Dose-dense chemotherapy enables elimination of RT for the majority of low-risk pediatric Hodgkin lymphomas: PHC study HOD08
Abstract
Abstract The Pediatric Hodgkin Consortium hypothesized that by increasing chemotherapeutic dose density for Hodgkin lymphoma (HL) they could increase the complete response (CR) rate among patients with favorable-risk HL after 8 weeks of Stanford V (vinblastine, doxorubicin, vincristine, bleomycin, mechlorethamine, etoposide and prednisone) compared with 8 weeks of VAMP (vinblastine, Adriamycin [doxorubicin], methotrexate, and prednisone). This would translate to a decrease in patients who required radiation therapy (RT) to achieve a cure. The HOD08 study was a phase 2 multicenter, investigator-initiated single-arm trial for patients aged ≤21 years with previously untreated stage 1A or 2A HL without mediastinal bulk or extranodal disease extension and <3 sites of disease. Treatment consisted of a modified 8-week Stanford V regimen. Modified, tailored, field RT was administered only to disease sites achieving less than a CR. The primary objective was to increase CR rate after 8 weeks of chemotherapy by at least 20% (from an estimated 44% to 64%) compared with patients treated on a previous trial (HOD99). HOD08 enrolled 85 patients with HL and 72 were evaluable for the primary objective, of whom 55 (76.4%) achieved a CR at all sites and did not receive RT. The 5-year event-free survival and overall survival rates for the entire cohort were 87.4% (95% confidence interval [CI], 80.4-95.0) and 98.7% (95% CI, 96.2-100), respectively. A dose-dense modified Stanford V regimen reduced the proportion of pediatric patients with low-risk HL who received RT while maintaining excellent outcomes. This trial was registered at www.clinicaltrials.gov as #NCT00846742.
Article Details
Authors (26)
Jamie E. Flerlage
Angela M. Feraco
3Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
Yiwang Zhou
4Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN
Ying Zheng
Jia Liang
John T. Lucas
Alison M. Friedmann
6Department of Pediatrics, Massachusetts General Hospital, Boston, MA
Howard J. Weinstein
7Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
Torunn I. Yock
6Department of Pediatrics, Massachusetts General Hospital, Boston, MA
Barry Shulkin
8Department of Radiology, St. Jude Children’s Research Hospital, Memphis, TN
Sue C. Kaste
8Department of Radiology, St. Jude Children’s Research Hospital, Memphis, TN
Lianna J. Marks
Matthew J. Ehrhardt
Stephanie B. Dixon
Scott Howard
10Resonance, Memphis, TN
Pedro de Alarcon
12Department of Pediatrics, University of Illinois College of Medicine, Peoria, Peoria, IL
Sandra Luna-Fineman
13Pediatric Hematology, Oncology and Bone Marrow Transplantation, University of Colorado, Children's Hospital Colorado, Aurora, CO
Amy Geddis
14Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, WA
Eric C. Larsen
15Maine Children’s Cancer Program, Scarborough, ME
Karen Marcus
16Division of Radiation Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
Amy L. Billett
3Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
Sarah S. Donaldson
17Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
Melissa M. Hudson
Monika L. Metzger
1Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
Matthew J. Krasin
5Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN
Michael P. Link
9Department of Pediatrics, Division of Pediatric Hematology/Oncology, Stanford University School of Medicine, Stanford, CA