title: Combined therapy in children and adolescents with classical Hodgkin's lymphoma: A report from the SFCE on MDH-03 national guidelines.
abstract: Hodgkin's lymphoma (HL) in children and adolescents is highly curable, but children are at risk of long-term toxicity. The MDH-03 guidelines were established in order to decrease the burden of treatment in good-responder patients, and this report should be considered a step toward further optimization of treatment within large collaborative trials. We report the therapy and long-term outcomes of 417 children and adolescents treated according to the national guidelines, which were applied between 2003 and 2007 in France. The patients were stratified into three groups according to disease extension. Chemotherapy consisted of four cycles of VBVP (vinblastine, bleomycin, VP16, prednisone) in localized stages (G1/95 pts/23%), four cycles of COPP/ABV (cyclophosphamide, vincristine, procarbazine, prednisone, adriamycin, bleomycin, vinblastine) cycles in intermediate stages (G2/184 pts/44%) and three cycles of OPPA (vincristine, procarbazine, prednisone, adriamycin) plus three cycles of COPP in advanced stages (G3/138 pts/33%). Radiation therapy of the involved field was given to 97% of the patients, with the dose limited to 20 Gy in good responders (88%). With a median follow-up of 6.6 years, the 5-year event-free survival (EFS) and overall survival (OS) were 86.7% (83.1-89.7%) and 97% (94.5-98.1%), respectively. EFS and OS for G1, G2, and G3 were 98% and 100%, 81% and 97%, and 87% and 95%, respectively. Low-risk patients treated without alkylating agents and anthracycline had excellent outcomes and a low expected incidence of late effects. Intensification with a third OPPA cycle in high-risk group patients, including stage IV patients, allowed for very good outcomes, without increased toxicity.
authors.affiliation: a Department of Pediatric Hematology , Robert-Debré Hospital , Paris , France.
authors.forename: E
authors.initials: E
authors.lastname: Seror
authors.affiliation: b Armand-Trousseau Hospital , Paris , France.
authors.forename: J
authors.initials: J
authors.lastname: Donadieu
authors.affiliation: c Institut Curie , Paris , France.
authors.forename: H
authors.initials: H
authors.lastname: Pacquement
authors.affiliation: d Institut Gustave Roussy , Villejuif , France.
authors.forename: S
authors.initials: S
authors.lastname: Abbou
authors.affiliation: e CHU Lille , Lille , France.
authors.forename: A
authors.initials: A
authors.lastname: Lambilliotte
authors.affiliation: f CAC Centre Léon Bérard , Lyon , France.
authors.forename: M
authors.initials: M
authors.lastname: Schell
authors.affiliation: g CHU La Timone , Marseille , France.
authors.forename: C
authors.initials: C
authors.lastname: Curtillet
authors.affiliation: h CHU Rennes , Rennes , France.
authors.forename: V
authors.initials: V
authors.lastname: Gandemer
authors.affiliation: i CHU Toulouse , Toulouse , France.
authors.forename: M
authors.initials: M
authors.lastname: Pasquet
authors.affiliation: j CHU Bordeaux , Bordeaux , France.
authors.forename: N
authors.initials: N
authors.lastname: Aladjidi
authors.affiliation: k CHU Strasbourg , Strasbourg , France.
authors.forename: P
authors.initials: P
authors.lastname: Lutz
authors.affiliation: l CHU Nancy , Nancy , France.
authors.forename: C
authors.initials: C
authors.lastname: Schmitt
authors.affiliation: m CHU Nice , Nice , France.
authors.forename: A
authors.initials: A
authors.lastname: Deville
authors.affiliation: n CHU Caen , Caen , France.
authors.forename: O
authors.initials: O
authors.lastname: Minckes
authors.affiliation: o CHU Rouen , Rouen , France.
authors.forename: J P
authors.initials: JP
authors.lastname: Vanier
authors.affiliation: p CHU Grenoble , Grenoble , France.
authors.forename: C
authors.initials: C
authors.lastname: Armari-Alla
authors.affiliation: q CHU Nantes , Nantes , France.
authors.forename: C
authors.initials: C
authors.lastname: Thomas
authors.affiliation: r CHU Reims , Reims , France.
authors.forename: S
authors.initials: S
authors.lastname: Gorde-Grosjean
authors.affiliation: s CHU Poitiers , Poitiers , France.
authors.forename: F
authors.initials: F
authors.lastname: Millot
authors.affiliation: t CHU Tours , Tours , France.
authors.forename: P
authors.initials: P
authors.lastname: Blouin
authors.affiliation: u CHU Lyon , Lyon , France.
authors.forename: N
authors.initials: N
authors.lastname: Garnier
authors.affiliation: g CHU La Timone , Marseille , France.
authors.forename: C
authors.initials: C
authors.lastname: Coze
authors.affiliation: v CHU Amiens , Amiens , France.
authors.forename: C
authors.initials: C
authors.lastname: Devoldere
authors.affiliation: w CHU St Denis, La Réunion , Saint-Denis , France.
authors.forename: Y
authors.initials: Y
authors.lastname: Reguerre
authors.affiliation: c Institut Curie , Paris , France.
authors.forename: S
authors.initials: S
authors.lastname: Helfre
authors.affiliation: f CAC Centre Léon Bérard , Lyon , France.
authors.forename: L
authors.initials: L
authors.lastname: Claude
authors.affiliation: x Unité INSERM UMRS 1153 , Université Paris Descartes , Paris , France.
authors.forename: J
authors.initials: J
authors.lastname: Clavel
authors.affiliation: d Institut Gustave Roussy , Villejuif , France.
authors.forename: O
authors.initials: O
authors.lastname: Oberlin
authors.affiliation: b Armand-Trousseau Hospital , Paris , France.
authors.forename: J
authors.initials: J
authors.lastname: Landman-Parker
authors.affiliation: a Department of Pediatric Hematology , Robert-Debré Hospital , Paris , France.
authors.forename: T
authors.initials: T
authors.lastname: Leblanc
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D015996:Survival Rate
keywords: Hodgkin's disease; lymphoma; pediatric oncology