Outcomes in intermediate-risk pediatric lymphocyte-predominant Hodgkin lymphoma: A report from the Children's Oncology Group Journal Article

Authors: Marks, L. J.; Pei, Q.; Bush, R.; Buxton, A.; Appel, B.; Kelly, K. M.; Schwartz, C. L.; Friedman, D. L.
Article Title: Outcomes in intermediate-risk pediatric lymphocyte-predominant Hodgkin lymphoma: A report from the Children's Oncology Group
Abstract: Purpose: Optimal management of patients with intermediate-risk lymphocyte-predominant Hodgkin lymphoma (LPHL) is unclear due to their small numbers in most clinical trials. Children's Oncology Group AHOD0031, a randomized phase III trial of pediatric patients with intermediate-risk Hodgkin lymphoma (HL), included patients with LPHL. We report the outcomes of these patients and present directions for future therapeutic strategies. Procedure: Patients received two cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (ABVE-PC) followed by response evaluation. Slow early responders were randomized to two additional ABVE-PC cycles ± two dexamethasone, etoposide, cisplatin, and cytarabine cycles and all received involved field radiotherapy (IFRT). Rapid early responders (RERs) received two additional ABVE-PC cycles. RERs with complete response (CR) were randomized to IFRT or no further therapy. RERs without CR received IFRT. Results: Ninety-six (5.6%) of 1711 patients on AHOD0031 had LPHL. Patients with LPHL were more likely to achieve RER (93.6% vs. 81.0%; P = 0.002) and CR (74.2% vs. 49.3%; P = 0.000005) following chemotherapy compared with patients with classical HL. Five-year event-free survival (EFS) was superior in patients with LPHL (92.2%) versus classical HL (83.5%) (P = 0.04), without difference in overall survival (OS). Among RERs with CR following chemotherapy (n = 33), there was no difference in EFS or OS between those randomized to receive or not receive IFRT. Conclusion: Children and adolescents with intermediate-risk LPHL represent ideal candidates for response-adapted therapy based on their favorable outcomes. The majority of patients treated with the ABVE-PC backbone achieve RER with CR status and can be treated successfully without IFRT. © 2018 Wiley Periodicals, Inc.
Keywords: clinical trial; pediatrics; lymphocyte-predominant hodgkin lymphoma
Journal Title: Pediatric Blood and Cancer
Volume: 65
Issue: 12
ISSN: 1545-5009
Publisher: Wiley Periodicals, Inc  
Date Published: 2018-12-01
Start Page: e27375
Language: English
DOI: 10.1002/pbc.27375
PUBMED: 30277639
PROVIDER: scopus
PMCID: PMC6192844
Notes: Article -- Export Date: 1 November 2018 -- Source: Scopus
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MSK Authors
  1. Lianna J Marks
    6 Marks