Long term follow-up study of reduced intensity treatments for early stage Hodgkin lymphoma

This study provided a long-term follow-up of patients diagnosed with early-stage Hodgkin lymphoma. The study concluded that current strategies for reduced intensity treatment of early-stage Hodgkin lymphoma are generally safe and effective. 

Hodgkin lymphoma (HL) is generally considered a curable disease. However, long-term health problems relating to high intensity treatment have been observed. Recently, steps have been taken to reduce the intensity of the treatment while also effectively treating the HL. More long-term follow-up research must be done to confirm the effectiveness of reduced intensity treatments for HL. 

4,276 patients with HL were recruited for four different trials. The studies recruited patients from 1993 to 1998 (group 1) and from 1998 to 2001 (group 2). 627 patients in group 1 and 1,190 patients in group 2 were classified as early-stage favorable HL. 1,064 patients in group 1 and 1,395 patients in group 2 were classified as early-stage unfavorable HL. The average follow-up time was 113 to 136 months.

In group 1-favorable patients, combined modality therapy (CMT) of ABVD chemotherapy followed by radiotherapy (RT) was shown to be significantly more effective than RT alone. The 15-year progression free survival (time from diagnosis to disease progression or death from any cause) for CMT was 73% compared to 52% for radiotherapy alone.

In group 2-favorable, there was no difference in treatment effectiveness between high intensity and low intensity chemotherapy regimens followed by RT. Two cycles of ABVD chemotherapy followed by 20 Gy RT was just as effective as 4 cycles of ABVD followed by 30 Gy RT. The 10-year overall survival (time from diagnosis to death from any cause) was 94% for all groups.

In group 1-unfavorable, there was no difference in treatment effectiveness between the more intense extended field radiotherapy (EFRT) and the less intense involved field radiotherapy (IFRT). Slightly fewer patients who received IFRT developed secondary cancers compared to patients who received EFRT. However, the trend was not significant.

In group 2-unfavorable, there was no difference in treatment effectiveness between escalated BEACOPP chemotherapy compared to standard ABVD chemotherapy when followed by 30 Gy IFRT. There was no difference in progression free survival, overall survival, or secondary cancers between the two types of chemotherapy. ABVD chemotherapy followed by 20 Gy IFRT was less effective than ABVD followed by 30 Gy IFRT.

The study concluded that reduced intensity therapies are just as effective as higher intensity therapies when treating patients with early-stage Hodgkin lymphoma.