Burton E Appel1, Lu Chen2, Allen B Buxton2, Robert E Hutchison2, David C Hodgson2, Peter F Ehrlich2, Louis S Constine2, Cindy L Schwartz2. 1. Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX. bappel@HackensackUMC.org. 2. Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX.
Abstract
PURPOSE: Children's Oncology Group study AHOD03P1 was designed to determine whether excellent outcomes can be maintained for patients with low-risk, pediatric lymphocyte-predominant Hodgkin lymphoma (LPHL) with a strategy of resection alone or minimal chemotherapy. PATIENTS AND METHODS: Patients with stage IA LPHL in a single node that was completely resected were observed without further therapy; recurrences were treated with three cycles of doxorubicin/vincristine/prednisone/cyclophosphamide (AV-PC). Patients with unresected stage IA or stage IIA LPHL were treated with three cycles of AV-PC. Patients with less than a complete response (CR) to AV-PC received 21-Gy involved-field radiation therapy (IFRT). RESULTS: A total of 183 eligible patients were enrolled; 178 were evaluable. Of these, 52 patients underwent complete resection of a single node. There were 13 relapses at a median of 11.5 months; 5-year event-free survival (EFS) was 77% (range, 62% to 87%). A total of 135 patients received AV-PC; 126 were treated at diagnosis and nine at relapse after surgery alone. Eleven patients receiving AV-PC had less than CR and received IFRT. Fourteen first events occurred among 135 patients (12 relapses and two second malignancies). Two relapses occurred in patients who had received IFRT. Five-year EFS was 88.8% (95% CI, 81.8% to 93.2%). Five-year EFS for the entire cohort was 85.5% (95% CI, 79.2% to 90.1%); overall survival was 100%. CONCLUSION: Some 75% of highly selected pediatric patients with LPHL may be spared chemotherapy after surgical resection alone. Pediatric LPHL has excellent EFS with chemotherapy that is less intensive than standard regimens; > 90% of patients can avoid radiation therapy. The salvage rate for the few relapses is high, with 100% survival overall.
PURPOSE:Children's Oncology Group study AHOD03P1 was designed to determine whether excellent outcomes can be maintained for patients with low-risk, pediatric lymphocyte-predominant Hodgkin lymphoma (LPHL) with a strategy of resection alone or minimal chemotherapy. PATIENTS AND METHODS: Patients with stage IA LPHL in a single node that was completely resected were observed without further therapy; recurrences were treated with three cycles of doxorubicin/vincristine/prednisone/cyclophosphamide (AV-PC). Patients with unresected stage IA or stage IIA LPHL were treated with three cycles of AV-PC. Patients with less than a complete response (CR) to AV-PC received 21-Gy involved-field radiation therapy (IFRT). RESULTS: A total of 183 eligible patients were enrolled; 178 were evaluable. Of these, 52 patients underwent complete resection of a single node. There were 13 relapses at a median of 11.5 months; 5-year event-free survival (EFS) was 77% (range, 62% to 87%). A total of 135 patients received AV-PC; 126 were treated at diagnosis and nine at relapse after surgery alone. Eleven patients receiving AV-PC had less than CR and received IFRT. Fourteen first events occurred among 135 patients (12 relapses and two second malignancies). Two relapses occurred in patients who had received IFRT. Five-year EFS was 88.8% (95% CI, 81.8% to 93.2%). Five-year EFS for the entire cohort was 85.5% (95% CI, 79.2% to 90.1%); overall survival was 100%. CONCLUSION: Some 75% of highly selected pediatric patients with LPHL may be spared chemotherapy after surgical resection alone. Pediatric LPHL has excellent EFS with chemotherapy that is less intensive than standard regimens; > 90% of patients can avoid radiation therapy. The salvage rate for the few relapses is high, with 100% survival overall.
