2013
DOI: 10.1002/pbc.24851
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Stratification of treatment intensity in relapsed pediatric Hodgkin lymphoma

Abstract: Risk-adapted, response-based therapies for pediatric Hodgkin lymphoma have resulted in 5-year survival exceeding 90%. Although high-dose chemotherapy and autologous hematopoietic stem cell transplantation (AHSCT) are considered standard for most patients with relapsed or refractory Hodgkin lymphoma, a subset of children with low risk relapse do not require AHSCT for cure. Currently there are no widely accepted criteria defining who should receive standard dose chemotherapy and/or radiotherapy, nor is there a s… Show more

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Cited by 40 publications
(39 citation statements)
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“…The rationale for our approach was that many patients with limited stage cHL who relapse with low disease burden after chemotherapy alone can be successfully retreated with further chemotherapy and involved-field radiation therapy (IFRT) without the use of high-dose chemotherapy/stem cell rescue or higher dose radiation therapy. 9,10 Our objective was to investigate a response-directed treatment paradigm that delivered minimal initial chemotherapy, with low-dose radiation reserved for those who did not achieve a complete response (CR), and integrating a conventional chemotherapy/low-dose radiation salvage regimen for protocol-defined, low-risk recurrence. We also evaluated the role of response measured by a fluorodeoxyglucosepositron emission tomography scan after 1 cycle of chemotherapy (PET1 response) as a marker of chemosensitivity.…”
Section: Introductionmentioning
confidence: 99%
“…The rationale for our approach was that many patients with limited stage cHL who relapse with low disease burden after chemotherapy alone can be successfully retreated with further chemotherapy and involved-field radiation therapy (IFRT) without the use of high-dose chemotherapy/stem cell rescue or higher dose radiation therapy. 9,10 Our objective was to investigate a response-directed treatment paradigm that delivered minimal initial chemotherapy, with low-dose radiation reserved for those who did not achieve a complete response (CR), and integrating a conventional chemotherapy/low-dose radiation salvage regimen for protocol-defined, low-risk recurrence. We also evaluated the role of response measured by a fluorodeoxyglucosepositron emission tomography scan after 1 cycle of chemotherapy (PET1 response) as a marker of chemosensitivity.…”
Section: Introductionmentioning
confidence: 99%
“…In contrast, patients with late relapse of low-stage disease are predicted to have excellent outcomes with conventional chemotherapy or chemoradiotherapy, and thus may be able to avoid the acute and long-term toxicity associated with AHSCT. 17 …”
Section: Lessons From Recent Clinical Trials In Children and Adolescementioning
confidence: 99%
“…Risk factors for reduced survival post‐HSCT included first remission <12 months, poor performance status, chemo‐resistance, extra‐nodal disease at relapse and receipt of first line therapy regimens other than ABVD/ABVD‐like. Patients with late relapse of low‐stage disease are predicted to have excellent outcomes with conventional chemotherapy or chemo‐radiotherapy, and thus may be able to avoid the acute and long‐term toxicity associated with HSCT (Harker‐Murray et al , ). A strategy to stratify the intensity of salvage treatment based on time to relapse and stage of disease at relapse in paediatric HL is under evaluation (NCT02927769).…”
Section: Primary Prevention To Close the Survivorship Gapmentioning
confidence: 99%