Impact of low‐dose involved‐field radiation therapy on pediatric patients with lymphocyte‐predominant Hodgkin lymphoma treated with chemotherapy: A report from the Children's Oncology Group

Abstract

Background Treatment of pediatric lymphocyte-predominant Hodgkin lymphoma (LPHL) is controversial but has typically consisted of both chemotherapy and radiation. Radiation therapy is associated with potential late effects in children and adolescents. We examined the impact of radiation therapy on long-term outcome of patients with LPHL treated on CCG-5942, a large pediatric cooperative group study of Hodgkin lymphoma. Procedure Eighty-two patients with LPHL were registered on CCG-5942. Fifty-two patients (63%) received chemotherapy alone; 29 patients (35%) received chemotherapy followed by involved-field radiation therapy (IFRT). Results The median follow-up of the LPHL patients is 7.7 years; 63 patients (77%) have > 5 years of follow-up. The 5-year event-free survival (EFS) and overall survival (OS) were 97% and 100%. Two relapses occurred, both in patients who did not receive IFRT. There were no significant differences in EFS or OS between patients who received or did not receive IFRT. Conclusions This subset analysis demonstrates the chemosensitivity of pediatric LPHL. Patients who had a complete response to chemotherapy had an excellent EFS and OS without the addition of radiotherapy.

Outcomes in intermediate‐risk pediatric lymphocyte‐predominant Hodgkin lymphoma: A report from the Children's Oncology Group

“…Among early‐stage patients with LPHL, COG AHOD03P1 demonstrated that 75% of stage IA patients can avoid chemotherapy after complete surgical resection alone and >90% can avoid IFRT while maintaining excellent outcomes when treated with three cycles of doxorubicin, vincristine, prednisone, and cyclophosphamide (AV‐PC) . The impact of low‐dose IFRT on patients with LPHL was evaluated previously on study CCG‐5942 . On this protocol, intermediate‐risk (group 2) patients (including stage I with adverse disease features, stage II with adverse disease features, and/or with clinical B symptoms, and stage III) received 6 cycles of cyclophosphamide, vincristine, prednisone, procarbazine, doxorubicin, bleomycin, and vinblastine (COPP/ABV) and were then randomized to IFRT or no further treatment if they achieved a CR .…”

Unfavorable presentation but comparable outcome: Presentation and outcome of children with nodular lymphocyte predominant Hodgkin lymphoma from India

“…In the past 15 years, studies in pediatric NLPHL (including a large recent prospective North American study) have focused on decreasing treatment in early stage NLPHL. Excellent overall survivals have been reported with complete nodal excision of Stage IA (especially when only a single node was involved), involved field radiotherapy alone in Stage IA disease, or lower intensity chemotherapy in early stage unresectable disease . Relapses in NLPHL have been found amenable to salvage chemotherapy, hence the trend toward decreasing the intensity of frontline therapy to minimize the risk of treatment toxicity and late effects .…”

Relapsed or poorly responsive nodular lymphocyte predominant Hodgkin lymphoma in children and adolescents – a report from the United Kingdom's Children's Cancer and Leukaemia Study Group

“…This is very encouraging and assuages concerns of widespread disease at relapse after surgery as the sole treatment. Moreover, the first line surgery alone approach will spare around 70–80% of patients the chemotherapy‐related acute and late toxicity without compromising cure rates in the 20–30% of patients who will relapse with this treatment strategy (Mauz‐Körholz et al , ; Appel et al , ).…”

“…Although excision lymph node biopsy as primary treatment in selected stage IA patients is a reasonable treatment option (Pellegrino et al, 2003;Mauz-K€ orholz et al, 2007;Appel et al, 2012;Shankar et al, 2012), a minority will relapse, mainly those who had incomplete resection. However, salvage after relapse appears to be relatively straight forward, as is shown in this retrospective report.…”

“…Recently, there has been a significant change in the treatment paradigm for patients with early stage disease, namely towards de‐escalation of treatment intensity. While this approach has been therapeutically effective in the majority (Pellegrino et al , ; Mauz‐Körholz et al , ; Appel et al , ; Shankar et al , ), a small but significant minority of patients either responds poorly to primary low intensity treatment or experiences a relapse. Compared to cHL, the prognostic determinants predictive of a poor treatment response are less clear in childhood nLPHL, although recently published literature appears to suggest that patients with variant histology tend to have poorer outcome when compared to those with typical nLPHL (Gloghini et al , ; Shankar et al , ).…”