Authors: S Bodis; M D Kraus; G Pinkus; B Silver; M E Kadin; G P Canellos; L N Shulman; N J Tarbell; P M Mauch Journal: J Clin Oncol Date: 1997-09 Impact factor: 44.544
Authors: Andrew Wirth; Kally Yuen; Michael Barton; Daniel Roos; Kumar Gogna; Gary Pratt; Craig Macleod; Sean Bydder; Graeme Morgan; David Christie Journal: Cancer Date: 2005-09-15 Impact factor: 6.860
Authors: Martin T King; Sarah S Donaldson; Michael P Link; Yasodha Natkunam; Ranjana H Advani; Richard T Hoppe Journal: Int J Radiat Oncol Biol Phys Date: 2015-05-01 Impact factor: 7.038
Authors: Ranjana H Advani; Sandra J Horning; Richard T Hoppe; Sarah Daadi; John Allen; Yasodha Natkunam; Nancy L Bartlett Journal: J Clin Oncol Date: 2014-02-10 Impact factor: 44.544
Authors: S Bhatia; L L Robison; O Oberlin; M Greenberg; G Bunin; F Fossati-Bellani; A T Meadows Journal: N Engl J Med Date: 1996-03-21 Impact factor: 91.245
Authors: Debra L Friedman; John Whitton; Wendy Leisenring; Ann C Mertens; Sue Hammond; Marilyn Stovall; Sarah S Donaldson; Anna T Meadows; Leslie L Robison; Joseph P Neglia Journal: J Natl Cancer Inst Date: 2010-07-15 Impact factor: 11.816
Authors: Jennifer H Aldrink; Burton Appel; Joel A Kaplan; Robert E Hutchison; Cindy L Schwartz; Kara M Kelly; Kathleen McCarten; Peter F Ehrlich Journal: J Pediatr Hematol Oncol Date: 2018-04 Impact factor: 1.289
Authors: Ramona Vesna Untanu; Jason Back; Burton Appel; Qinglin Pei; Lu Chen; Allen Buxton; David C Hodgson; Peter F Ehrlich; Louis S Constine; Cindy L Schwartz; Robert E Hutchison Journal: Pediatr Blood Cancer Date: 2017-08-12 Impact factor: 3.167
Authors: Sven Borchmann; Erel Joffe; Craig H Moskowitz; Andrew D Zelenetz; Ariela Noy; Carol S Portlock; John F Gerecitano; Connie L Batlevi; Philip C Caron; Pamela Drullinsky; Audrey Hamilton; Paul A Hamlin; Steven M Horwitz; Anita Kumar; Matthew J Matasar; Alison J Moskowitz; Colette N Owens; M Lia Palomba; Anas Younes; David J Straus Journal: Blood Date: 2019-02-15 Impact factor: 22.113
Authors: Lianna J Marks; Qinglin Pei; Rizvan Bush; Allen Buxton; Burton Appel; Kara M Kelly; Cindy L Schwartz; Debra L Friedman Journal: Pediatr Blood Cancer Date: 2018-09-14 Impact factor: 3.167
Authors: Joachim Yahalom; Bouthaina Shbib Dabaja; Umberto Ricardi; Andrea Ng; N George Mikhaeel; Ivan R Vogelius; Tim Illidge; Shunan Qi; Andrew Wirth; Lena Specht Journal: Blood Date: 2020-05-21 Impact factor: 22.113
Authors: Jennifer E Agrusa; Brooks P Scull; Harshal A Abhyankar; Howard Lin; Nmazuo W Ozuah; Rikhia Chakraborty; Olive S Eckstein; Nitya Gulati; Elmoataz Abdel Fattah; Nader K El-Mallawany; Rayne H Rouce; ZoAnn E Dreyer; Julienne Brackett; Judith F Margolin; Joseph Lubega; Terzah M Horton; Catherine M Bollard; M Monica Gramatges; Kala Y Kamdar; Kenneth L McClain; Tsz-Kwong Man; Carl E Allen Journal: Cancers (Basel) Date: 2020-12-02 Impact factor: 6.639