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DOI: 10.1055/s-0034-1371119
Intensive Therapy Free Survival (ITFS) for Early-Stage Hodgkin Lymphoma (cHL) Including Chemotherapy and Radiation Therapy (IFRT) for Recurrence after Chemotherapy alone
Introduction: AHOD0431 investigated whether a prescribed salvage regimen of conventional chemotherapy and IFRT is an effective strategy for treating children with early-stage cHL that recur after initial treatment with a minimally toxic chemotherapy regimen.
Methods: AHOD0431 treated patients with IA/IIA cHL without bulk with 3 cycles of doxorubicin, vincristine, prednisone and cyclophosphamide. Patients achieving a complete response after 3 cycles received no further therapy. Those with a partial response received 21 Gy IFRT. Subjects that experienced a low-risk relapse after treatment with chemotherapy alone were eligible for the salvage regimen. Salvage included 2 cycles of ifosfamide/venorelbine followed by 2 cycles of DECA (dexamethasone/etoposide/cisplatin/cytarabine) and 21 Gy IFRT. We assessed intensive-therapy-free-survival (ITFS) as a primary endpoint. ITFS was defined as event free survival (EFS) without need for high dose radiation or stem cell transplant.
Results: Four year EFS for the 278 eligible patients was 79.8%; overall survival was 99.6%. Among 88 PR subjects who received IFRT, 15 events (2 SMN) occurred. Among 162 CR subjects without IFRT, 1 SMN and 36 relapses (4 high risk) occurred. Among 20 subjects that completed the salvage regimen there were 5 relapses with a median time to relapse of 14 months; median follow-up of the other 15 subjects is 52 months. The 4 year ITFS for the entire cohort was 89%. 48% of subjects were successfully treated without radiation therapy.
Conclusions: The treatment strategy allowed for almost half of subjects to be successfully treated with a chemotherapy regimen with minimal anticipated long term toxicity and no radiation therapy. The incorporation of a salvage regimen of conventional chemotherapy and IFRT for those that relapsed after chemotherapy alone allowed for 89% of subjects to be successfully treated without high dose chemotherapy/stem cell rescue.