title: Final results of a prospective clinical trial with VAMP and low-dose involved-field radiation for children with low-risk Hodgkin's disease.
abstract: OBJECTIVE
  To evaluate outcome and assess complications in children and adolescents with low-risk Hodgkin's disease treated with vinblastine, doxorubicin, methotrexate, and prednisone (VAMP) chemotherapy and low-dose, involved-field radiation therapy (IFRT).
  
  
  METHODS
  One hundred ten children with low-risk Hodgkin's disease were treated with four cycles of VAMP and 15 Gy IFRT for those who achieved a complete response (CR) or 25.5 Gy for those with a partial response after two cycles of VAMP.
  
  
  RESULTS
  With median follow-up of 9.6 years (range, 1.7 to 15.0), 5- and 10-year overall survival were 99.1% and 96.1%, respectively, and 5-and 10-year event-free survival (EFS) were 92.7% and 89.4%. Factors contributing to 10-year EFS were: early CR (P = .02), absence of B symptoms (P = .01), lymphocyte predominant histologic subtype (P = .04), and less than three initial sites of disease (P = .02). Organ toxicity has been limited to correctable hypothyroidism in 42% of irradiated patients, and one case of cardiac dysfunction. Seventeen healthy babies have been born to 106 survivors. There have been two malignant tumors: one thyroid cancer within the radiation therapy field and one Ewing's sarcoma outside the radiation therapy field.
  
  
  CONCLUSIONS
  Risk-adapted, combined-modality therapy using VAMP chemotherapy with radiation is effective and well tolerated. Pediatric patients with low-risk Hodgkin's disease can be cured with therapy without an alkylating agent, bleomycin, etoposide, or high-dose, extended-field radiotherapy. Thus, these children are expected to retain normal fertility, organ function, and be at low risk of a second malignant tumor.
authors.affiliation: Stanford University Medical Center, Stanford, CA, USA. sarah2@stanford.edu
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Donaldson
authors.forename: Michael P
authors.initials: MP
authors.lastname: Link
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Weinstein
authors.forename: Shesh N
authors.initials: SN
authors.lastname: Rai
authors.forename: Sam
authors.initials: S
authors.lastname: Brain
authors.forename: Amy L
authors.initials: AL
authors.lastname: Billett
authors.forename: Craig A
authors.initials: CA
authors.lastname: Hurwitz
authors.forename: Matthew
authors.initials: M
authors.lastname: Krasin
authors.forename: Larry E
authors.initials: LE
authors.lastname: Kun
authors.forename: Karen C
authors.initials: KC
authors.lastname: Marcus
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Tarbell
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Young
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014747:Vinblastine / Q000627:therapeutic use
chemical_list: D014747:Vinblastine; D004317:Doxorubicin; D011241:Prednisone; D008727:Methotrexate