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

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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. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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