What are the outcomes for early-stage HL patients treated with ABVD and radiotherapy alone?

This study determined the outcomes of early-stage classical Hodgkin’s lymphoma (HL) patients who received ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy and radiotherapy (RT) only. The study concluded that patients who showed a good partial response (tumor shrinkage) to ABVD chemotherapy were successfully treated by salvage radiotherapy alone.

Early-stage classical Hodgkin’s lymphoma (HL) is commonly treated with ABVD chemotherapy followed by radiotherapy to kill any remaining cancer cells. This treatment combination results in a long-term cure for most patients. However, some patients develop relapsed or refractory (does not respond to treatment) disease. Individualized treatment is needed for these patients to avoid under- or over-treatment.

FDG PET-CT scans are used to determine the risk of relapse or progression after treatment. These scans have become a standard tool in HL management. Whether these scans can help predict the success of radiotherapy alone in these patients remains under investigation.

This study involved 174 patients with either stage 1 (32) or stage 2 disease (142). 30% of patients had bulky disease (tumors bigger than 10 centimeters). 31% of patients had B symptoms (severe night sweats, unexplained fever and weight loss). All patients received ABVD chemotherapy and radiotherapy.  PET-CT scans were used to determine their response to treatment. Certain patients who had positive scans were given either radiotherapy or salvage chemotherapy with ASCT (autologous stem cell transplant). The average follow-up period was 53 months.

The overall 5-year freedom from progression (time from initial diagnosis to diagnosis with relapsed/refractory disease) was 97%. Freedom from progression (FFP) was significantly associated with PET-CT scan results. FFP was 67% or 83% for patients who showed remaining cancer (depending on the amount of remaining disease). FFP was 97% to 100% for patients who showed complete tumor disappearance.

After ABVD chemotherapy, 15% of patients showed positive PET-CT scans (remaining cancer). Of these, 42.3% received salvage chemotherapy with ASCT, and 57.7% received radiotherapy only. 40% of the salvage chemotherapy/ASCT patients and 18% of the radiotherapy patients relapsed (reoccurring cancer).

This study concluded that radiotherapy alone can be successful in some early-stage HL patients who show an incomplete but good response to ABVD chemotherapy.

The current study is limited by the small number of patients who relapsed compared to the whole population. Because PET-CT scan data was unavailable for all the patients, the results may not represent the whole patient population. These results need to be confirmed in studies with larger patient populations.

If you have early-stage refractory HL after receiving ABVD chemotherapy, talk to your care team about whether salvage radiotherapy is an option.