ABVD Alone versus Radiation-Based Therapy in Limited-Stage Hodgkin's Lymphoma

Abstract

BACKGROUND Chemotherapy plus radiation treatment is effective in controlling stage IA or IIA nonbulky Hodgkin’s lymphoma in 90% of patients but is associated with late treatment-related deaths. Chemotherapy alone may improve survival because it is associated with fewer late deaths. METHODS We randomly assigned 405 patients with previously untreated stage IA or IIA non-bulky Hodgkin’s lymphoma to treatment with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) alone or to treatment with subtotal nodal radiation therapy, with or without ABVD therapy. Patients in the ABVD-only group, both those with a favorable risk profile and those with an unfavorable risk profile, received four to six cycles of ABVD. Among those assigned to subtotal nodal radiation therapy, patients who had a favorable risk profile received subtotal nodal radiation therapy alone and patients with an unfavorable risk profile received two cycles of ABVD plus subtotal nodal radiation therapy. The primary end point was 12-year overall survival. RESULTS The median length of follow-up was 11.3 years. At 12 years, the rate of overall survival was 94% among those receiving ABVD alone, as compared with 87% among those receiving subtotal nodal radiation therapy (hazard ratio for death with ABVD alone, 0.50; 95% confidence interval [CI], 0.25 to 0.99; P = 0.04); the rates of freedom from disease progression were 87% and 92% in the two groups, respectively (hazard ratio for disease progression, 1.91; 95% CI, 0.99 to 3.69; P = 0.05); and the rates of event-free survival were 85% and 80%, respectively (hazard ratio for event, 0.88; 95% CI, 0.54 to 1.43; P = 0.60). Among the patients randomly assigned to ABVD alone, 6 patients died from Hodgkin’s lymphoma or an early treatment complication and 6 died from another cause; among those receiving radiation therapy, 4 deaths were related to Hodgkin’s lymphoma or early toxic effects from the treatment and 20 were related to another cause. CONCLUSIONS Among patients with Hodgkin’s lymphoma, ABVD therapy alone, as compared with treatment that included subtotal nodal radiation therapy, was associated with a higher rate of overall survival owing to a lower rate of death from other causes. (Funded by the Canadian Cancer Society and the National Cancer Institute; HD.6 ClinicalTrials.gov number, NCT00002561.)

The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease

“…Overall survival (OS) rates were similar in each study, although final analysis of the National Cancer Institute of Canada Clinical Trials Group (NCIC-CTG) Eastern Cooperative Oncology Group (ECOG) HD.6 study showed superior OS for chemotherapy alone at 12 years due to increased late events/toxicity in the CMT arm. 34 A recent analysis that combined individual patient data from the NCIC-CTG HD.6 and German Hodgkin Study Group (GHSG) HD10/HD11 studies showed that disease control (ie, 8-year time to treatment progression) was improved by 6% with CMT versus chemotherapy alone, whereas OS rates were identical at 95%. 35 Similar data regarding the improvement in disease control (ie, event-free survival) with similar OS was seen in a pediatric HL study randomizing patients who achieved CR on CT to IFRT or no radiotherapy.…”

Advances in the treatment of Hodgkin lymphoma

“…However, the chemotherapy-only arm was closed on the basis of an interim analysis due to an increased number of events so that all patients with a negative PET now receive additional RT. Long-term results from a trial conducted by the National Cancer Institute of Canada (NCIC) and the Eastern Cooperative Oncology Group (ECOG) indicate that chemotherapy-only approaches appear possible in patients with early unfavorable HL, at least in those with non-bulky disease [10]. The 276 patients with early HL presenting with unfavorable clinical features included in this trial were randomized to receive either 4-6 cycles of ABVD alone or two cycles of ABVD followed by STNI.…”

ABVD vs. radiotherapy in early stage Hodgkin’s lymphoma

“…The recently published paper on the results of the HD.6 trial conducted by the NCIC Clinical Trials Group and the Eastern Cooperative Oncology Group reported on increased death rates from other causes than HL in patients with unfavorable risk profile undergoing (now outdated) STNRT [15].…”