This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chow, L. M.L. Articles by Greenberg, M. L. Search for Related Content PubMed PubMed Citation Articles by Chow, L. M.L. Articles by Greenberg, M. L. Social Bookmarking                            What's this?

Survival and Late Effects in Children With Hodgkin's Lymphoma Treated With MOPP/ABV and Low-Dose, Extended-Field Irradiation

Lionel M.L. Chow, Paul C. Nathan, David C. Hodgson, Derek Jenkin, Sheila Weitzman, Ronald M. Grant, David Manson, Adee Bross, John J. Doyle, Cyril Danjoux, Mark L. Greenberg

From the Division of Haematology & Oncology, Department of Paediatrics; Department of Diagnostic Imaging; Division of Radiation Oncology, Toronto Sunnybrook Regional Cancer Centre, The Hospital for Sick Children; and the Department of Radiation Oncology, Princess Margaret Hospital, The University of Toronto, Toronto, Ontario, Canada

Address reprint requests to Mark L. Greenberg, MBChB, Division of Haematology & Oncology, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; e-mail: mark.greenberg{at}sickkids.ca

PURPOSE: Reduced-intensity protocols for pediatric Hodgkin's lymphoma are aimed at preserving excellent relapse-free survival while decreasing the incidence of late effects.

PATIENTS AND METHODS: We retrospectively reviewed the outcome of 123 children treated consecutively for Hodgkin's lymphoma at a single institution. Patients with stages I-IIIB disease received three cycles of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP)/ doxorubicin, bleomycin, and vinblastine (ABV) followed by 15 Gy of extended-field irradiation, while those with stage IV disease were treated with six to eight cycles of MOPP/ABV chemotherapy with or without radiotherapy.

RESULTS: At a median follow-up of 8.5 years (range, 1.4 to 15.5 years), the estimated 10-year overall survival and event-free survival are 94% (SE, 2.2%) and 88% (SE, 3.1%) respectively. There have been 12 treatment failures and six disease-related deaths. A very large mediastinal mass ( 50% of the maximal thoracic diameter) was associated with a 10-year event-free survival of 50% (SE, 14%) compared with 91% (SE, 4.0%) for smaller masses (P < .001). Late cardiopulmonary toxicity is largely absent, and the incidence of hypothyroidism is 14%. There have been no cases of secondary leukemia and four secondary solid malignancies observed to date.

CONCLUSION: MOPP/ABV and low-dose, extended-field radiotherapy is an effective treatment for pediatric Hodgkin's lymphoma. With median follow-up of 8.5 years, late cardiopulmonary effects and secondary malignancies from this treatment regimen are infrequent. Continued longitudinal observations, particularly for breast cancer in female patients and gonadotoxicity, will determine whether the goal of decreasing treatment-related complications while maintaining excellent survival has been achieved.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?