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

Debra L. Friedman, Lu Chen, Suzanne Wolden, Allen Buxton, Kathleen McCarten, Thomas J. FitzGerald, Sandra Kessel, Pedro A. De Alarcon, Allen R Chen, Nathan Kobrinsky, Peter Ehrlich, Robert E. Hutchison, Louis S. Constine, Cindy L. Schwartz

Research output: Contribution to journalArticle

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

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.

Original languageEnglish (US)
Pages (from-to)3651-3658
Number of pages8
JournalJournal of Clinical Oncology
Volume32
Issue number32
DOIs
StatePublished - Nov 10 2014

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Hodgkin Disease
Radiotherapy
Drug Therapy
Etoposide
Therapeutics
Cytarabine
Bleomycin
Vincristine
Prednisone
Doxorubicin
Cyclophosphamide
Dexamethasone
Cisplatin
Disease-Free Survival
Pediatrics
Health

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

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. / Friedman, Debra L.; Chen, Lu; Wolden, Suzanne; Buxton, Allen; McCarten, Kathleen; FitzGerald, Thomas J.; Kessel, Sandra; De Alarcon, Pedro A.; Chen, Allen R; Kobrinsky, Nathan; Ehrlich, Peter; Hutchison, Robert E.; Constine, Louis S.; Schwartz, Cindy L.

In: Journal of Clinical Oncology, Vol. 32, No. 32, 10.11.2014, p. 3651-3658.

Research output: Contribution to journalArticle

Friedman, DL, Chen, L, Wolden, S, Buxton, A, McCarten, K, FitzGerald, TJ, Kessel, S, De Alarcon, PA, Chen, AR, Kobrinsky, N, Ehrlich, P, Hutchison, RE, Constine, LS & Schwartz, CL 2014, '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 of Clinical Oncology, vol. 32, no. 32, pp. 3651-3658. https://doi.org/10.1200/JCO.2013.52.5410
Friedman, Debra L. ; Chen, Lu ; Wolden, Suzanne ; Buxton, Allen ; McCarten, Kathleen ; FitzGerald, Thomas J. ; Kessel, Sandra ; De Alarcon, Pedro A. ; Chen, Allen R ; Kobrinsky, Nathan ; Ehrlich, Peter ; Hutchison, Robert E. ; Constine, Louis S. ; Schwartz, Cindy L. / 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. In: Journal of Clinical Oncology. 2014 ; Vol. 32, No. 32. pp. 3651-3658.
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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 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.",
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T1 - Dose-intensive response-based chemotherapy and radiation therapy for children and adolescents with newly diagnosed intermediate-risk Hodgkin lymphoma

T2 - A report from the children's oncology group study AHOD0031

AU - Friedman, Debra L.

AU - Chen, Lu

AU - Wolden, Suzanne

AU - Buxton, Allen

AU - McCarten, Kathleen

AU - FitzGerald, Thomas J.

AU - Kessel, Sandra

AU - De Alarcon, Pedro A.

AU - Chen, Allen R

AU - Kobrinsky, Nathan

AU - Ehrlich, Peter

AU - Hutchison, Robert E.

AU - Constine, Louis S.

AU - Schwartz, Cindy L.

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N2 - 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 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.

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