ABSTRACT
Hodgkin's lymphoma (HL) in children and adolescents is highly curable, but children are at risk of long-term toxicity. The MDH-03 guidelines were established in order to decrease the burden of treatment in good-responder patients, and this report should be considered a step toward further optimization of treatment within large collaborative trials. We report the therapy and long-term outcomes of 417 children and adolescents treated according to the national guidelines, which were applied between 2003 and 2007 in France. The patients were stratified into three groups according to disease extension. Chemotherapy consisted of four cycles of VBVP (vinblastine, bleomycin, VP16, prednisone) in localized stages (G1/95 pts/23%), four cycles of COPP/ABV (cyclophosphamide, vincristine, procarbazine, prednisone, adriamycin, bleomycin, vinblastine) cycles in intermediate stages (G2/184 pts/44%) and three cycles of OPPA (vincristine, procarbazine, prednisone, adriamycin) plus three cycles of COPP in advanced stages (G3/138 pts/33%). Radiation therapy of the involved field was given to 97% of the patients, with the dose limited to 20 Gy in good responders (88%). With a median follow-up of 6.6 years, the 5-year event-free survival (EFS) and overall survival (OS) were 86.7% (83.1–89.7%) and 97% (94.5–98.1%), respectively. EFS and OS for G1, G2, and G3 were 98% and 100%, 81% and 97%, and 87% and 95%, respectively. Low-risk patients treated without alkylating agents and anthracycline had excellent outcomes and a low expected incidence of late effects. Intensification with a third OPPA cycle in high-risk group patients, including stage IV patients, allowed for very good outcomes, without increased toxicity.
Acknowledgments
The authors thank Geneviève Vaudre for help in data collection and registration. They also thank the associations “Recherche Maladies Hématologiques de l'Enfant” for financial support for the database and “Centre de Recherche en Oncologie et Hématologie Pédiatrique” for financial support for the manuscript. They also would like to thank all the investigators for their contribution in the MDH-03 registration:
Amiens: Dr Catherine Devoldere | |||||
Angers: Pr Philippe Moreau, Dr Isabelle Pellier | |||||
Besançon: Dr Sarah Cohen Beaussant, Dr Emmanuel Plouvier | |||||
Bordeaux: Dr Nathalie Aladjidi, Dr Yves Perel | |||||
Brest: Dr Philippe Lemoine | |||||
Caen: Dr Odile Minckes, | |||||
Clermont-Ferrand: Dr François Demeocq, Dr Justyna Kanold | |||||
Curie: Dr Sylvie Helfre, Dr Jean Michon, Dr Hélène Pacquement | |||||
Dijon: Dr Gérard Couillaud | |||||
Grenoble: Dr Corinne Armari-Alla, Pr Dominique Plantaz | |||||
IGR: Dr Samuel Abbou, Dr Odile Oberlin, Pr Dominique Valteau-Couanet | |||||
La Réunion: Dr Mathilde Jehanne, Dr Yves Reguerre | |||||
Lille: Dr Anne Lambilliotte, Dr Brigitte Nelken | |||||
Limoges: Dr Christophe Piguet | |||||
Lyon CAC (Léon Bérard): Dr Christophe Bergeron, Dr Line Claude, Dr Mathias Schell | |||||
Lyon Hémato: Pr Yves Bertrand, Dr Nathalie Garnier | |||||
Marseille Hémato: Dr Carole Coze, Dr Catherine Curtillet, Pr Gérard Michel | |||||
Nancy: Dr Pascal Chastagner, Dr Claudine Schmitt | |||||
Nantes: Dr Caroline Thomas | |||||
Nice: Dr Anne Deville, Pr Pierre-Simon Rohrlich | |||||
Poitiers: Pr Guillaume Levard, Dr Frédéric Millot | |||||
Reims: Pr Michel Abely, Dr Stéphanie Gorde-Grosjean, Dr Carole Munzer | |||||
Rennes:Virginie Gandemer | |||||
Rouen: Dr Pascale Schneider, Pr Jean-Pierre Vannier | |||||
St Etienne: Pr Jean-Louis Stephan | |||||
St Louis-Debré: Pr André Baruchel, Dr Benoit Brethon, Dr Josette Brière, Pr Eric De Kerviller, Dr Saliha Haouari, Dr Thierry Leblanc, Dr Brigitte Lescoeur, Dr Anne-France Ray-Lunven, Dr Elisa Seror, Dr Bogdana Tilea, Dr Karima Yakouben | |||||
Strasbourg: Dr Patrick Lutz | |||||
Toulouse: Dr Marlène Pasquet, Dr Geneviève Plat, Pr Hervé Rubie | |||||
Tours: Dr Pascale Blouin, Pr Emmanuel Gyan, Dr Odile Lejars | |||||
Trousseau: Dr Sabah Boudjemaa, Dr Aurore Coulomb, Dr Jean Donadieu, Pr Judith Landman-Parker, Pr Guy Leverger, Dr Arnaud Petit, Geneviève Vaudre |
Authors' contributions
Dr Coze, Dr Helfre, Pr. Landman-Parker, Dr Lambilliotte, Dr Leblanc, Dr Oberlin, Dr Pacquement, and Dr Schmitt designed the MDH-03 guidelines for the SFCE. All authors contributed to the collection of data. Dr Seror, Dr Donadieu, Dr Clavel, Pr. Landman-Parker and Dr Leblanc contributed to the writing of the manuscript. All authors approved the final version of the manuscript.
Declaration of interests
The authors declare no conflict of interest.