • Early response assessment supported use of additional chemotherapy in slow early responders with PET-positive disease. 

As reported in the Journal of Clinical Oncology by Friedman and colleagues, the Children’s Oncology Group study AHOD0031 has shown that early response to dose-intensive chemotherapy can be used to tailor subsequent therapy in pediatric intermediate-risk Hodgkin lymphoma.

Study Details

In the trial, which enrolled patients between September 2002 and July 2009, 1,712 evaluable patients (median age at diagnosis = 15.2 years, range = 1.9–21.9 years) received two cycles of ABVE-PC (doxorubicin, bleomycin, vincristine, etoposide, cyclophosphamide, and prednisone) followed by response evaluation. Rapid early responders (n = 1,369) received two additional ABVE-PC cycles followed by a complete response evaluation.

Those with a complete response (n = 762) were randomly assigned to receive involved-field radiotherapy (n = 380) or no additional therapy (n = 382). Slow early responders to two cycles of ABVE-PC (n = 305) were randomly assigned to receive two additional ABVE-PC cycles with (n = 153) or without (n = 151) two cycles of DECA (dexamethasone, etoposide, cisplatin, and cytarabine), with all slow early responders receiving involved-field radiotherapy.

Overall, 4-year event-free survival was 85.0%, including 86.9% for rapid early responders and 77.4% for slow early responders (P < .001), and 4-year overall survival was 97.8%, including 98.5% for rapid and 95.3% for slow early responders (P < .001).

Effect of Radiotherapy in Rapid Responders

Among rapid early responders with a complete response, the 4-year event-free survival rate was 87.9% in those receiving involved-field radiotherapy vs 84.3% in those not receiving radiotherapy (P = .11). In a subgroup of 550 patients undergoing positron-emission tomography (PET) assessment for response, 4-year event-free survival was 86.7% vs 87.3% (P = .87) among those with PET-negative results and 83.1% vs 78.1% (P = .80) in those with PET-positive results.

Effect of DECA in Slow Responders

Among slow early responders, 4-year event-free survival was 79.3% in those receiving DECA vs 75.2% in those not receiving DECA (P = .11). In a subgroup of 196 patients with PET results, 4-year event-free survival was 90.1% with DECA vs 85.6% without DECA (P = .54) in those with PET-negative results and 70.7% vs 54.6% (P = .05) in those with PET-positive results.

The investigators concluded: “This trial demonstrated that early response assessment supported therapeutic titration (omitting radiotherapy in [rapid early responders] with [complete response]; augmenting chemotherapy in [slow early responders] with PET-positive disease). Strategies directed toward improved response assessment and risk stratification may enhance tailoring of treatment to patient characteristics and response.”

The study was supported by a National Cancer Institute grant. The authors indicated no potential conflicts of interest.

Debra L. Friedman, MD, of Vanderbilt-Ingram Cancer Center, is the corresponding author for the Journal of Clinical Oncology article. 

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