Treatment of early stage unfavorable Hodgkin lymphoma: Efficacy and toxicity of 4 vs. 6 cycles of ABVD chemotherapy with radiation
Menée sur 128 patients traités entre 2000 et 2013 pour un lymphome hodgkinien de stade précoce et de pronostic défavorable (durée médiane de suivi : 5 ans), cette étude évalue l'efficacité, du point de vue de l'absence de récidive et de la survie globale à 6 ans, et la toxicité de 4 et 6 cycles de chimiothérapie de type ABVD en combinaison avec une radiothérapie
Purpose/Objective(s) : GHSG HD11 trial validated 4 cycles of 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)). Methods and Materials : 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. Toxicities were evaluated. Results : Median follow-up 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, 6 year OS was 100% and 97% (p=0.35), respectively, and 6 year FFR was 100% and 98% (p=0.28), respectively. More patients received 6 cycles if treated before 2010 (HD11 report) (p=0.01) and if bulky (p<0.01). Sixty-eight percent of patients received ISRT. Six year FFR was 99% and 100% for patients receiving ISRT and IFRT, respectively (p=0.58). More patients developed bleomycin pulmonary toxicity in the 6 cycle group (20% vs 31%, p=0.16). For bulky patients, 4 year FFR was similar with receipt of 4 (100%) or 6 (98%) cycles (p=0.48) and IFRT (100%) or ISRT (98%) (p=0.52). There were no deaths amongst bulky patients. Conclusions : Patients diagnosed 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.