Final Results of a Prospective Clinical Trial With VAMP and Low-Dose Involved-Field Radiation for Children With Low-Risk Hodgkin's Disease

Donaldson, Sarah S.; Link, Michael P.; Weinstein, Howard J.; Shesh, N.; Brain, Susie; Billett, Amy L.; Hurwitz, Craig A.; Krasin, Matthew J.; Kun, Larry E.; Marcus, Karen; Tarbell, Nancy J.; Young, Jeffrey A.; Hudson, Melissa M.

doi:10.1200/jco.2006.08.4772

Cited by 126 publications

(79 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is assumed that childhood cancer survivors treated with modern therapy designed to minimize late effects will experience less late onset morbidity, but this remains to be proven as they age into adulthood. 41 Despite these limitations, our findings are important in guiding the clinical care of current older adult survivors, and knowledge of their health status helps to define risk periods and latency periods for health outcomes experienced by current survivors as they age.…”

Section: Discussionmentioning

confidence: 99%

Health status of the oldest adult survivors of cancer during childhood

Kenney

Nancarrow

Najita

et al. 2009

Cancer

View full text Add to dashboard Cite

BACKGROUND: Young adult survivors of childhood cancer have an increased risk for treatment-related morbidity and mortality. In this study, the authors assessed how treatment for childhood cancer affects older-adult health and health practices. METHODS: One hundred seven adults treated for childhood cancer between 1947 and 1968, known to have survived past age 50 years, were identified from a single-institution cohort established in 1975. Updated vital status on eligible cases was obtained from public records. Survivors and a control group of their age-matched siblings and cousins completed a mailed survey to assess physical and social function, healthcare practices, and the prevalence of common adult illnesses. RESULTS: Of the 107 survivors known to be alive at age 50 years, 16 were deceased at follow-up; 7 deaths could be associated with prior treatment (second malignancy in radiation field [3], small bowel obstruction after abdominal radiation [2], and cardiac disease after chest irradiation [2]). The 55 survivors (median age, 56 years; range, 51-71 years), and 32 family controls (median age, 58 years; range, 48-70 years), reported similar health practices, health-related quality of life, and social function. However, survivors reported more frequent visits to healthcare providers (P < .05), more physical impairments (P < .05), fatigue (P ¼.02), hypertension (P ¼.001), and coronary artery disease (P ¼.01). An increased risk of hypertension was associated with nephrectomy during childhood (odds ratio, 18.9; 95% confidence interval, 3.0-118.8). CONCLUSIONS: The oldest adult survivors of childhood cancer continue to be at risk for treatment-related complications that potentially decrease their life expectancy and compromise their quality of life. Cancer 2010;116:497-505.

show abstract

Section: Discussionmentioning

confidence: 99%

Health status of the oldest adult survivors of cancer during childhood

Kenney

Nancarrow

Najita

et al. 2009

Cancer

View full text Add to dashboard Cite

show abstract

“…Approximately 10% of patients with early stage, and up to 25% with advanced stage disease, relapse after first line therapy (Donaldson et al, 2007;Schwartz et al, 2009). Cure may still be achieved in patients with recurrent disease and all should receive second-line standard dose salvage chemotherapy (SDCT).…”

Section: Salvage Therapy -General Considerationsmentioning

confidence: 99%

Management of relapsed and refractory classical Hodgkin lymphoma in children and adolescents

2010

View full text Add to dashboard Cite

SummaryThere are a number of options for salvage treatment in children and adolescents with relapsed and refractory classical Hodgkin Lymphoma. These include salvage with standard dose chemotherapy, high dose chemotherapy with autologous stem cell transplant, allogeneic stem cell transplant or other novel approach. Radiotherapy has an important role in the salvage of some patients as part of a combined modality approach. This review outlines these salvage approaches and discusses whether the evidence from paediatric studies justifies a risk-adapted approach to salvage for individual patients or whether all patients should receive consolidation with high dose chemotherapy and autologous stem cell transplantation, which is often described as standard salvage management in adults. The important prognostic factors and how these may be used to allocate patients to standard versus high dose chemotherapy regimens are discussed. The role of allogeneic transplantation, novel agents and late effects will also be discussed.Keywords: paediatric, Hodgkin lymphoma, relapsed, refractory, salvage.The cure rates of first-line treatment for classical Hodgkin lymphoma (HL) in children are very high with the use of modern effective chemotherapy, often used in combination with involved field radiotherapy (IFRT). The most effective regimens achieve cure rates in excess of 90% for early stage and 80% for advanced stage disease, with equivalent outcomes for adolescents and children (Schellong et al, 1986(Schellong et al, , 1999Vecchi et al, 1993Vecchi et al, , 1997Hunger et al, 1994;Schellong, 1996;Donaldson & Link, 1997;Hutchinson et al, 1998;Dörffel et al, 2003;El-Badawy et al, 2008). Single modality radiotherapy (RT) is rarely used now as primary treatment due to unacceptable failure rates even in low stage patients (Shankar et al, 1997). Paediatric paradigms for primary treatment have evolved to reduce late effects whilst maintaining excellent cure rates (Hodgson et al, 2007), achieved by developing chemotherapeutic regimens that minimize late toxicity and, when given, RT is low dose (20-25 Gy) and involved field. Primary chemotherapy is allocated using a risk-adapted approach utilizing prognostic factors associated with primary treatment failure (Smith et al, 2003), and response to chemotherapy is under study to guide either the final number of chemotherapy cycles (Schwartz et al, 2009), or to limit or remove RT in patients who achieve complete remission with chemotherapy alone (Dörffel et al, 2003). Salvage therapy -general considerationsApproximately 10% of patients with early stage, and up to 25% with advanced stage disease, relapse after first line therapy (Donaldson et al, 2007;Schwartz et al, 2009). Cure may still be achieved in patients with recurrent disease and all should receive second-line standard dose salvage chemotherapy (SDCT). Salvage single modality RT is rarely used. There are no randomized trials in children defining the 'best' salvage chemotherapy regimen or comparing SDCT with high dose chemotherapy (HDCT) and...

