Risk based and response adapted radiation therapy for children and adolescents with newly diagnosed advanced stage Hodgkin lymphoma treated with ABVD chemotherapy: a report from the Indian pediatric oncology group study InPOG-HL-15-01

Abstract

This multi-centric prospective study (InPOG-HL-15-01) assessed epidemiological, clinical and outcome data of advanced stage Hodgkin Lymphoma (IIB, III and IV) in children and adolescents (N = 262). Chemotherapy regimen was ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and radiotherapy (RT) was restricted to patients with bulky disease at diagnosis or with suboptimal response at early response assessment (ERA). ERA revealed complete response in 175 (68.1%), partial response in 77 (29.9%), stable disease in 2 (0.8%), and progressive disease in 3 (1.2%) patients. RT was administered to 111 (97 bulky disease, 14 suboptimal response) patients. Five-year event free (EFS) and overall survival for the whole cohort was 81.1% and 90.8% respectively. On multivariate analysis, the only statistically significant predictor of EFS was use of RT (89% versus 74.2%; p-value <0.001). This study reinforces the benefit of consolidative RT in bulky disease and in those with suboptimal response at ERA on an ABVD backbone.

Keywords:

• Hodgkin lymphoma
• chemotherapy
• ABVD
• radiotherapy
• advanced stage

Acknowledgements

We would like to thank the patients, their families and caregivers, and the study investigators, coordinators, and nurses who participated in this study. We acknowledge the contribution of Soma De (Saroj Gupta Cancer Centre and Research Institute, West Bengal), Pritanjali Singh (AIIMS, Patna, Bihar), Jayanthi Srirambhatla (MNJ Cancer Hospital Hyderabad, Telangana), Krishnakumar Rathnam (Meenakshi Mission Hospital and Research Centre, Madurai, Tamil Nadu), Sirisha Rani (Rainbow Children Hospital, Hyderabad, Telangana), Priya Kumari (Regional Cancer Centre, Thiruvananthapuram), Biswajit Dubashi (Jawaharlal Institute of Postgraduate Medical Education & Research, JIPMER, Puducherry), Nandini Hazarika,(Madhukar Rainbow Children’s Hospital, Delhi), Sunil Bhat (Mazumdar Shaw Medical Center, Bangalore), Arun Seshachalam (GVN Hospital (P) Ltd. – Multispecialty Hospital Trichy, Tamil Nadu), and Poonam Bagai (CanKids).

Author contributions

S. Jain performed data analysis and wrote initial manuscript. S. Bakhshi, A. Mahajan, R.S Arora, V. Dinand, M. Kalra, J. Chandra reviewed and revised the final manuscript. A. Mahajan, R.S Arora, V. Dinand, M. Kalra, J. Chandra, S. Jain, P. Mandal designed study. A. Sharma designed the statistical analysis. R. Seth, N. Verma M. Singh, V. Radhakrishnan, A Taluja, S Thulkar, A Biswas and all other authors co‐ordinated and supervised data collection.

Disclosure statement

All the authors declare no competing financial interests.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author [SJ].

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.