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 language | English (US) |
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Pages (from-to) | 3065-3069 |
Number of pages | 5 |
Journal | Annals of Oncology |
Volume | 24 |
Issue number | 12 |
DOIs | |
State | Published - Dec 2013 |
Funding
SH is employed by Genentech and has equity ownership in Roche. AE has received honorarium from Millenium and The Takeda Oncology Company. RM has received hororaria from Lilly and Celgene. In addition, the NCIC Clinical Trials Group of which RM was Director received research funding from Amgen Canada, Ariad Pharma, Astex Therapeutics, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Janssen Ortho, Novartis, Oncothyreon, Pfizer, Roche, Sanofi-Aventis and Schering Canada. All remaining authors have declared no conflicts of interest. PB has received research funding from Millenium and The Takeda Oncology Company alongside travel grants from GmbH.
Keywords
- Chemotherapy
- Clinical trial
- Combined modality therapy
- Hodgkin lymphoma
- Progression-free survival
- Radiation therapy
ASJC Scopus subject areas
- Hematology
- Oncology