Treatment of classical Hodgkin’s lymphoma Summary

Early stage favorable Hodgkin’s lymphoma

·         HD 10 trial: NEJM 2010:

o   1370 pts, 4 arms:

§  4 cycles of ABVD followed by 30 Gy

§  4 cycles of ABVD followed by 20 Gy

§  2 cycles of ABVD followed by 30 Gy

§  2 cycles of ABVD followed by 20 Gy

o   No difference in freedom from treatment failure, OS at 5 yrs

o   2 cycles of ABVD followed by 20 Gy should be the new standard of care

Unfavorable characteristics

Bulky disease (>10 cm or 1/3 max. transverse thorax diameter

Extranodal site involvement

3 or more lymph node areas involved

ESR > 50 mm/h or > 30 mm/hr with B symptoms.

                                                                                                                                         

Early stage unfavorable Hodgkin’s lymphoma

·         HD 11 trial: JCO 2010

o   1395 pts, 4 arms:

§  4 cycles of ABVD followed by 30 Gy of IFRT

§  4 cycles of ABVD followed by 20 Gy of IFRT

§  4 cycles of BEACOPP followed by 30 Gy of IFRT

§  4 cycles of BEACOPP followed by 20 Gy of IFRT

o   BEACOPP more effective than ABVD when followed by 20 Gy  (FFTF, PFS, OS)

o   No difference between BEACOPP & ABVD when followed by 30 Gy (FFTF, PFS, OS)

o   After 4 cycles of BEACOPP 20 Gy was not inferior to 30 Gy

o   Inferiority can’t be excluded for 20 Gy after 4 cycles of ABVD when compared to 30 Gy

o   4 cycles of ABVD followed by 30 Gy of IFRT should be the standard of care

Advanced stage Hodgkin’s lymphoma

·         CALGB trial : NEJM 1992

o   361 pts, 3 arms:

§  MOPP for 6 to 8 cycles

§  MOPP alternating with ABV D for 12 cycles

§  ABVD for 6 to 8 cycles

o   ABVD alone was superior to MOPP alone in 5 yrs Failure free survival  and OS

o   ABVD alone was as effective as MOPP alternating with ABVD but less toxic

o   ABVD for 6 to 8 cycles should be the standard of care