HD10: Investigating reduction of combined modality treatment intensity in early stage Hodgkin's Lymphoma. Interim analysis of a randomized trial of the German Hodgkin's Study Group (GHSG)

English

Reviewer: Ryan Smith , MD
OncoLink
Ultima Vez Modificado: 14 de mayo del 2005

Presenter: V. Diehl
Presenter's Affiliation: German Hodgkin's Study Group
Type of Session: Scientific

Background

Patients with early stage Hodgkin's lymphoma (HL) have an excellent prognosis
This is especially true in patients without risk factors, defined by this group as a large mediastinal mass, high ESR, 3 or more areas involved, or extranodal disease
The current thrust of research in HL is to reduce the amount of therapy these patients require, in attempts to reduce toxicity
This study investigates less intensive treatment in patients with clinical stage I-II HL without risk factors

Materials and Methods

1131 patients were randomized in a 2x2 factorial design between ABVD x2 vs. ABVD x4 and involved field radiation (IF-RT) to 20 Gy vs. 30 Gy
Patients were equally balanced with respect to age, gender, performance status, and stage
Median follow up was 28 months

Results

There was more toxicity in the group that received 4 cycles of ABVD, with respect to hair loss, leukopenia, and infection, though none of these reached statistical significance
There was no increase in second malignancies in any arm
Complete responses were seen in 98% of patients in all arms
Progression free survival was similar in all arms (96%)
Overall survival was similar in all arms (98%)
There were 13 deaths, with 5 from HL and 5 from treatment-many from bleomycin induced pulmonary toxicity
There have been 10 second malignancies: 5 solid malignancies, 4 NHL, 1 AML

Author's Conclusions

This trial confirms the excellent results from the HD7 trial, looking at ABVDx4 + low dose radiation
There is no difference in PFS or OS between the arms with reduced treatment
There may be a reduced toxicity with less chemotherapy. It is logical that the same will be true for reduced radiation, though it could not be proven from this data

Clinical/Scientific Implications

HL is usually readily curable, though the toxicity of therapy can be detrimental in these young patients. It appears that ABVDx2 cycles is as efficacious to 4 cycles and that 20 Gy is equivalent to 30 Gy. However, with a median follow up of just over two years, this cannot be accepted as standard just yet. What may be most interesting is that this study serves as the impetus for the German group's next study, which is using PET scans after treatment to dictate further treatment. Using functional imaging such as this may lead to the individual treatment design that has long been awaited in HL.