Randomized study of intensive MOOP-ABVD with or without low-dose total- nodal radiation therapy in the treatment of stages IIB, IIIA2, IIIB, and IV Hodgkin's disease in pediatric patients: A Pediatric Oncology Group Study

Michael A. Weiner, Brigid Leventhalt, Martin L. Brecher, Robert B. Marcus, Alan Cantor, Peter W. Gieser, Jessie L. Ternberg, Fred G. Behm, Moody D. Wharam, Allen R. Chauvenet

Research output: Contribution to journalArticle

Abstract

Purpose: To determine whether the addition of lowdose total-nodal irradiation (TNI) in pediatric patients with advanced-stage Hodgkin's disease who have received eight cycles of alternating mechlorethamine, vincristine, procarbazine, and prednisone (MAP) and doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) will improve the event-free survival (EFS) and overall survival (OS) when compared with patients who have received chemotherapy only. Patients and Methods: At diagnosis, 183 children and adolescents with stages IIB, IIIA2, IIIB, and IV Hodgkin's disease were randomized to receive eight cycles of alternating MAP-ABVD with or without low-dose TNI. Results: Of 183 patients, four were rendered ineligible before treatment was initiated. One hundred sixty-one of 179 patients (90%) were in complete remission (CR) at the completion of eight cycles of alternating MAP-ABVD; 81 were in the chemotherapy-only group and proceeded to observation off therapy, whereas 80 of 161 were to receivecombined modality therapy (CMT). Nine of 80 patients randomized at the time of diagnosis to receive CMT did not receive radiation (RT) because of a protocol violation, but were monitored for EFS and OS and included in all analyses. The estimated EFS and OS rates at 5 years for the 179 eligible patients are 79% and 92%, respectively. The actuarial EFS at 5 years was 80% for patients who received CMT and 79% for patients who received MAP-ABVD only. The OS for the former group is estimated to be 87% and for the latter patients 96%. Age ≤ 13 years of age at diagnosis and the attainment of a clinical CR after three cycles of chemotherapy were associated with a statistically significant improved EFS. Concluslon: Our results indicate that after the delivery of eight cycles of MAP-ABVD, the addition of low-dose RT does not improve the estimated EFS or OS in pediatric patients with advanced-stage Hodgkin's disease.

Original languageEnglish (US)
Pages (from-to)2769-2779
Number of pages11
JournalJournal of Clinical Oncology
Volume15
Issue number8
StatePublished - Aug 1997
Externally publishedYes

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Dacarbazine
Vinblastine
Bleomycin
Hodgkin Disease
Doxorubicin
Radiotherapy
Pediatrics
Disease-Free Survival
Therapeutics
Survival
Drug Therapy
Radiation
Procarbazine
Mechlorethamine
Vincristine
Prednisone
Survival Rate
Observation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Randomized study of intensive MOOP-ABVD with or without low-dose total- nodal radiation therapy in the treatment of stages IIB, IIIA2, IIIB, and IV Hodgkin's disease in pediatric patients : A Pediatric Oncology Group Study. / Weiner, Michael A.; Leventhalt, Brigid; Brecher, Martin L.; Marcus, Robert B.; Cantor, Alan; Gieser, Peter W.; Ternberg, Jessie L.; Behm, Fred G.; Wharam, Moody D.; Chauvenet, Allen R.

In: Journal of Clinical Oncology, Vol. 15, No. 8, 08.1997, p. 2769-2779.

Research output: Contribution to journalArticle

Weiner, MA, Leventhalt, B, Brecher, ML, Marcus, RB, Cantor, A, Gieser, PW, Ternberg, JL, Behm, FG, Wharam, MD & Chauvenet, AR 1997, 'Randomized study of intensive MOOP-ABVD with or without low-dose total- nodal radiation therapy in the treatment of stages IIB, IIIA2, IIIB, and IV Hodgkin's disease in pediatric patients: A Pediatric Oncology Group Study', Journal of Clinical Oncology, vol. 15, no. 8, pp. 2769-2779.
Weiner, Michael A. ; Leventhalt, Brigid ; Brecher, Martin L. ; Marcus, Robert B. ; Cantor, Alan ; Gieser, Peter W. ; Ternberg, Jessie L. ; Behm, Fred G. ; Wharam, Moody D. ; Chauvenet, Allen R. / Randomized study of intensive MOOP-ABVD with or without low-dose total- nodal radiation therapy in the treatment of stages IIB, IIIA2, IIIB, and IV Hodgkin's disease in pediatric patients : A Pediatric Oncology Group Study. In: Journal of Clinical Oncology. 1997 ; Vol. 15, No. 8. pp. 2769-2779.
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title = "Randomized study of intensive MOOP-ABVD with or without low-dose total- nodal radiation therapy in the treatment of stages IIB, IIIA2, IIIB, and IV Hodgkin's disease in pediatric patients: A Pediatric Oncology Group Study",
abstract = "Purpose: To determine whether the addition of lowdose total-nodal irradiation (TNI) in pediatric patients with advanced-stage Hodgkin's disease who have received eight cycles of alternating mechlorethamine, vincristine, procarbazine, and prednisone (MAP) and doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) will improve the event-free survival (EFS) and overall survival (OS) when compared with patients who have received chemotherapy only. Patients and Methods: At diagnosis, 183 children and adolescents with stages IIB, IIIA2, IIIB, and IV Hodgkin's disease were randomized to receive eight cycles of alternating MAP-ABVD with or without low-dose TNI. Results: Of 183 patients, four were rendered ineligible before treatment was initiated. One hundred sixty-one of 179 patients (90{\%}) were in complete remission (CR) at the completion of eight cycles of alternating MAP-ABVD; 81 were in the chemotherapy-only group and proceeded to observation off therapy, whereas 80 of 161 were to receivecombined modality therapy (CMT). Nine of 80 patients randomized at the time of diagnosis to receive CMT did not receive radiation (RT) because of a protocol violation, but were monitored for EFS and OS and included in all analyses. The estimated EFS and OS rates at 5 years for the 179 eligible patients are 79{\%} and 92{\%}, respectively. The actuarial EFS at 5 years was 80{\%} for patients who received CMT and 79{\%} for patients who received MAP-ABVD only. The OS for the former group is estimated to be 87{\%} and for the latter patients 96{\%}. Age ≤ 13 years of age at diagnosis and the attainment of a clinical CR after three cycles of chemotherapy were associated with a statistically significant improved EFS. Concluslon: Our results indicate that after the delivery of eight cycles of MAP-ABVD, the addition of low-dose RT does not improve the estimated EFS or OS in pediatric patients with advanced-stage Hodgkin's disease.",
author = "Weiner, {Michael A.} and Brigid Leventhalt and Brecher, {Martin L.} and Marcus, {Robert B.} and Alan Cantor and Gieser, {Peter W.} and Ternberg, {Jessie L.} and Behm, {Fred G.} and Wharam, {Moody D.} and Chauvenet, {Allen R.}",
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T1 - Randomized study of intensive MOOP-ABVD with or without low-dose total- nodal radiation therapy in the treatment of stages IIB, IIIA2, IIIB, and IV Hodgkin's disease in pediatric patients

