An individual patient-data comparison of combined modality therapy and ABVD alone for patients with limited-stage Hodgkin lymphoma

A. E. Hay, B. Klimm, B. E. Chen, H. Goergen, L. E. Shepherd, M. Fuchs, M. K. Gospodarowicz, P. Borchmann, J. M. Connors, J. Markova, M. Crump, A. Lohri, J. N. Winter, B. Dörken, R. G. Pearcey, V. Diehl, S. J. Horning, H. T. Eich, A. Engert, R. M. Meyer*

*Corresponding author for this work

Research output: Contribution to journalArticle

36 Scopus citations

Abstract

Background: Treatment options for patients with nonbulky stage IA-IIA Hodgkin lymphoma include combined modality therapy (CMT) using doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) plus involved-field radiation therapy (IFRT), and chemotherapy with ABVD alone. There are no mature randomized data comparing ABVD with CMT using modern radiation techniques. Patients and methods: Using German Hodgkin Study Group HD10/HD11 and NCIC Clinical Trials Group HD.6 databases, we identified 588 patients who met mutually inclusive eligibility criteria from the preferred arms of HD10 or 11 (n = 406) and HD.6 (n = 182). We evaluated time to progression (TTP), progression-free (PFS) and overall survival, including in three predefined exploratory subset analyses. Results: With median follow-up of 91 (HD10/11) and 134 (HD.6) months, respective 8-year outcomes were for TTP, 93% versus 87%[hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.24-0.78]; for PFS, 89% versus 86% (HR 0.71, 95% CI 0.42-1.18) and for overall survival, 95% versus 95%(HR 1.09, 95% CI 0.49-2.40). In the exploratory subset analysis including HD10 eligible patients who achieved complete response (CR) or unconfirmed complete response (CRu) after two cycles of ABVD, 8-year PFS was 87% (HD10) versus 95% (HD.6) (HR 2.8; 95%CI 0.64-12.5) and overall survival 96% versus 100%. In contrast, among those without CR/CRu after two cycles of ABVD, 8-year PFS was 88% versus 74% (HR 0.35; 95%CI 0.16-0.79) and overall survival 95% versus 91%, respectively (HR 0.42; 95% CI 0.12-1.44). Conclusions: In patients with nonbulky stage IA-IIA Hodgkin lymphoma, CMT provides better disease control than ABVD alone, especially among those not achieving complete response after two cycles of ABVD. Within the follow-up duration evaluated, overall survivals were similar. Longer follow-up is required to understand the implications of radiation and chemotherapy-related late effects. Clinical trials: The trials included in this analysis were registered at ClinicalTrials.gov: HD10-NCT00265018, HD11-NCT00264953, HD.6-NCT00002561.

Original languageEnglish (US)
Article numbermdt389
Pages (from-to)3065-3069
Number of pages5
JournalAnnals of Oncology
Volume24
Issue number12
DOIs
StatePublished - Dec 1 2013

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Keywords

  • Chemotherapy
  • Clinical trial
  • Combined modality therapy
  • Hodgkin lymphoma
  • Progression-free survival
  • Radiation therapy

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

Hay, A. E., Klimm, B., Chen, B. E., Goergen, H., Shepherd, L. E., Fuchs, M., Gospodarowicz, M. K., Borchmann, P., Connors, J. M., Markova, J., Crump, M., Lohri, A., Winter, J. N., Dörken, B., Pearcey, R. G., Diehl, V., Horning, S. J., Eich, H. T., Engert, A., & Meyer, R. M. (2013). An individual patient-data comparison of combined modality therapy and ABVD alone for patients with limited-stage Hodgkin lymphoma. Annals of Oncology, 24(12), 3065-3069. [mdt389]. https://doi.org/10.1093/annonc/mdt389