Treatment of Early-Stage Unfavorable Hodgkin Lymphoma: Efficacy and Toxicity of 4 Versus 6 Cycles of ABVD Chemotherapy With Radiation.
The German Hodgkin Study Group HD11 trial validated 4 cycles of doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy followed by involved field radiation therapy (IFRT) for early unfavorable Hodgkin lymphoma (HL) patients. However, practitioners often recommend 6 cycles followed by RT, especially for bulky disease. We compared patient outcomes after treatment with 4 or 6 cycles of ABVD followed by RT (IFRT and involved site RT [ISRT]).



We identified 128 patients treated for early unfavorable HL (GHSG criteria) between 2000 and 2013. Clinical outcomes (overall survival [OS] and freedom from relapse [FFR]) were estimated using Kaplan-Meier analysis. Toxicities were evaluated.



The median follow-up time was 5.0 years. Patients received 4 (70 patients, 55%) or 6 (58 patients, 45%) cycles of chemotherapy. Bulky disease was present in 22 patients (31%; 0 stage IA, 3 stage IB, 19 stage IIA) of the 4-cycle group and 42 patients (72%; 5 stage IA, 3 stage IB, 34 stage IIA) of the 6-cycle group. For patients receiving 4 and 6 cycles, the 6-year OS was 100% and 97% (P=.35), respectively, and the 6 year FFR was 100% and 98% (P=.28), respectively. More patients received 6 cycles if they were treated before 2010 (HD11 report) (P=.01) and if they had bulky disease (P<.01). Sixty-eight percent of patients received ISRT. The 6-year FFR was 99% and 100% for patients receiving ISRT and IFRT, respectively (P=.58). More patients experienced bleomycin pulmonary toxicity in the 6-cycle group (20% vs 31%, P=.16). For patients with bulky disease, the 4-year FFR was similar with receipt of 4 (100%) or 6 (98%) cycles (P=.48) and IFRT (100%) or ISRT (98%) (P=.52). There were no deaths among patients with bulky disease.



Patients with early unfavorable HL have excellent outcomes with 4 cycles of ABVD chemotherapy followed by ISRT. Six cycles of chemotherapy does not appear superior for disease control, even for bulky disease.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Jillian R
JR
Gunther
Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Michelle A
MA
Fanale
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Jay P
JP
Reddy
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, Texas.
Mani
M
Akhtari
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Grace L
GL
Smith
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Chelsea C
CC
Pinnix
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Sarah A
SA
Milgrom
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Zeinab Abou
ZA
Yehia
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Pamela K
PK
Allen
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Eleanor M
EM
Osborne
Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Osama
O
Mawlawi
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: bdabaja@mdanderson.org.
Bouthaina S
BS
Dabaja
D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001761:Bleomycin / Q000008:administration & dosage; D059248:Chemoradiotherapy / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D015897:Comorbidity; D003606:Dacarbazine / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D006689:Hodgkin Disease / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015995:Prevalence; D011832:Radiation Injuries / Q000401:mortality* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention / Q000706:statistics & numerical data; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D017211:Treatment Failure; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage; D055815:Young Adult
D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin