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Clinical Trial
. 2019 Oct;187(1):39-48.
doi: 10.1111/bjh.16014. Epub 2019 Jun 10.

Response-adapted therapy for the treatment of children with newly diagnosed high risk Hodgkin lymphoma (AHOD0831): a report from the Children's Oncology Group

Kara M Kelly  1 , Peter D Cole  2 , Qinglin Pei  3 , Rizvan Bush  4 , Kenneth B Roberts  5 , David C Hodgson  6 , Kathleen M McCarten  7 , Steve Y Cho  8 , Cindy Schwartz  9
Affiliations
Clinical Trial

Response-adapted therapy for the treatment of children with newly diagnosed high risk Hodgkin lymphoma (AHOD0831): a report from the Children's Oncology Group

Kara M Kelly et al. Br J Haematol. 2019 Oct.

Abstract

The AHOD0831 study for paediatric patients with high risk Hodgkin lymphoma tested a response-based approach designed to limit cumulative alkylator exposure and reduce radiation volumes. Patients (Stage IIIB/IVB) received two cycles of ABVE-PC (doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide). Rapid early responders [RER, no positron emission tomography (PET) activity above mediastinal blood pool] were consolidated with 2 cycles of ABVE-PC. Slow early responders (SER) received 2 cycles of ifosfamide/vinorelbine and 2 cycles of ABVE-PC. Radiotherapy was administered to sites of initial bulk and/or SER. By intent-to-treat analysis, 4-year second event-free survival (EFS; freedom from second relapse or malignancy) was 91·9% [95% confidence interval (CI): 86·1-95·3%], below the projected baseline of 95% (P = 0·038). Five-year first EFS and overall survival (OS) rates are 79·1% (95% CI: 71·5-84·8%) and 95% (95% CI: 88·8-97·8%). Eight of 11 SER patients with persistent PET positive lesions at the end of chemotherapy had clinical evidence of active disease (3 biopsy-proven, 5 with progressive disease or later relapses). Although this response-directed approach did not reach the ambitiously high pre-specified target for second EFS, EFS and OS rates are comparable with results of recent trials despite the reduction in radiotherapy volumes from historical involved fields. Persistent PET at end of chemotherapy identifies a cohort at an especially high risk for relapse/early progression.

Keywords: Hodgkin lymphoma; paediatric; positron emission tomography; radiation; response adapted.

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Conflict of interest statement

Conflicts of Interest:

The authors declare no competing financial interests.

Figures

Figure 1.
Figure 1.
Flowchart diagram PET: positron emission tomography; PET2: positron emission tomography after Cycle 2 of treatment; RER: rapid early responder; SER: slow early responder.
Figure 2a.
Figure 2a.
First event free survival (1st EFS) of all evaluable patients (n=164)
Figure 2b.
Figure 2b.
Overall survival of all evaluable patients (n=164)
Figure 2c.
Figure 2c.
Second event free survival (2nd EFS) of all evaluable patients (n=164)
See this image and copyright information in PMC

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