title: APE chemotherapy for children with relapsed Hodgkin disease: a Pediatric Oncology Group trial.
abstract: BACKGROUND
  MOPP (mechlorethamine, vincristine, procarbazine, prednisone) and ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) are effective therapies for Hodgkin disease (HD) that may cause long-term toxicities in children. APE (cytosine arabinoside, cisplatin, etoposide) is a non-cross-resistant regimen with limited toxicities. We evaluated this regimen for patients with recurrent or refractory disease.
  
  
  METHODS
  Patients with recurrent Hodgkin disease who were <or=21 years of age and had previously received standard alkylating agent and doxorubicin-based therapy, were treated with APE chemotherapy (cytosine arabinoside 750 mg/m(2), cisplatin 15 mg/m(2), etoposide 20 mg/m(2)) every 12 hr, administered three or four times per cycle. Response, Event-free survival (EFS), and overall survival (OS) were assessed.
  
  
  RESULTS
  Thirty-one patients in first (n = 25) or second (n = 6) relapse of Hodgkin disease were eligible and evaluable. APE chemotherapy was well-tolerated, with the major toxicity consisting of short duration, grade 3/4 hematopoietic toxicity. The CR/PR response rate was 68% (42% CR, 26% PR). Allowing subsequent stem cell transplantation in some patients, 4-year EFS and OS were 27% +/- 8% and 49% +/- 9%, with 8-year EFS and OS of 23% +/- 9% and 34% +/- 10%.
  
  
  CONCLUSIONS
  APE is an efficacious regimen with minimal toxicity. Novel regimens are necessary to: (1) re-induce remission, (2) treat newly diagnosed patients, and (3) augment therapy in patients with slow response to standard regimens. This regimen had minimal toxicity and an excellent response rate that facilitated long term survival, often in conjunction with transplantation. The Children's Oncology Group is using a similar regimen to augment therapy for slow responders on a current Hodgkin disease trial.
authors.affiliation: Childrens Oncology Group, Arcadia, CA, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Wimmer
authors.forename: Allen R
authors.initials: AR
authors.lastname: Chauvenet
authors.forename: Wendy B
authors.initials: WB
authors.lastname: London
authors.forename: Doojduen
authors.initials: D
authors.lastname: Villaluna
authors.forename: Pedro A
authors.initials: PA
authors.lastname: de Alarcon
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D012008:Recurrence; D012074:Remission Induction; D033581:Stem Cell Transplantation; D014184:Transplantation, Homologous
chemical_list: D000970:Antineoplastic Agents; D003561:Cytarabine; D005047:Etoposide; D002945:Cisplatin