Risk-adapted, combined-modality therapy with VAMP/COP and response-based, involved-field radiation for unfavorable pediatric Hodgkin's disease

Melissa M. Hudson, Matthew Krasin, Michael P. Link, Sarah S. Donaldson, Catherine Billups, Thomas E. Merchant, Larry Kun, Amy L. Billet, Sue Kaste, Nancy J. Tarbell, Scott Howard, Alison M. Friedmann, Craig A. Hurwitz, Jeffrey A. Young, Karen C. Marcus, Shesh Rai, Traci Cowan, Howard J. Weinstein

Research output: Contribution to journalArticle

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Abstract

Purpose: To evaluate the efficacy of vinblastine, doxorubicin, methotrexate, and prednisone (VAMP) and cyclophosphamide, vincristine, and procarbazine (COP) chemotherapy and response-based, involved-field radiation, a combined-modality regimen that limits doses of alkylating agents, anthracyclines, and radiation, in children with advanced and unfavorable Hodgkin's disease. Patients and Methods: From 1993 to 2000, 159 children and adolescents with unfavorable Hodgkin's disease received three alternating cycles (total of six cycles) of VAMP/COP chemotherapy followed by response-based, involved-field radiation therapy: 15 Gy was administered to patients achieving a complete response, and 25.5 Gy was administered to those achieving a partial response after the first two cycles of chemotherapy and to all sites of bulky lymphadenopathy. Unfavorable disease was defined as clinical stage I and II with bulky peripheral nodal disease greater than 6 cm, initial bulky mediastinal mass 33% or more of the intrathoracic diameter, and/or "B" symptoms and all stage III and IV. Results: Study enrollment was closed after an interim analysis estimated a 5-year event-free survival (EFS) rate below a predefined level. Disease presentation was localized (stage I/II) in 77 patients (48.4%) and advanced (stage III/IV) in 82 patients (51.6%). At a median follow-up of 5.8 years (range, 1.3 to 10.0 years), 38 patients had events, including relapse/progression (n = 35), second malignancy (n = 2), and accidental death (n = 1); nine relapses (25.7%) occurred greater than 4 years from diagnosis. Five-year survival and EFS estimates are 92.7% ± 2.5% and 75.6% ± 4.1%, respectively. Conclusion: Risk-adapted combined-modality therapy with VAMP/COP and response-based, involved-field radiation therapy results in an unsatisfactory outcome for pediatric patients with unfavorable presentations of Hodgkin's disease.

Original languageEnglish (US)
Pages (from-to)4541-4550
Number of pages10
JournalJournal of Clinical Oncology
Volume22
Issue number22
DOIs
StatePublished - Dec 1 2004
Externally publishedYes

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Procarbazine
Combined Modality Therapy
Vinblastine
Vincristine
Prednisone
Hodgkin Disease
Methotrexate
Doxorubicin
Cyclophosphamide
Radiation
Pediatrics
Drug Therapy
Disease-Free Survival
Radiotherapy
Recurrence
Second Primary Neoplasms
Alkylating Agents
Anthracyclines
Survival Rate
Survival

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Hudson, M. M., Krasin, M., Link, M. P., Donaldson, S. S., Billups, C., Merchant, T. E., ... Weinstein, H. J. (2004). Risk-adapted, combined-modality therapy with VAMP/COP and response-based, involved-field radiation for unfavorable pediatric Hodgkin's disease. Journal of Clinical Oncology, 22(22), 4541-4550. https://doi.org/10.1200/JCO.2004.02.139

Risk-adapted, combined-modality therapy with VAMP/COP and response-based, involved-field radiation for unfavorable pediatric Hodgkin's disease. / Hudson, Melissa M.; Krasin, Matthew; Link, Michael P.; Donaldson, Sarah S.; Billups, Catherine; Merchant, Thomas E.; Kun, Larry; Billet, Amy L.; Kaste, Sue; Tarbell, Nancy J.; Howard, Scott; Friedmann, Alison M.; Hurwitz, Craig A.; Young, Jeffrey A.; Marcus, Karen C.; Rai, Shesh; Cowan, Traci; Weinstein, Howard J.

