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Randomized Controlled Trial
. 2018 Dec;65(12):e27375.
doi: 10.1002/pbc.27375. Epub 2018 Sep 14.

Outcomes in intermediate-risk pediatric lymphocyte-predominant Hodgkin lymphoma: A report from the Children's Oncology Group

Lianna J Marks  1 , Qinglin Pei  2 , Rizvan Bush  3 , Allen Buxton  3 , Burton Appel  4 , Kara M Kelly  5 , Cindy L Schwartz  6 , Debra L Friedman  7
Affiliations
Randomized Controlled Trial

Outcomes in intermediate-risk pediatric lymphocyte-predominant Hodgkin lymphoma: A report from the Children's Oncology Group

Lianna J Marks et al. Pediatr Blood Cancer. 2018 Dec.

Abstract

Purpose: Optimal management of patients with intermediate-risk lymphocyte-predominant Hodgkin lymphoma (LPHL) is unclear due to their small numbers in most clinical trials. Children's Oncology Group AHOD0031, a randomized phase III trial of pediatric patients with intermediate-risk Hodgkin lymphoma (HL), included patients with LPHL. We report the outcomes of these patients and present directions for future therapeutic strategies.

Procedure: Patients received two cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (ABVE-PC) followed by response evaluation. Slow early responders were randomized to two additional ABVE-PC cycles ± two dexamethasone, etoposide, cisplatin, and cytarabine cycles and all received involved field radiotherapy (IFRT). Rapid early responders (RERs) received two additional ABVE-PC cycles. RERs with complete response (CR) were randomized to IFRT or no further therapy. RERs without CR received IFRT.

Results: Ninety-six (5.6%) of 1711 patients on AHOD0031 had LPHL. Patients with LPHL were more likely to achieve RER (93.6% vs. 81.0%; P = 0.002) and CR (74.2% vs. 49.3%; P = 0.000005) following chemotherapy compared with patients with classical HL. Five-year event-free survival (EFS) was superior in patients with LPHL (92.2%) versus classical HL (83.5%) (P = 0.04), without difference in overall survival (OS). Among RERs with CR following chemotherapy (n = 33), there was no difference in EFS or OS between those randomized to receive or not receive IFRT.

Conclusion: Children and adolescents with intermediate-risk LPHL represent ideal candidates for response-adapted therapy based on their favorable outcomes. The majority of patients treated with the ABVE-PC backbone achieve RER with CR status and can be treated successfully without IFRT.

Keywords: clinical trial; lymphocyte-predominant Hodgkin lymphoma; pediatrics.

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Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
CONSORT Diagram: Numbers represent LP patients only. ABVE-PC, doxorubicin, bleomycin, vincristine, etoposide, cyclophosphamide, and prednisone; CR, complete response; DECA, dexamethasone, etoposide, cisplatin, and cytarabine; IFRT, Involved Field Radiotherapy; RER, rapid early responder; SER, slow early responder.
FIGURE 2
FIGURE 2
(A) EFS and (B) OS for other versus LP patients
FIGURE 3
FIGURE 3
(A) EFS and (B) OS for RER versus SER LP patients
FIGURE 4
FIGURE 4
(A) EFS and (B) OS by IFRT random assignment for LP RER/CR patients
See this image and copyright information in PMC

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