show abstract

“…[45] Pediatrik hastalarda 5-10 yıllık sağ kalımın %90'ların üze-rine çıkarılmasına rağmen uygulanan tedavilere bağlı olarak geç dönemde gelişen sekonder maligniteler ve komplikasyonlar nedeni ile bu başarının belirgin olarak azalması ve takip eden yıllarda bu oranın daha da arttığının görülmesi, [32,46] Avrupa ve Amerikada ki çeşitli gruplar tarafından hastaların risk gruplarına ayrılarak "risk ve yanıt ilişkili" tedavi uygulamaları ile düşük riskli hastalarda daha az, yüksek riskli hastalarda yoğun tedavi ile uzun süreli sağ kalımın sağlanacağı tedavi protokollerini gündeme getirmiştir. [47][48][49][50][51] Cevap ilişkili tedavi ile amaç radyoterapi doz, volüm veya her ikisinin hangi hastada azaltılacağının veya radyoterapinin hangi hastada uygulanmayacağının ayırt edilmesi idi. [43,47,49,52] Almanların DAL-HD kodlu HL protokol çalış-maları 1978'de başlamış ve üç-dört sene aralarla elde edilen sonuçlara göre toksisitenin azaltılması amaçlı kemoteropetiklerin düzenlenmesi (erkek- [47,48,[53][54][55][56][57] 1982'den beri evre I ve IIA'ya (grup I) iki kür OPPA, evre IIB-IIIA'ya (grup II) iki kür OPPA+iki kür COPP, evre IIIB ve IV'e (grup III) iki kür OPPA+dört kür COPP kemoterapisi uygulanmış ve kemoterapi sonrası her evrede IF RT kullanılmıştı.…”

Section: Kemoterapi Ile Radyoterapinin Birlikte Kullanıldığı "Risk Vunclassified

“…[47][48][49][50][51] Cevap ilişkili tedavi ile amaç radyoterapi doz, volüm veya her ikisinin hangi hastada azaltılacağının veya radyoterapinin hangi hastada uygulanmayacağının ayırt edilmesi idi. [43,47,49,52] Almanların DAL-HD kodlu HL protokol çalış-maları 1978'de başlamış ve üç-dört sene aralarla elde edilen sonuçlara göre toksisitenin azaltılması amaçlı kemoteropetiklerin düzenlenmesi (erkek- [47,48,[53][54][55][56][57] 1982'den beri evre I ve IIA'ya (grup I) iki kür OPPA, evre IIB-IIIA'ya (grup II) iki kür OPPA+iki kür COPP, evre IIIB ve IV'e (grup III) iki kür OPPA+dört kür COPP kemoterapisi uygulanmış ve kemoterapi sonrası her evrede IF RT kullanılmıştı. Bu grup 1990 yılından beri evreleme laparotomisi ve splenektomi yapmamaktadır.…”

Section: Kemoterapi Ile Radyoterapinin Birlikte Kullanıldığı "Risk Vunclassified

“…[64] St. Jude/Stanford/Dana Farber'da düşük riskli HL'li hastalarda tedavinin ve toksisitenin azaltıl-ması amaçlı alkilleyici ajan, bleomisin ve etoposid kullanılmadan VAMP'li (vinkristin, adriamisin, methotreksat, prednizolon) KT ve sonrasında tutulu alan düşük doz radyoterapinin uygulandığı 1990-2000 yılları arasındaki çalışmada 10 yıllık OS %96.1; EFS %89.4 olarak saptandı. [49] Bu ça-lışma daha sonra 2000-2008 yılları arasında nonrandomize olarak düşük riskli, tedaviye erken tam cevap veren hastalarda dört kür VAMP sonrası RT uygulanan ve uygulanmayan grup şeklinde değer-lendirildiğinde, iki yıllık EFS'yi RT almayan grupta %89.4; RT alan grupta %92.5 olarak (p=0.61) saptadılar. [65] Bu şekilde alkilleyici ajan, bleomisin, etoposid, radyoterapi kullanılmadan risk adapte, cevap ilişkili tedavi yaklaşımı ile düşük riskli seçilmiş hasta gruplarında uygulanabilecek etkili ve daha iyi tolere edilebilen tedavi şeması olduğunu vurgulamışlardır.…”

Section: Risk Grup Hasta Sayısı Sonuçunclassified

See 1 more Smart Citation

Treatment of Hodgkin’s lymphoma in children

Kebudi¹

2015

TJ Oncol

View full text Add to dashboard Cite

With the advances in current diagnostics and treatment modalities the survival in children with Hodgkin's lymphoma have significantly increased. The aim of the treatment nowadays is administering the most effective and least toxic treatment. This has leaded to "risk adapted, response and gender modified" treatments. In this review, the treatment modalities and results used in Hodgkin's lymphoma in children within decades have been assessed.

show abstract

Final Results of a Prospective Clinical Trial With VAMP and Low-Dose Involved-Field Radiation for Children With Low-Risk Hodgkin's Disease

Cited by 126 publications

References 17 publications

Health status of the oldest adult survivors of cancer during childhood

Health status of the oldest adult survivors of cancer during childhood

Management of relapsed and refractory classical Hodgkin lymphoma in children and adolescents

Treatment of Hodgkin’s lymphoma in children

Contact Info

Product

Resources

About