Dose-Intensive Response-Based Chemotherapy and Radiation Therapy for Children and Adolescents With Newly Diagnosed Intermediate-Risk Hodgkin Lymphoma: A Report From the Children%26apos;s Oncology Group Study AHOD0031

作者：Friedman Debra L^*; Chen Lu; Wolden Suzanne; Buxton Allen; McCarten Kathleen; FitzGerald Thomas J; Kessel Sandra; De Alarcon Pedro A; Chen Allen R; Kobrinsky Nathan; Ehrlich Peter; Hutchison Robert E; Constine Louis S; Schwartz Cindy L

来源：Journal of Clinical Oncology, 2014, 32(32): 3651-3658.

DOI：10.1200/JCO.2013.52.5410

Purpose The Children%26apos;s Oncology Group study AHOD0031, a randomized phase III study, was designed to evaluate the role of early chemotherapy response in tailoring subsequent therapy in pediatric intermediate-risk Hodgkin lymphoma. To avoid treatment-associated risks that compromise long-term health and to maintain high cure rates, dose-intensive chemotherapy with limited cumulative doses was used. %26lt;br%26gt;Patients and Methods %26lt;br%26gt;Patients received two cycles of doxorubicin, bleomycin, vincristine, etoposide, cyclophosphamide, and prednisone (ABVE-PC) followed by response evaluation. Rapid early responders (RERs) received two additional ABVE-PC cycles, followed by complete response (CR) evaluation. RERs with CR were randomly assigned to involved-field radiotherapy (IFRT) or no additional therapy; RERs with less than CR were nonrandomly assigned to IFRT. Slow early responders (SERs) were randomly assigned to receive two additional ABVE-PC cycles with or without two cycles of dexamethasone, etoposide, cisplatin, and cytarabine (DECA). All SERs were assigned to receive IFRT. %26lt;br%26gt;Results %26lt;br%26gt;Among 1,712 eligible patients, 4-year event-free survival (EFS) was 85.0%: 86.9% for RERs and 77.4% for SERs (P %26lt; .001). Four-year overall survival was 97.8%: 98.5% for RERs and 95.3% for SERs (P %26lt; .001). Four-year EFS was 87.9% versus 84.3% (P = .11) for RERs with CR who were randomly assigned to IFRT versus no IFRT, and 86.7% versus 87.3% (P = .87) for RERs with positron emission tomography (PET) -negative results at response assessment. Four-year EFS was 79.3% versus 75.2% (P = .11) for SERs who were randomly assigned to DECA versus no DECA, and 70.7% versus 54.6% (P = .05) for SERs with PET-positive results at response assessment. %26lt;br%26gt;Conclusion %26lt;br%26gt;This trial demonstrated that early response assessment supported therapeutic titration (omitting radiotherapy in RERs with CR; augmenting chemotherapy in SERs with PET-positive disease). Strategies directed toward improved response assessment and risk stratification may enhance tailoring of treatment to patient characteristics and response.

• 出版日期2014-11-10