title: Risk-adapted, combined-modality therapy with VAMP/COP and response-based, involved-field radiation for unfavorable pediatric Hodgkin's disease.
abstract: OBJECTIVE
  To evaluate the efficacy of vinblastine, doxorubicin, methotrexate, and prednisone (VAMP) and cyclophosphamide, vincristine, and procarbazine (COP) chemotherapy and response-based, involved-field radiation, a combined-modality regimen that limits doses of alkylating agents, anthracyclines, and radiation, in children with advanced and unfavorable Hodgkin's disease.
  
  
  METHODS
  From 1993 to 2000, 159 children and adolescents with unfavorable Hodgkin's disease received three alternating cycles (total of six cycles) of VAMP/COP chemotherapy followed by response-based, involved-field radiation therapy: 15 Gy was administered to patients achieving a complete response, and 25.5 Gy was administered to those achieving a partial response after the first two cycles of chemotherapy and to all sites of bulky lymphadenopathy. Unfavorable disease was defined as clinical stage I and II with bulky peripheral nodal disease greater than 6 cm, initial bulky mediastinal mass 33% or more of the intrathoracic diameter, and/or "B" symptoms and all stage III and IV.
  
  
  RESULTS
  Study enrollment was closed after an interim analysis estimated a 5-year event-free survival (EFS) rate below a predefined level. Disease presentation was localized (stage I/II) in 77 patients (48.4%) and advanced (stage III/IV) in 82 patients (51.6%). At a median follow-up of 5.8 years (range, 1.3 to 10.0 years), 38 patients had events, including relapse/progression (n = 35), second malignancy (n = 2), and accidental death (n = 1); nine relapses (25.7%) occurred greater than 4 years from diagnosis. Five-year survival and EFS estimates are 92.7% +/- 2.5% and 75.6% +/- 4.1%, respectively.
  
  
  CONCLUSIONS
  Risk-adapted combined-modality therapy with VAMP/COP and response-based, involved-field radiation therapy results in an unsatisfactory outcome for pediatric patients with unfavorable presentations of Hodgkin's disease.
authors.affiliation: Department of Hematology-Oncology, Radiological Sciences and Biostatistics, St Jude Children's Research Hospital and the University of Tennessee College of Medicine, Memphis, TN 38105, USA. melissa.hudson@stjude.org
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.forename: Matthew
authors.initials: M
authors.lastname: Krasin
authors.forename: Michael P
authors.initials: MP
authors.lastname: Link
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Donaldson
authors.forename: Catherine
authors.initials: C
authors.lastname: Billups
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Merchant
authors.forename: Larry
authors.initials: L
authors.lastname: Kun
authors.forename: Amy L
authors.initials: AL
authors.lastname: Billet
authors.forename: Sue
authors.initials: S
authors.lastname: Kaste
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Tarbell
authors.forename: Scott
authors.initials: S
authors.lastname: Howard
authors.forename: Alison M
authors.initials: AM
authors.lastname: Friedmann
authors.forename: Craig A
authors.initials: CA
authors.lastname: Hurwitz
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Young
authors.forename: Karen C
authors.initials: KC
authors.lastname: Marcus
authors.forename: Shesh
authors.initials: S
authors.lastname: Rai
authors.forename: Traci
authors.initials: T
authors.lastname: Cowan
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Weinstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D018450:Disease Progression; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D011379:Prognosis; D018570:Risk Assessment; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D011344:Procarbazine; D014747:Vinblastine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone; D008727:Methotrexate