Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Low-Risk Childhood Hodgkin Lymphoma
Treatment of low-risk childhood Hodgkin lymphoma may include combination chemotherapy with or without low-doseradiation therapy to involved areas.
Check for U.S. clinical trials from NCI's list of cancer...
ABVD: doxorubicin plus bleomycin plus vinblastine plus dacarbazine.
MOPP: mechlorethamine plus vincristine plus procarbazine plus prednisone.
MOPP/ABV hybrid: mechlorethamine plus vincristine plus procarbazine plus prednisone/doxorubicin plus bleomycin plus vinblastine.
Stanford V: doxorubicin plus vinblastine plus mechlorethamine plus etoposide plus vincristine plus bleomycin plus prednisone.
MOPPEBVCAD: mechlorethamine plus vincristine plus procarbazine plus prednisone plus epidoxorubicin plus bleomycin plus vinblastine plus lomustine plus doxorubicin plus vindesine.
Patients are designated as having advanced favorable Hodgkin lymphoma (HL) if they have clinical stage III or stage IV disease and three or fewer risk factors on the International Prognostic Index for HL, which corresponds to a freedom-from-progression at greater than 60% at 5 years with combination chemotherapy.
ABVD therapy for 6 to 8 months is as effective as 12 months of MOPP alternating with ABVD, and both are superior to MOPP alone in terms of failure-free survival (FFS) (50% vs. 36% with a 14-year median follow-up; P = .03).[2,3][Level of evidence: 1iiA] The Intergroup trial comparing ABVD with MOPP/ABV hybrid showed equivalent efficacy in FFS and overall survival (OS), but increased toxic effects in the hybrid arm, especially from second malignancies.[Level of evidence: 1iiA] A prospective randomized study, from the Medical Research Council (MRC) (MRC-UKLG-LY09), of 807 patients compared ABVD with two multidrug regimens also incorporating etoposide, chlorambucil, vincristine, and procarbazine. With 52 months' median follow-up, the 3-year event-free survival was 75% (confidence interval [CI], 71%-79%) for all three regimens, and 88% to 90% OS (CI, 84%-93%) for all three regimens, but there were significantly fewer toxic effects with ABVD.[Level of evidence: 1iiA] Stanford V is an alternative drug combination that was clinically evaluated in the Eastern Cooperative Oncology Group (ECOG) (ECOG-2496) trial. A prospective randomized trial of 355 patients compared Stanford V to ABVD and a variation of MOPP/ABV (MOPPEBVCAD). With a median follow-up of 5.1 years, the FFS was worse for patients on Stanford V compared with those on the other regimens (54% vs. 78% and 81% at 5 years; P < .01).[Level of evidence: 1iiDiii]
In a meta-analysis of 1,740 patients treated on 14 different trials, no improvement was observed in 10-years' OS for patients with advanced-stage HL who received combined modality therapy versus chemotherapy alone.[Level of evidence: 1iiA] Three prospective randomized trials and a meta-analysis did not show a benefit in OS from the addition of consolidative radiation therapy to chemotherapy for patients with advanced-stage disease.[9,10,11,12] The lack of difference in OS was attributed to a greater number of second malignancies and poorer response and survival after relapse among patients who received combined modality therapy.