Does bulky disease at diagnosis influence outcome in childhood Hodgkin’s disease and require higher radiation doses? Results from the German–Austrian Pediatric Multicenter Trial DAL-HD-90

Dieckmann, Karin; Pötter, Richard; Hofmann, Johanna; Heinzl, Harald; Wagner, W.; Schellong, G

doi:10.1016/s0360-3016(03)00125-1

Cited by 29 publications

(8 citation statements)

References 27 publications

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“…However, several factors such as disease stage, bulk, B symptoms and early response to CHT are likely to continue to influence the choice and success of therapy. However, the situation is complicated by the fact that these factors are interrelated and are frequently co-dependent and that they are used in therapeutic schemes to stratify patients into risk groups receiving less or more intense therapy [77]. For example, in the Polish therapeutic protocol for childhood HL, the stage, presence of B symptoms and extensive lymphatic mass including bulky disease determine the number of CHT cycles and also the use, the field and the total dose of RTX.…”

Section: Discussionmentioning

confidence: 99%

Serum Soluble Interleukin‐2 Receptor, Beta2‐Microglobulin, Lactate Dehydrogenase and Erythrocyte Sedimentation Rate in Children with Hodgkin’s Lymphoma

Bień

Balcerska

2009

Scand J Immunol

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The study was to determine clinical utility of serum soluble interleukin (IL)‐2 receptor (sIL‐2Rα), β2‐microglobulin (β2‐M), lactate dehydrogenase (LDH) and erythrocyte sedimentation rate (ESR) as markers of diagnosis, prognosis and monitoring of response to therapy in childhood Hodgkin’s lymphoma (HL). The markers were measured prospectively before treatment and in complete remission (CR) during and after therapy in 30 children with HL (F/M:19/11; median age: 11.3 years) and once in 50 healthy children (F/M: 24/26; median age: 8.7 years). Median pretreatment levels of all analysed markers were significantly higher than in healthy controls. Increased pretreatment sIL‐2Rα, LDH and ESR correlated with bulky disease; sIL‐2Rα, β2‐M and ESR with presence of B symptoms and sIL‐2Rα and LDH with advanced HL stages. There was a correlation between sIL‐2Rα and LDH and between β2‐M and ESR. The levels and rates of elevated markers reflected well the response to chemotherapy, decreasing significantly when patients achieved CR and further on with therapy continuation. Since all patients survived thus the markers’ value to predict the outcome was not established. Serum sIL‐2Rα, β2‐M, LDH and ESR may act as markers for diagnostics and used in monitoring of therapy effectiveness in childhood HL. The markers were also increased in subgroups of patients with unfavourable clinical features; however, small sample size of the study did not allow to draw conclusion on their prognostic roles. We were also not able to establish the influence of markers on event free survival and overall survival because all children survived independent of initial clinical characteristics and pretreatment levels of sIL‐2Rα, β2‐M, LDH and ESR.

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Section: Discussionmentioning

confidence: 99%

Serum Soluble Interleukin‐2 Receptor, Beta2‐Microglobulin, Lactate Dehydrogenase and Erythrocyte Sedimentation Rate in Children with Hodgkin’s Lymphoma

Bień

Balcerska

2009

Scand J Immunol

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“…The first multi-modality therapies began with the Stanford pediatric protocols [1, 2]. Cure rates improved with dose-intensified treatment regimens utilizing a combination of chemotherapy and IFRT [3–4]; however, treatment-related late toxicity, particularly as related to radiation therapy, has continued to drive the search for risk-adapted treatment regimens that are specifically tailored to an individual’s treatment response without compromising outcome [5–10]. …”

Section: Introductionmentioning

confidence: 99%

Patterns of Relapse From a Phase 3 Study of Response-Based Therapy for Intermediate-Risk Hodgkin Lymphoma (AHOD0031): A Report From the Children's Oncology Group

Dharmarajan¹,

Friedman²,

Schwartz³

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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Purpose The study was designed to determine whether response-based therapy improves outcomes in intermediate-risk Hodgkin lymphoma. We examined patterns of first relapse in the study. Methods From 9/02 – 7/10, 1712 patients <22 yrs of age with stage I–IIA with bulk, I–IIAE, I–IIB, and IIIA–IVA with/without bulk were enrolled. Patients were categorized as rapid (RER) or slow early responders (SER) after 2 cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (ABVE-PC). SER patients were randomized to 2 additional ABVE-PC cycles or augmented chemotherapy with 21Gy IFRT. RER patients were stipulated to undergo 2 additional ABVEPC cycles and were then randomized to 21Gy IFRT or no further treatment if complete response (CR) was achieved. RER without CR patients were non-randomly assigned to 21Gy IFRT. Relapses were characterized with respect to site (initial, new or both; and initial bulk or initial non-bulk), and IFRT field (in-field, out-of-field, or both). Patients were grouped by treatment assignment (SER; RER/no CR; RER/CR/IFRT; and RER/CR/no IFRT). Summary statistics were reported. Results At 4-year median follow-up, 244 patients had relapsed, 198 of whom were fully evaluable for review. Those who progressed on treatment (n=30) or lacked relapse imaging (n=16) were excluded. Median time to relapse was 12.8 months. Of the 198 patients, 30% were RER/no CR, 26% were SER, 26% were RER/CR/no IFRT, 16% were RER/CR/IFRT, and 2% remained uncategorized. 74% and 75% relapses involve initially bulky and non-bulky sites, respectively. First relapses rarely occurred at exclusively new or out-of-field sites. In contrast, relapses usually occurred at nodal sites of initial bulky and non-bulky disease. Conclusion While response-based therapy has helped define treatment for select RER patients, it has not improved outcome for SER patients or facilitated refinement of IFRT volumes or doses.