In: Journal of Clinical Oncology, Vol. 22, No. 22, 01.12.2004, p. 4541-4550.

Research output: Contribution to journalArticle

Hudson, MM, Krasin, M, Link, MP, Donaldson, SS, Billups, C, Merchant, TE, Kun, L, Billet, AL, Kaste, S, Tarbell, NJ, Howard, S, Friedmann, AM, Hurwitz, CA, Young, JA, Marcus, KC, Rai, S, Cowan, T & Weinstein, HJ 2004, 'Risk-adapted, combined-modality therapy with VAMP/COP and response-based, involved-field radiation for unfavorable pediatric Hodgkin's disease', Journal of Clinical Oncology, vol. 22, no. 22, pp. 4541-4550. https://doi.org/10.1200/JCO.2004.02.139
Hudson, Melissa M. ; Krasin, Matthew ; Link, Michael P. ; Donaldson, Sarah S. ; Billups, Catherine ; Merchant, Thomas E. ; Kun, Larry ; Billet, Amy L. ; Kaste, Sue ; Tarbell, Nancy J. ; Howard, Scott ; Friedmann, Alison M. ; Hurwitz, Craig A. ; Young, Jeffrey A. ; Marcus, Karen C. ; Rai, Shesh ; Cowan, Traci ; Weinstein, Howard J. / Risk-adapted, combined-modality therapy with VAMP/COP and response-based, involved-field radiation for unfavorable pediatric Hodgkin's disease. In: Journal of Clinical Oncology. 2004 ; Vol. 22, No. 22. pp. 4541-4550.
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abstract = "Purpose: To evaluate the efficacy of vinblastine, doxorubicin, methotrexate, and prednisone (VAMP) and cyclophosphamide, vincristine, and procarbazine (COP) chemotherapy and response-based, involved-field radiation, a combined-modality regimen that limits doses of alkylating agents, anthracyclines, and radiation, in children with advanced and unfavorable Hodgkin's disease. Patients and Methods: From 1993 to 2000, 159 children and adolescents with unfavorable Hodgkin's disease received three alternating cycles (total of six cycles) of VAMP/COP chemotherapy followed by response-based, involved-field radiation therapy: 15 Gy was administered to patients achieving a complete response, and 25.5 Gy was administered to those achieving a partial response after the first two cycles of chemotherapy and to all sites of bulky lymphadenopathy. Unfavorable disease was defined as clinical stage I and II with bulky peripheral nodal disease greater than 6 cm, initial bulky mediastinal mass 33{\%} or more of the intrathoracic diameter, and/or {"}B{"} symptoms and all stage III and IV. Results: Study enrollment was closed after an interim analysis estimated a 5-year event-free survival (EFS) rate below a predefined level. Disease presentation was localized (stage I/II) in 77 patients (48.4{\%}) and advanced (stage III/IV) in 82 patients (51.6{\%}). At a median follow-up of 5.8 years (range, 1.3 to 10.0 years), 38 patients had events, including relapse/progression (n = 35), second malignancy (n = 2), and accidental death (n = 1); nine relapses (25.7{\%}) occurred greater than 4 years from diagnosis. Five-year survival and EFS estimates are 92.7{\%} ± 2.5{\%} and 75.6{\%} ± 4.1{\%}, respectively. Conclusion: Risk-adapted combined-modality therapy with VAMP/COP and response-based, involved-field radiation therapy results in an unsatisfactory outcome for pediatric patients with unfavorable presentations of Hodgkin's disease.",
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T1 - Risk-adapted, combined-modality therapy with VAMP/COP and response-based, involved-field radiation for unfavorable pediatric Hodgkin's disease

AU - Hudson, Melissa M.

AU - Krasin, Matthew

AU - Link, Michael P.

AU - Donaldson, Sarah S.

AU - Billups, Catherine

AU - Merchant, Thomas E.

AU - Kun, Larry

AU - Billet, Amy L.

AU - Kaste, Sue

AU - Tarbell, Nancy J.

