CALGB 50604: Risk-adapted treatment of nonbulky early-stage Hodgkin lymphoma based on interim PET

David J. Straus, Sin Ho Jung, Brandelyn Pitcher, Lale Kostakoglu, John C. Grecula, Eric D. Hsi, Heiko Schöder, Leslie L. Popplewell, Julie E. Chang, Craig H. Moskowitz, Nina Wagner-Johnston, John P. Leonard, Jonathan W. Friedberg, Brad S. Kahl, Bruce D. Cheson, Nancy L. Bartlett

Research output: Contribution to journalArticle

Abstract

A negative interim positron emission tomography/computerized tomography (PET/CT) after 1 to 3 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in patients with newly diagnosed, nonbulky stage I or II Hodgkin lymphoma (HL) predicts a low relapse rate. This phase 2 trial was designed to determine if a population of patients with early-stage disease can be treated with short-course ABVD without radiation therapy (RT) on the basis of a negative interim PET/CT, thereby limiting the risks of treatment. Between 15 May 2010 and 21 February 2013, 164 previously untreated patients with nonbulky stage I/II HL were enrolled, and 149 were included in the final analysis. Patients received 2 cycles of ABVD followed by PET. Deauville scores 1 to 3 were negative (£ liver uptake) based on central review. PET2 patients received 2 more cycles of ABVD, and PET1 patients received 2 cycles of dose-intense bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (escalated BEACOPP) plus 3060-cGy involved-field RT. The primary objective was to determine 3-year progression-free survival (PFS) for the PET2 group. One hundred thirty-five patients (91%) were interim PET2, and 14 patients (9%) were PET1. With median follow-up time of 3.8 years, the estimated 3-year PFS was 91% for the PET2 group and 66% for the PET1 group (hazard ratio, 3.84; 95% confidence interval, 1.50-9.84; P 5 .011). There was 1 death as a result of suicide. Four cycles of ABVD resulted in durable remissions for a majority of patients with early-stage nonbulky HL and a negative interim PET.

Original languageEnglish (US)
Pages (from-to)1013-1021
Number of pages9
JournalBlood
Volume132
Issue number10
DOIs
StatePublished - Sep 6 2018
Externally publishedYes

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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  • Cite this

    Straus, D. J., Jung, S. H., Pitcher, B., Kostakoglu, L., Grecula, J. C., Hsi, E. D., Schöder, H., Popplewell, L. L., Chang, J. E., Moskowitz, C. H., Wagner-Johnston, N., Leonard, J. P., Friedberg, J. W., Kahl, B. S., Cheson, B. D., & Bartlett, N. L. (2018). CALGB 50604: Risk-adapted treatment of nonbulky early-stage Hodgkin lymphoma based on interim PET. Blood, 132(10), 1013-1021. https://doi.org/10.1182/blood-2018-01-827246