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“…Die konsekutiven, prospektiven DAL / GPOH-HD Studien haben seit 1990 Heilungsraten von ü ber 90 % f ü r alle Stadien und langj ä hrige Ü berlebensraten von 94 % trotz kontinuierlicher Reduktion von Bestrahlungsvolumina und Bestrahlungsdosen in Kombination mit einer stadienadaptierten Chemotherapie erbracht (8,9,25,26). Die in den 90er-Jahren etablierten prospektiven zentralen Review-Prozesse sind inzwischen zum festen Bestandteil der HD-Studienprojekte geworden und werden im Folgeprotokoll EuroNet PHL-C1 fortgesetzt (GPOH-HD 95: 1018 Pat., GPOH-HD 2002: 671 Patienten mit 750 referenzradioonkologischen Begutachtungen) (pers ö nliche Mitteilung aus der Interimsanalyse anl ä sslich des Studientreffens am 16.11.…”

Section: Euronet -Phl -C1unclassified

“…Institut 1 Klinik und Poliklinik f ü r Strahlentherapie und Radioonkologie der Universit ä t Leipzig 2 Klinik und Poliklinik f ü r Strahlentherapie und Radioonkologie der Universit ä t K ö ln 3 Klinik und Poliklinik f ü r Strahlentherapie und Radioonkologie der Universit ä t Wien 4 Klinik und Poliklinik f ü r Strahlentherapie und Radioonkologie der Universit ä t L ü beck 5 Klinik und Poliklinik f ü r Strahlentherapie und Radioonkologie der Universit ä t W ü rzburg 6 Klinik und Poliklinik f ü r Strahlentherapie und Radioonkologie der Universit ä t Magdeburg 7 Klinik und Poliklinik f ü r Strahlentherapie und Radioonkologie der Universit ä t G ö ttingen 8 Klinik und Poliklinik f ü r Strahlentherapie und Radioonkologie der Medizinischen Hochschule Hannover 9 Klinik und Poliklinik f ü r Strahlentherapie und Radioonkologie der Universit ä t D ü sseldorf 10 Klinik und Poliklinik f ü r Strahlentherapie und Radioonkologie der Universit ä t Berlin 11 Katharinenhospital Stuttgart 12 Klinik und Poliklinik f ü r Strahlentherapie und Radioonkologie der Universit ä t M ü nster 13 Klinik und Poliklinik f ü r Strahlentherapie und Radioonkologie der Universit ä t Heidelberg 14 Klinik und Poliklinik f ü r Strahlentherapie und Radioonkologie der Universit ä t Hamburg 15 Paul Scherrer Institut Villigen (Schweiz) 16 Klinik und Poliklinik f ü r Strahlentherapie und Radioonkologie der Universit ä t Regensburg 17 Vorstand der GPOH 18 Vorstand der GPOH 19 Klinik und Poliklinik f ü r Strahlentherapie und Radioonkologie der Universit ä t Homburg / Saar…”

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Anforderungen und Leistungsprofile der Arbeitsgemeinschaft Pädiatrische Radioonkologie (APRO): Eine Bestandsaufnahme und Darstellung zukünftiger Entwicklungen

Kortmann

Bongartz²,

Dieckmann³

et al. 2007

Klin Padiatr

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In the future, modern technology (intensity modulated radiotherapy, proton therapy, inclusion of imaging in treatment planning) will be part of disease management in pediatric oncology. A working group for modern radiotherapy technology was established to enhance this development. Prospective studies of the GPOH with primary or secondary radio-oncological questions require the implementation of corresponding tasks (documentation, monitoring, etc.) in order to meet future demands on clinical trials and to achieve the aims of the protocol. Consequently adequate financial support is indispensable.

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Does bulky disease at diagnosis influence outcome in childhood Hodgkin’s disease and require higher radiation doses? Results from the German–Austrian Pediatric Multicenter Trial DAL-HD-90

Cited by 29 publications

References 27 publications

Serum Soluble Interleukin‐2 Receptor, Beta2‐Microglobulin, Lactate Dehydrogenase and Erythrocyte Sedimentation Rate in Children with Hodgkin’s Lymphoma

Serum Soluble Interleukin‐2 Receptor, Beta2‐Microglobulin, Lactate Dehydrogenase and Erythrocyte Sedimentation Rate in Children with Hodgkin’s Lymphoma

Patterns of Relapse From a Phase 3 Study of Response-Based Therapy for Intermediate-Risk Hodgkin Lymphoma (AHOD0031): A Report From the Children's Oncology Group

Anforderungen und Leistungsprofile der Arbeitsgemeinschaft Pädiatrische Radioonkologie (APRO): Eine Bestandsaufnahme und Darstellung zukünftiger Entwicklungen

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