Risk and response adapted therapy for early stage Hodgkin lymphoma: a prospective multicenter study of the Australasian Leukaemia and Lymphoma Group/Trans-Tasman Radiation Oncology Group

Abstract

In this prospective, multicenter, non-randomized study for patients with stage I–II Hodgkin lymphoma, group 1 (without risk-factors [RF]) had three cycles of ABVD chemotherapy (adriamycin, bleomycin, vinblastine, and dacarbazine) and group 2 (any of bulk, extranodal site, >3 regions, raised erythrocyte sedimentation rate [ESR]) and group 3 (B-symptoms) received four cycles. Involved field radiotherapy (IFRT) 30 Gy was given after adequate chemotherapy response. Five-year overall survival and freedom from progression (FFP) were 96% (95% confidence interval [CI] 91–98%) and 90% (84–94%), respectively. Five-year FFP was 97% (90–99%), 89% (75–95%), and 73% (52–86%) for groups 1, 2, and 3, respectively. In patients with RF, chemotherapy responses of complete response unconfirmed (CRu), partial response (PR), and stable disease (SD) were associated with FFP of 90%, 86%, and 62% (p=0.17), and CR/no CR on functional imaging with FFP of 90%/67%, respectively (p=0.05). The 97% FFP in group 1 compares favorably with previously reported results from cooperative trial groups. Intensification of therapy warrants study in patients with RF and a poor chemotherapy response.

Keywords:

• Lymphoma and Hodgkin disease
• radiation
• chemotherapeutic approaches
• prognostication

Acknowledgements

The following clinicians and data managers contributed to the conduct of the study:

Jane Matthews, Peter MacCallum Cancer Centre; Sophie Katsabanis, Peter MacCallum Cancer Centre; Sheryl Campbell, David Joske, Sir Charles Gairdner Hospital; Vu Nguyen, John Gallo Liverpool Hospital; Marivic Lagleva, Jay Jayamoham, Westmead Hospital; Daniel Goodwin, Noemi Horvath, Royal Adelaide Hospital; Trish Jenkins, George Quong, ARMC Repat Centre; Julie Forbes, Monash Medical Centre; Claire Bligh, Yvonne Zissiadis, Prince of Wales Hospital; Peter Shuttleworth, Kuen Ho Lieu, Royal Melbourne Hospital; Isobel Marshall, Philip Campbell, Michael Francis, Ballarat Hospital; Judy Murray, Peter Dady, Wellington Hospital; Jan Kilmurray, Sandra Deveridge, Peter O'Brien, Mater Newcastle Hospital; Steven Ivanhoe, Paula Marlton, Princess Alexandra Hospital; Roslyn Ristuccia, Tim Brighton, Peter Graham, St George Hospital; Nikki Cross, Jeremy Shapiro, Alfred Hospital; Carmel Mellican, Vinod Ganju, Frankston Hospital; Sandra Chaning-Pearce, Simon Allan, Palmerston North Hospital; Louise Kerr, Paul Vincent, Michael Jackson, Royal Prince Alfred Hospital; Julie Hollis, Pauline Warburton, Elias Nasser, Wollongong Hospital; Nicole Humphreys, Craig Underhill, Craig Macleod, Albury Hospital; Adrienne See, Kerry Taylor, Kumar Gogna, Mater Brisbane Hospital; Emma Gray, Ivon Burns, St Vincent's Hospital (Melbourne); Sue Yeend, Ian Lewis, Queen Elizabeth Hospital; Jacqui Keller, Simon Durrant, Gary Pratt, Royal Brisbane Hospital; Janfrey Doak, Bernie Fitzharris, Brigid Hickey, Christchurch Hospital; Elaine Yeow, Roger McLennan, Rod Lynch, Andrew Love Cancer Centre; Candace Carter, David Byram, Launceston Hospital.

Declaration of interest: This work was supported by Amgen Australia.