T2 - A Pediatric Oncology Group Study

AU - Weiner, Michael A.

AU - Leventhalt, Brigid

AU - Brecher, Martin L.

AU - Marcus, Robert B.

AU - Cantor, Alan

AU - Gieser, Peter W.

AU - Ternberg, Jessie L.

AU - Behm, Fred G.

AU - Wharam, Moody D.

AU - Chauvenet, Allen R.

PY - 1997/8

Y1 - 1997/8

N2 - Purpose: To determine whether the addition of lowdose total-nodal irradiation (TNI) in pediatric patients with advanced-stage Hodgkin's disease who have received eight cycles of alternating mechlorethamine, vincristine, procarbazine, and prednisone (MAP) and doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) will improve the event-free survival (EFS) and overall survival (OS) when compared with patients who have received chemotherapy only. Patients and Methods: At diagnosis, 183 children and adolescents with stages IIB, IIIA2, IIIB, and IV Hodgkin's disease were randomized to receive eight cycles of alternating MAP-ABVD with or without low-dose TNI. Results: Of 183 patients, four were rendered ineligible before treatment was initiated. One hundred sixty-one of 179 patients (90%) were in complete remission (CR) at the completion of eight cycles of alternating MAP-ABVD; 81 were in the chemotherapy-only group and proceeded to observation off therapy, whereas 80 of 161 were to receivecombined modality therapy (CMT). Nine of 80 patients randomized at the time of diagnosis to receive CMT did not receive radiation (RT) because of a protocol violation, but were monitored for EFS and OS and included in all analyses. The estimated EFS and OS rates at 5 years for the 179 eligible patients are 79% and 92%, respectively. The actuarial EFS at 5 years was 80% for patients who received CMT and 79% for patients who received MAP-ABVD only. The OS for the former group is estimated to be 87% and for the latter patients 96%. Age ≤ 13 years of age at diagnosis and the attainment of a clinical CR after three cycles of chemotherapy were associated with a statistically significant improved EFS. Concluslon: Our results indicate that after the delivery of eight cycles of MAP-ABVD, the addition of low-dose RT does not improve the estimated EFS or OS in pediatric patients with advanced-stage Hodgkin's disease.

AB - Purpose: To determine whether the addition of lowdose total-nodal irradiation (TNI) in pediatric patients with advanced-stage Hodgkin's disease who have received eight cycles of alternating mechlorethamine, vincristine, procarbazine, and prednisone (MAP) and doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) will improve the event-free survival (EFS) and overall survival (OS) when compared with patients who have received chemotherapy only. Patients and Methods: At diagnosis, 183 children and adolescents with stages IIB, IIIA2, IIIB, and IV Hodgkin's disease were randomized to receive eight cycles of alternating MAP-ABVD with or without low-dose TNI. Results: Of 183 patients, four were rendered ineligible before treatment was initiated. One hundred sixty-one of 179 patients (90%) were in complete remission (CR) at the completion of eight cycles of alternating MAP-ABVD; 81 were in the chemotherapy-only group and proceeded to observation off therapy, whereas 80 of 161 were to receivecombined modality therapy (CMT). Nine of 80 patients randomized at the time of diagnosis to receive CMT did not receive radiation (RT) because of a protocol violation, but were monitored for EFS and OS and included in all analyses. The estimated EFS and OS rates at 5 years for the 179 eligible patients are 79% and 92%, respectively. The actuarial EFS at 5 years was 80% for patients who received CMT and 79% for patients who received MAP-ABVD only. The OS for the former group is estimated to be 87% and for the latter patients 96%. Age ≤ 13 years of age at diagnosis and the attainment of a clinical CR after three cycles of chemotherapy were associated with a statistically significant improved EFS. Concluslon: Our results indicate that after the delivery of eight cycles of MAP-ABVD, the addition of low-dose RT does not improve the estimated EFS or OS in pediatric patients with advanced-stage Hodgkin's disease.

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