title: Survival and late effects in children with Hodgkin's lymphoma treated with MOPP/ABV and low-dose, extended-field irradiation.
abstract: OBJECTIVE
  Reduced-intensity protocols for pediatric Hodgkin's lymphoma are aimed at preserving excellent relapse-free survival while decreasing the incidence of late effects.
  
  
  METHODS
  We retrospectively reviewed the outcome of 123 children treated consecutively for Hodgkin's lymphoma at a single institution. Patients with stages I-IIIB disease received three cycles of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP)/ doxorubicin, bleomycin, and vinblastine (ABV) followed by 15 Gy of extended-field irradiation, while those with stage IV disease were treated with six to eight cycles of MOPP/ABV chemotherapy with or without radiotherapy.
  
  
  RESULTS
  At a median follow-up of 8.5 years (range, 1.4 to 15.5 years), the estimated 10-year overall survival and event-free survival are 94% (SE, 2.2%) and 88% (SE, 3.1%) respectively. There have been 12 treatment failures and six disease-related deaths. A very large mediastinal mass ( 50% of the maximal thoracic diameter) was associated with a 10-year event-free survival of 50% (SE, 14%) compared with 91% (SE, 4.0%) for smaller masses (P < .001). Late cardiopulmonary toxicity is largely absent, and the incidence of hypothyroidism is 14%. There have been no cases of secondary leukemia and four secondary solid malignancies observed to date.
  
  
  CONCLUSIONS
  MOPP/ABV and low-dose, extended-field radiotherapy is an effective treatment for pediatric Hodgkin's lymphoma. With median follow-up of 8.5 years, late cardiopulmonary effects and secondary malignancies from this treatment regimen are infrequent. Continued longitudinal observations, particularly for breast cancer in female patients and gonadotoxicity, will determine whether the goal of decreasing treatment-related complications while maintaining excellent survival has been achieved.
authors.affiliation: Division of Haematology & Oncology, Department of Paediatrics, Toronto Sunnybrook Regional Cancer Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Lionel M L
authors.initials: LM
authors.lastname: Chow
authors.forename: Paul C
authors.initials: PC
authors.lastname: Nathan
authors.forename: David C
authors.initials: DC
authors.lastname: Hodgson
authors.forename: Derek
authors.initials: D
authors.lastname: Jenkin
authors.forename: Sheila
authors.initials: S
authors.lastname: Weitzman
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Grant
authors.forename: David
authors.initials: D
authors.lastname: Manson
authors.forename: Adee
authors.initials: A
authors.lastname: Bross
authors.forename: John J
authors.initials: JJ
authors.lastname: Doyle
authors.forename: Cyril
authors.initials: C
authors.lastname: Danjoux
authors.forename: Mark L
authors.initials: ML
authors.lastname: Greenberg
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006321:Heart / Q000187:drug effects; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D007037:Hypothyroidism / Q000209:etiology; D007223:Infant; D008168:Lung / Q000187:drug effects; D008297:Male; D008466:Mechlorethamine / Q000008:administration & dosage; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D011344:Procarbazine; D008466:Mechlorethamine; D014750:Vincristine; D014747:Vinblastine; D004317:Doxorubicin; D011241:Prednisone