AU - Howard, Scott

AU - Friedmann, Alison M.

AU - Hurwitz, Craig A.

AU - Young, Jeffrey A.

AU - Marcus, Karen C.

AU - Rai, Shesh

AU - Cowan, Traci

AU - Weinstein, Howard J.

PY - 2004/12/1

Y1 - 2004/12/1

N2 - Purpose: To evaluate the efficacy of vinblastine, doxorubicin, methotrexate, and prednisone (VAMP) and cyclophosphamide, vincristine, and procarbazine (COP) chemotherapy and response-based, involved-field radiation, a combined-modality regimen that limits doses of alkylating agents, anthracyclines, and radiation, in children with advanced and unfavorable Hodgkin's disease. Patients and Methods: From 1993 to 2000, 159 children and adolescents with unfavorable Hodgkin's disease received three alternating cycles (total of six cycles) of VAMP/COP chemotherapy followed by response-based, involved-field radiation therapy: 15 Gy was administered to patients achieving a complete response, and 25.5 Gy was administered to those achieving a partial response after the first two cycles of chemotherapy and to all sites of bulky lymphadenopathy. Unfavorable disease was defined as clinical stage I and II with bulky peripheral nodal disease greater than 6 cm, initial bulky mediastinal mass 33% or more of the intrathoracic diameter, and/or "B" symptoms and all stage III and IV. Results: Study enrollment was closed after an interim analysis estimated a 5-year event-free survival (EFS) rate below a predefined level. Disease presentation was localized (stage I/II) in 77 patients (48.4%) and advanced (stage III/IV) in 82 patients (51.6%). At a median follow-up of 5.8 years (range, 1.3 to 10.0 years), 38 patients had events, including relapse/progression (n = 35), second malignancy (n = 2), and accidental death (n = 1); nine relapses (25.7%) occurred greater than 4 years from diagnosis. Five-year survival and EFS estimates are 92.7% ± 2.5% and 75.6% ± 4.1%, respectively. Conclusion: Risk-adapted combined-modality therapy with VAMP/COP and response-based, involved-field radiation therapy results in an unsatisfactory outcome for pediatric patients with unfavorable presentations of Hodgkin's disease.

AB - Purpose: To evaluate the efficacy of vinblastine, doxorubicin, methotrexate, and prednisone (VAMP) and cyclophosphamide, vincristine, and procarbazine (COP) chemotherapy and response-based, involved-field radiation, a combined-modality regimen that limits doses of alkylating agents, anthracyclines, and radiation, in children with advanced and unfavorable Hodgkin's disease. Patients and Methods: From 1993 to 2000, 159 children and adolescents with unfavorable Hodgkin's disease received three alternating cycles (total of six cycles) of VAMP/COP chemotherapy followed by response-based, involved-field radiation therapy: 15 Gy was administered to patients achieving a complete response, and 25.5 Gy was administered to those achieving a partial response after the first two cycles of chemotherapy and to all sites of bulky lymphadenopathy. Unfavorable disease was defined as clinical stage I and II with bulky peripheral nodal disease greater than 6 cm, initial bulky mediastinal mass 33% or more of the intrathoracic diameter, and/or "B" symptoms and all stage III and IV. Results: Study enrollment was closed after an interim analysis estimated a 5-year event-free survival (EFS) rate below a predefined level. Disease presentation was localized (stage I/II) in 77 patients (48.4%) and advanced (stage III/IV) in 82 patients (51.6%). At a median follow-up of 5.8 years (range, 1.3 to 10.0 years), 38 patients had events, including relapse/progression (n = 35), second malignancy (n = 2), and accidental death (n = 1); nine relapses (25.7%) occurred greater than 4 years from diagnosis. Five-year survival and EFS estimates are 92.7% ± 2.5% and 75.6% ± 4.1%, respectively. Conclusion: Risk-adapted combined-modality therapy with VAMP/COP and response-based, involved-field radiation therapy results in an unsatisfactory outcome for pediatric patients with unfavorable presentations of Hodgkin's disease.

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