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Final Results of a Prospective Clinical Trial With VAMP and Low-Dose Involved-Field Radiation for Children With Low-Risk Hodgkin's Disease

Sarah S. Donaldson, Michael P. Link, Howard J. Weinstein, Shesh N. Rai, Sam Brain, Amy L. Billett, Craig A. Hurwitz, Matthew Krasin, Larry E. Kun, Karen C. Marcus, Nancy J. Tarbell, Jeffrey A. Young, Melissa M. Hudson

From the Stanford University Medical Center, Stanford, CA; Dana-Farber Cancer Institute and the Massachusetts General Hospital, Boston, MA; Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME; and St Jude Children's Research Hospital, Memphis TN

Address reprint requests to Sarah S. Donaldson, MD, Department of Radiation Oncology, Cancer Center, 875 Blake Wilbur Dr, G-226, Stanford, CA 94305-5847; e-mail: sarah2{at}stanford.edu

PURPOSE: To evaluate outcome and assess complications in children and adolescents with low-risk Hodgkin's disease treated with vinblastine, doxorubicin, methotrexate, and prednisone (VAMP) chemotherapy and low-dose, involved-field radiation therapy (IFRT).

PATIENTS AND METHODS: One hundred ten children with low-risk Hodgkin's disease were treated with four cycles of VAMP and 15 Gy IFRT for those who achieved a complete response (CR) or 25.5 Gy for those with a partial response after two cycles of VAMP.

RESULTS: With median follow-up of 9.6 years (range, 1.7 to 15.0), 5- and 10-year overall survival were 99.1% and 96.1%, respectively, and 5-and 10-year event-free survival (EFS) were 92.7% and 89.4%. Factors contributing to 10-year EFS were: early CR (P = .02), absence of B symptoms (P = .01), lymphocyte predominant histologic subtype (P = .04), and less than three initial sites of disease (P = .02). Organ toxicity has been limited to correctable hypothyroidism in 42% of irradiated patients, and one case of cardiac dysfunction. Seventeen healthy babies have been born to 106 survivors. There have been two malignant tumors: one thyroid cancer within the radiation therapy field and one Ewing's sarcoma outside the radiation therapy field.

CONCLUSION: Risk-adapted, combined-modality therapy using VAMP chemotherapy with radiation is effective and well tolerated. Pediatric patients with low-risk Hodgkin's disease can be cured with therapy without an alkylating agent, bleomycin, etoposide, or high-dose, extended-field radiotherapy. Thus, these children are expected to retain normal fertility, organ function, and be at low risk of a second malignant tumor.

Supported by St Jude Children's Research Hospital Cancer Center (CORE) Grant No. CA 21765 from the National Cancer Institute and the American Lebanese Syrian Associated Charities (ALSAC).

Presented in part at the 47th Annual Meeting of the American Society of Therapeutic Radiology and Oncology, Denver, CO, October 17, 2005.

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