Two Cycles of Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine Plus Extended-Field Radiotherapy Is Superior to Radiotherapy Alone in Early Favorable Hodgkin's Lymphoma: Final Results of the GHSG HD7 Trial

Engert, Andreas; Franklin, Jeremy; Eich, Hans Theodor; Brillant, Corinne; Sehlen, Susanne; Cartoni, Claudio; Herrmann, Richard; Pfreundschuh, Michael; Sieber, M.; Tesch, Hans; Franke, Astrid; Koch, P.; Wit, Maike de; Paulus, U.; Hasenclever, Dirk; Loeffler, Markus; Müller, Rolf-Peter; Müller‐Hermelink, Hans Konrad; Dühmke, Eckhart; Diehl, Volker

doi:10.1200/jco.2006.07.0482

Cited by 232 publications

(101 citation statements)

References 34 publications

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“…Three groups have reported the results based on the use of brief exposure to ABVD followed by irradiation for clinical stage IA or IIA non-bulky HL [47], [48] and [49]. The results from these studies favour this approach in minimising the risks for later infertility, premature menopause, leukaemia as well as cardiopulmonary toxicity [50] and [51].…”

Section: Limitedmentioning

confidence: 99%

Human immunodeficiency and Hodgkin lymphoma

Sissolak

Jacobs

2010

Transfusion and Apheresis Science

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Presentation of Hodgkin lymphoma (HL) is distinctive in the infected individual being more advanced, accompanied by B symptoms and the presence of extranodal disease particularly lymphadenopathy of the head and neck. Bone marrow involvement may be found in over 50% of cases. Virtually all co express gamma-herpesvirus. Phenotypically there is prominence of the mixed-cellularity and lymphocyte depleted histopathologic subtypes that define an aggressive clinical course in comparison to other variants. Prior to the induction of cART, median survival was only 1-2 years. Notably the first chemotherapy trial using ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in 21 patients, without treating the viral infection, resulted in a 43% complete remission rate accompanied by severe haematological toxicities but did not extend median survival with this being 1.5 years matching the negative cases.Significant change accompanied concomitant anti-retroviral therapy that could be given safely even with dose intensive regimens exemplified by BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) in 12 patients or the Stanford V regimen (doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin, prednisone) coupled with involved-field radiation for bulky disease studied in 59 patients. BEACOPP extended overall survival (OS) to 83% at 2 years. A similar trend was seen 1 when using the Stanford V regimen with an OS rate of 51% at 3 years, disease-free survival (DFS) of 68% and freedom from progression (FFP) in 60%. Additional benefits accrued from supportive care with stimulatory peptides such as G-CSF and when combined with bacterial prophylaxis results approached that found in the uninfected reference group. Current consensus holds this particular lymphoma as still among the non-AIDS defining cancers being lung, stomach, liver or anal despite these having recently gained more attention as several of these neoplasms may be occurring more commonly in the era of cART.While the relative risk of developing a non-AIDS-defining neoplasm in HIV-infected persons on the average is 2-3 times, the risk for developing HL in HIV-infected cases impressively ranges between 5 and 25 times when compared to the general population. Based on the precedent in which Kaposi sarcoma and the non-Hodgkin lymphomas distinctively alter the course of this retroviral infection in a way indistinguishable from concurrent Hodgkin lymphoma we propose that this entity be similarly regarded and the hypothesis tested in large randomised prospective study.

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Section: Limitedmentioning

confidence: 99%

Human immunodeficiency and Hodgkin lymphoma

Sissolak

Jacobs

2010

Transfusion and Apheresis Science

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“…Later trials revealed that the risk of relapse in non-irradiated sites was approximately 20-30% and that a number of these relapsed patients were rescued by chemotherapy (CT). This warranted investigation to determine whether combined modality therapy (CT + RT) improves the results as compared to RT alone (8)(9)(10)(11)(12). A number of trials have assessed the possibility of treating HL patients with CT alone (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Therapy of Hodgkin’s lymphoma in clinical practice: A retrospective long-term follow-up analysis

et al. 2011

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Abstract. Treatment of Hodgkin's lymphoma (HL) is perceived to be relatively straightforward. Consequently, patients are not usually referred to hemato-oncologically specialized centres and are treated locally instead. Comprehensive findings beyond prospective controlled trials are therefore lacking. Clinical data of 209 patients who had received a HL diagnosis were collected. A total of 7 patients received radiotherapy (RT) alone (3%), 75 (35%) were treated with a combination of chemotherapy (CT) and RT and 127 patients received CT alone [mainly doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD)]. Complete response (CR) following first-line treatment was achieved in 178 patients (85%) and in 195 (93%) after salvage treatment. Favorable disease (p=0.000359), limitedstage disease (p=0.0003), involvement of lymph nodes above the diaphragm (p=0.05) and absence of mediastinal bulky tumor involvement positively affected the CR rate following first-line treatment. Out of the 195 patients that achieved CR, 31 relapsed. Male gender (p=0.043) and age over 45 years (p=0.047) were significantly associated with an increased incidence of relapse. Age at diagnosis was the key factor affecting long-term outcome. The event-free survival (EFS) projected at 120 months was 80 and 57% for patients younger and older than 45 years, respectively (p=0.022). The overall survival (OS) projected at 120 months was 92 and 38% for patients younger and older than 45 years, respectively (p=0.00561). A second neoplasia was diagnosed in 8 patients. The development of a tumor in 4 cases (breast, lung and thyroid cancer) was likely RT-related. Only 1 patient not receiving RT developed acute myeloid leukemia. The EFS and OS of the 141 early-stage patients treated with CT + RT (n=62) or with CT alone (n=79) were not statistically different.

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“…In the GHSG HD7 trial, patients were randomly assigned to receive either 30 Gy extended-field RT (EF-RT) alone or two cycles of ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) followed by the same RT [2]. Response rates did not differ between treatment arms.…”

Section: Treatment Of Early Favorable Hlmentioning

confidence: 99%

Advances in the treatment of Hodgkin lymphoma

Eichenauer

Engert

2012

Int J Hematol

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In the past decades, Hodgkin lymphoma (HL) has turned from an incurable disease to one with the most favorable prognosis among adult malignancies. This is due to the introduction of effective multi-agent chemotherapy and the optimization of radiation techniques. At present, 80-90 % of patients achieve long-term remission when receiving appropriate first-line treatment. Even in case of relapse, up to 50 % can be successfully salvaged with highdose chemotherapy and autologous stem cell transplantation. Thus, current studies do not necessarily aim at increasing treatment efficacy but rather focus on a possible reduction of acute and late toxicity by decreasing treatment intensity if possible. One promising strategy to spare therapy in good-risk patients is early response-adapted treatment stratification according to the result of interim positron emission tomography. The evaluation of novel drugs and the optimization of treatment for elderly HL patients and those with nodular lymphocyte-predominant HL are further aspects that are currently being addressed in ongoing trials. This review will give an overview on more recent clinical trials and discuss possible future strategies for the treatment of HL.

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Two Cycles of Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine Plus Extended-Field Radiotherapy Is Superior to Radiotherapy Alone in Early Favorable Hodgkin's Lymphoma: Final Results of the GHSG HD7 Trial

Abstract: CMT consisting of two cycles of ABVD plus EF-RT is more effective than EF-RT alone.

Cited by 232 publications

References 34 publications

Human immunodeficiency and Hodgkin lymphoma

Human immunodeficiency and Hodgkin lymphoma

Therapy of Hodgkin’s lymphoma in clinical practice: A retrospective long-term follow-up analysis

Advances in the treatment of Hodgkin lymphoma

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