Dose-intensive response-based chemotherapy and radiation therapy for children and adolescents with newly diagnosed intermediate-risk Hodgkin lymphoma: A report from the Children's Oncology Group Study AHOD0031 Journal Article


Authors: Friedman, D. L.; Chen, L.; Wolden, S.; Buxton, A.; McCarten, K.; FitzGerald, T. J.; Kessel, S.; De Alarcon, P. A.; Chen, A. R.; Kobrinsky, N.; Ehrlich, P.; Hutchison, R. E.; Constine, L. S.; Schwartz, C. L.
Article Title: Dose-intensive response-based chemotherapy and radiation therapy for children and adolescents with newly diagnosed intermediate-risk Hodgkin lymphoma: A report from the Children's Oncology Group Study AHOD0031
Abstract: Purpose: The Children's Oncology Group study AHOD0031, a randomized phase III study, was designed to evaluate the role of early chemotherapy response in tailoring subsequent therapy in pediatric ntermediate-risk Hodgkin lymphoma. To avoid treatment-associated risks that compromise long-term health and to maintain high cure rates, dose-intensive chemotherapy with limited cumulative doses was used. Patients and Methods: Patients received two cycles of doxorubicin, bleomycin, vincristine, etoposide, cyclophosphamide, and prednisone (ABVE-PC) followed by response evaluation. Rapid early responders (RERs) received two additional ABVE-PC cycles, followed by complete response (CR) evaluation. RERs with CR were randomly assigned to involved-field radiotherapy (IFRT) or no additional therapy; RERs with less than CR were nonrandomly assigned to IFRT. Slow early responders (SERs) were randomly assigned to receive two additional ABVE-PC cycles with or without two cycles of dexamethasone, etoposide, cisplatin, and cytarabine (DECA). All SERs were assigned to receive IFRT. Results: Among 1,712 eligible patients, 4-year event-free survival (EFS) was 85.0%: 86.9% for RERs and 77.4% for SERs (P <.001). Four-year overall survival was 97.8%: 98.5% for RERs and 95.3% for SERs (P <.001). Four-year EFS was 87.9% versus 84.3% (P =.11) for RERs with CR who were randomly assigned to IFRT versus no IFRT, and 86.7% versus 87.3% (P =.87) for RERs with positron emission tomography (PET)-negative results at response assessment Four-year EFS was 79.3% versus 75.2% (P =.11) for SERs who were randomly assigned to DECA versus no DECA, and 70.7% versus 54.6% (P =.05) for SERs with PET-positive results at response assessment. Conclusion: This trial demonstrated that early response assessment supported therapeutic titration (omitting radiotherapy in RERs with CR; augmenting chemotherapy in SERs with PET-positive disease) Strategies directed toward improved response assessment and risk stratification may enhance tailoring of treatment to patient characteristics and response.
Keywords: osteosarcoma; adolescent; adult; cancer survival; child; controlled study; event free survival; treatment response; leukemia; major clinical study; overall survival; prednisone; cancer recurrence; cisplatin; doxorubicin; cancer combination chemotherapy; drug withdrawal; multimodality cancer therapy; cancer radiotherapy; cytarabine; outcome assessment; positron emission tomography; follow up; antineoplastic agent; cancer diagnosis; multiple cycle treatment; basal cell carcinoma; etoposide; randomized controlled trial; cyclophosphamide; dexamethasone; vincristine; childhood cancer; hodgkin disease; febrile neutropenia; cause of death; hematologic malignancy; myelodysplastic syndrome; infant; newborn; lymphoma; bleomycin; thyroid cancer; seizure; phase 3 clinical trial; synovial sarcoma; testis cancer; mycosis fungoides; gram negative sepsis; intermediate risk patient; candidemia; traffic accident; involved field radiation therapy; human; male; female; article; adolescent disease
Journal Title: Journal of Clinical Oncology
Volume: 32
Issue: 32
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2014-11-10
Start Page: 3651
End Page: 3658
Language: English
DOI: 10.1200/jco.2013.52.5410
PROVIDER: scopus
PMCID: PMC4220044
PUBMED: 25311218
DOI/URL:
Notes: Export Date: 2 January 2015 -- Source: Scopus
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MSK Authors
  1. Suzanne L Wolden
    417 Wolden