Evaluating a response-adapted treatment approach for pediatric patients with high-risk Hodgkin lymphoma

This study evaluated the outcomes of pediatric patients with high-risk Hodgkin lymphoma (HL) after response-adapted treatment. This study concluded that PET scanning during treatment can help adapt further treatments and improve outcomes for these patients.

For most pediatric patients with HL, outcomes after intensive therapy have been positive. However, for high-risk patients, radiotherapy remains an important part of treatment. Chemotherapy agents are also needed, even though these are associated with long-term side effects. New strategies are needed for these high-risk patients.

Adapting additional treatments to how well patients respond to therapy early on can help. For patients who respond to chemotherapy, this can help reduce further unnecessary exposure. This helps reduce risks for long-term side effects. For patients who do not respond to chemotherapy, other regimens can be used to induce a better response. Whether this approach improves outcomes for pediatric patients with high-risk HL is unclear.

This study had 166 pediatric patients with high-risk HL. 43% of patients had stage 3 disease and 57% of patients had stage 4 disease. All patients first received two cycles of ABVE-PC (doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide) chemotherapy. Patients who responded to treatment then received two more cycles of this regimen, with or without radiotherapy. PET scanning was done during treatment to assess treatment response. Patients were followed-up for an average of 4.5 years.

Overall, 49% of patients had minimal to no signs of cancer after 2 cycles of treatment. 50% of patients had a complete disappearance of all signs of cancer. 50% of patients had tumor shrinkage or stable disease (neither tumor shrinkage nor growth).

76% of all patients (125) received radiotherapy. Of these, 60 patients had a complete disappearance of all signs of cancer. 65 patients had tumor shrinkage or stable disease.

Overall, 91.9% of patients were still alive 4 years later without the cancer coming back. At 5 years, this rate was 79.1%. 95% of all patients were still alive 5 years later.

24% of patients had seriously low white blood cell count with fever. Sore mouth or gums was also reported in 14% of patients.

This study concluded that using PET during treatment to gauge response can help adapt further treatments and improve outcomes for pediatric patients with high-risk HL. The authors suggest that patients who have residual cancer at the end of chemotherapy have a high risk for early relapse.