Treatment outcome in children and adolescents with relapsed Hodgkin lymphoma--results of the UK HD3 relapse treatment strategy

Br J Haematol. 2014 May;165(4):534-44. doi: 10.1111/bjh.12768. Epub 2014 Feb 7.

Abstract

The purpose of this national retrospective study was to evaluate the outcome in children with relapsed or primary refractory Hodgkin lymphoma [HL] after a primary chemotherapy alone treatment strategy. Between 2000 and 2005, 80 children with relapsed [n = 69] or primary refractory [n = 11] HL were treated on a standardized treatment protocol of 4-6 cycles of EPIC [etoposide, prednisolone, ifosfamide and cisplatin] chemotherapy. Radiotherapy was recommended to all relapsed sites. High dose therapy with stem cell rescue [SCT] was recommended for patients with poor response. The 5-year overall survival [OS] and progression-free survival from relapse was 75·8% [64·8-83·9] and 59·9% [48·3-69·7] respectively. Duration of first remission was strongly associated with OS; risk of death was decreased by 53% [Hazard ratio (HR): 0·47, 95% confidence interval (CI): 0·19-1·18] for those with a time from end of treatment to relapse of 3-12 months (compared to <3 months) and reduced by 80% (HR 0·20, 95% CI: 0·04-0·90) for those >12 months after end of treatment. Other poor prognostic factors included advanced stage disease at relapse and B symptoms at first diagnosis. The most important factor associated with salvage failure was time to relapse. Survival outcome in children with primary refractory HL is poor.

Keywords: Hodgkin lymphoma; children; refractory disease; relapse; survival.

MeSH terms

  • Adolescent
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Bleomycin / administration & dosage
  • Carmustine / administration & dosage
  • Child
  • Chlorambucil / administration & dosage
  • Cisplatin / administration & dosage
  • Cisplatin / adverse effects
  • Clinical Trials as Topic
  • Combined Modality Therapy
  • Cyclophosphamide / administration & dosage
  • Cyclophosphamide / adverse effects
  • Cytarabine / administration & dosage
  • Dacarbazine / administration & dosage
  • Dexamethasone / administration & dosage
  • Disease-Free Survival
  • Doxorubicin / administration & dosage
  • Doxorubicin / adverse effects
  • Epirubicin / administration & dosage
  • Etoposide / administration & dosage
  • Etoposide / adverse effects
  • Follow-Up Studies
  • Hematopoietic Stem Cell Transplantation
  • Hodgkin Disease / drug therapy*
  • Hodgkin Disease / mortality
  • Hodgkin Disease / radiotherapy
  • Hodgkin Disease / surgery
  • Humans
  • Ifosfamide / administration & dosage
  • Ifosfamide / adverse effects
  • Kaplan-Meier Estimate
  • Melphalan / administration & dosage
  • Multicenter Studies as Topic
  • Neoplasm Staging
  • Prednisolone / administration & dosage
  • Prednisolone / adverse effects
  • Prednisone / administration & dosage
  • Procarbazine / administration & dosage
  • Prognosis
  • Radiotherapy, Adjuvant
  • Recurrence
  • Remission Induction
  • Retrospective Studies
  • Salvage Therapy
  • Treatment Outcome
  • Vinblastine / administration & dosage
  • Vincristine / administration & dosage
  • Vincristine / adverse effects

Substances

  • Cytarabine
  • Bleomycin
  • Chlorambucil
  • Procarbazine
  • Epirubicin
  • Vincristine
  • Vinblastine
  • Etoposide
  • Dacarbazine
  • Dexamethasone
  • Doxorubicin
  • Cyclophosphamide
  • Prednisolone
  • Cisplatin
  • Melphalan
  • Carmustine
  • Ifosfamide
  • Prednisone

Supplementary concepts

  • ABVD protocol
  • BEAM regimen
  • CHIVPP protocol
  • DHAP protocol
  • IEV protocol