Cancer Health Center

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OS of patients who receive chemotherapy alone may be similar to that for patients who receive both chemotherapy and LD-IFRT, despite a difference in EFS. This results from the ability to effectively salvage patients who relapse after initial therapy.[9,21,25] If this potential can be accomplished with relatively nontoxic salvage therapy, then initial treatment with less-intense therapy may be appropriate. If, however, salvage therapy results in a substantial risk for late events such as cardiac failure or secondary malignancies, less-intense initial therapy would be unwise. Thus, it will be important to evaluate prognostic factors that may influence the magnitude of the EFS benefit that derives from the use of LD-IFRT in patients achieving a CR to initial chemotherapy. In the German study, the benefit of radiation therapy was greater in patients with advanced-stage disease at presentation. Other potential prognostic factors may include histology, erythrocyte sedimentation rate, bulk disease, and presence of symptoms.

Accepted Treatment Strategies for Newly Diagnosed Children and Adolescent Patients with Hodgkin Lymphoma

LD-IFRT includes radiation dosages between 15 Gy and 25 Gy.

Low-Risk Disease (stages I-IIA; no bulk; no B symptoms)

• VAMP � 4 plus LD-IFRT.[16]
• COPP/ABV hybrid � 4 plus LD-IFRT.[9]
• ABVE � 2 to 4 and LD-IFRT (2 vs. 4 cycles based on early response).[15]
• OEPA (males) or OPPA (females) � 2 and LD-IFRT (German studies suggest that these patients may not require radiation therapy if a CR is obtained).[21,26]

Event-free survival (EFS) rate: Approximately 92%.[9,15,16,21,26]

Overall survival (OS) rate: Approximately 98%.[9,15,16,21,26]

Intermediate-Risk Disease (all stage I and II patients not classified as early stage; stage IIIA; stage IVA)

• COPP/ABV � 6 plus LD-IFRT.[9]
• ABVE-PC � 3 or 5 plus LD-IFRT (3 vs. 5 cycles based on early response).[13][Level of evidence: 1iiDi]
• OPPA/OEPA � 2; COPP � 2 (girls) or COPDAC x 2 (boys), plus LD-IFRT.[11,21,26]

EFS rate: Approximately 85%.[9,13,21,26]

OS rate: Approximately 93%.[9,13,21,26]

High-Risk Disease (stages IIIB, IVB)

• ABVE-PC � 3 or 5 plus LD-IFRT (3 vs. 5 cycles based on early response).[13][Level of evidence: 1iiDi]
• Intensive chemotherapy with cytarabine/etoposide, COPP/ABV or CHOP (2 cycles of each) plus LD-IFRT.[9]
• OPPA/OEPA � 2; COPP � 4 (girls) or COPDAC x 4 (boys), plus LD-IFRT.[11,21,26]

EFS rate: Approximately 83%.[9,13,21,26]

OS rate: Approximately 94%.[9,13,21,26]

Nodular lymphocyte-predominant Hodgkin lymphoma

Both children and adults treated for nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) have a favorable outcome, particularly when the disease is localized (stage I), as it is for most patients.[27,28,29,30,31,32] A retrospective study that included 210 adults with NLPHL found that only 8 of 32 deaths in these patients could be attributed directly to Hodgkin lymphoma, with most of the remaining deaths being the result of treatment-related toxicity (both acute and long-term).[28] Thus, for both adults and children, treatment for NLPHL focuses on reducing initial therapy to reduce long-term treatment-related morbidity and mortality.