Reduced treatment intensity in patients with early-stage Hodgkin's lymphoma - PubMed (original) (raw)
Randomized Controlled Trial
. 2010 Aug 12;363(7):640-52.
doi: 10.1056/NEJMoa1000067.
Annette Plütschow, Hans Theodor Eich, Andreas Lohri, Bernd Dörken, Peter Borchmann, Bernhard Berger, Richard Greil, Kay C Willborn, Martin Wilhelm, Jürgen Debus, Michael J Eble, Martin Sökler, Antony Ho, Andreas Rank, Arnold Ganser, Lorenz Trümper, Carsten Bokemeyer, Hartmut Kirchner, Jörg Schubert, Zdenek Král, Michael Fuchs, Hans-Konrad Müller-Hermelink, Rolf-Peter Müller, Volker Diehl
Affiliations
- PMID: 20818855
- DOI: 10.1056/NEJMoa1000067
Free article
Randomized Controlled Trial
Reduced treatment intensity in patients with early-stage Hodgkin's lymphoma
Andreas Engert et al. N Engl J Med. 2010.
Free article
Abstract
Background: Whether it is possible to reduce the intensity of treatment in early (stage I or II) Hodgkin's lymphoma with a favorable prognosis remains unclear. We therefore conducted a multicenter, randomized trial comparing four treatment groups consisting of a combination chemotherapy regimen of two different intensities followed by involved-field radiation therapy at two different dose levels.
Methods: We randomly assigned 1370 patients with newly diagnosed early-stage Hodgkin's lymphoma with a favorable prognosis to one of four treatment groups: four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by 30 Gy of radiation therapy (group 1), four cycles of ABVD followed by 20 Gy of radiation therapy (group 2), two cycles of ABVD followed by 30 Gy of radiation therapy (group 3), or two cycles of ABVD followed by 20 Gy of radiation therapy (group 4). The primary end point was freedom from treatment failure; secondary end points included efficacy and toxicity of treatment.
Results: The two chemotherapy regimens did not differ significantly with respect to freedom from treatment failure (P=0.39) or overall survival (P=0.61). At 5 years, the rates of freedom from treatment failure were 93.0% (95% confidence interval [CI], 90.5 to 94.8) with the four-cycle ABVD regimen and 91.1% (95% CI, 88.3 to 93.2) with the two-cycle regimen. When the effects of 20-Gy and 30-Gy doses of radiation therapy were compared, there were also no significant differences in freedom from treatment failure (P=1.00) or overall survival (P=0.61). Adverse events and acute toxic effects of treatment were most common in the patients who received four cycles of ABVD and 30 Gy of radiation therapy (group 1).
Conclusions: In patients with early-stage Hodgkin's lymphoma and a favorable prognosis, treatment with two cycles of ABVD followed by 20 Gy of involved-field radiation therapy is as effective as, and less toxic than, four cycles of ABVD followed by 30 Gy of involved-field radiation therapy. Long-term effects of these treatments have not yet been fully assessed. (Funded by the Deutsche Krebshilfe and the Swiss Federal Government; ClinicalTrials.gov number, NCT00265018.)
Similar articles
- A randomized trial of brief treatment of early- stage Hodgkin lymphoma: Is it effective?
Hamed RH, Anter AH, Awad IA. Hamed RH, et al. Hematol Oncol Stem Cell Ther. 2012;5(1):36-41. doi: 10.5144/1658-3876.2012.36. Hematol Oncol Stem Cell Ther. 2012. PMID: 22446609 Clinical Trial. - Intensified chemotherapy and dose-reduced involved-field radiotherapy in patients with early unfavorable Hodgkin's lymphoma: final analysis of the German Hodgkin Study Group HD11 trial.
Eich HT, Diehl V, Görgen H, Pabst T, Markova J, Debus J, Ho A, Dörken B, Rank A, Grosu AL, Wiegel T, Karstens JH, Greil R, Willich N, Schmidberger H, Döhner H, Borchmann P, Müller-Hermelink HK, Müller RP, Engert A. Eich HT, et al. J Clin Oncol. 2010 Sep 20;28(27):4199-206. doi: 10.1200/JCO.2010.29.8018. Epub 2010 Aug 16. J Clin Oncol. 2010. PMID: 20713848 Clinical Trial. - Treatment of early-stage Hodgkin's disease with four cycles of ABVD followed by adjuvant radio-therapy: analysis of efficacy and long-term toxicity.
Brusamolino E, Lunghi F, Orlandi E, Astori C, Passamonti F, Baraté C, Pagnucco G, Baio A, Franchini P, Lazzarino M, Bernasconi C. Brusamolino E, et al. Haematologica. 2000 Oct;85(10):1032-9. Haematologica. 2000. PMID: 11025593 Clinical Trial. - Optimisation of chemotherapy and radiotherapy for untreated Hodgkin lymphoma patients with respect to second malignant neoplasms, overall and progression-free survival: individual participant data analysis.
Franklin J, Eichenauer DA, Becker I, Monsef I, Engert A. Franklin J, et al. Cochrane Database Syst Rev. 2017 Sep 13;9(9):CD008814. doi: 10.1002/14651858.CD008814.pub2. Cochrane Database Syst Rev. 2017. PMID: 28901021 Free PMC article. Review. - Limited-stage Hodgkin lymphoma: optimal chemotherapy and the role of radiotherapy.
Bartlett NL. Bartlett NL. Am Soc Clin Oncol Educ Book. 2013:374-80. doi: 10.14694/EdBook_AM.2013.33.374. Am Soc Clin Oncol Educ Book. 2013. PMID: 23714551 Review.
Cited by
- Cancer therapy-related salivary dysfunction.
Paz C, Glassey A, Frick A, Sattar S, Zaorsky NG, Blitzer GC, Kimple RJ. Paz C, et al. J Clin Invest. 2024 Sep 3;134(17):e182661. doi: 10.1172/JCI182661. J Clin Invest. 2024. PMID: 39225092 Free PMC article. Review. - Survival of patients with classical Hodgkin lymphoma in Finland: a national population-based analysis.
Hannuksela N, Partanen A, Anttalainen A, Ukkola-Vuoti L, Toppila I, Vikkula J, Marin K, Kuitunen H, Miettinen T, Kuittinen O, Rönkä A. Hannuksela N, et al. Blood Cancer J. 2024 Aug 20;14(1):139. doi: 10.1038/s41408-024-01125-4. Blood Cancer J. 2024. PMID: 39164236 Free PMC article. No abstract available. - The role of radiotherapy in patients with refractory Hodgkin's lymphoma after treatment with brentuximab vedotin and/or immune checkpoint inhibitors.
Zhao R, Shao H, Shi G, Qiu Y, Tang T, Lin Y, Chen S, Huang C, Liao S, Chen J, Fu H, Liu J, Xu B, Liu T, Zhang Y, Yang Y. Zhao R, et al. J Natl Cancer Cent. 2023 Nov 10;4(1):86-92. doi: 10.1016/j.jncc.2023.11.001. eCollection 2024 Mar. J Natl Cancer Cent. 2023. PMID: 39036380 Free PMC article. - Autologous Stem Cell Transplantation in Adult Hodgkin Lymphoma at a Tertiary Care Center in India: Analysis of Outcomes and Prognostic Factors.
Kumar S, Sharma A, Bakhshi S, Pushpam D, Gogia A, Sahoo RK, Pramanik R, Kumar A, Pathak N, Thulkar S, Sharma MC, Gupta R, Mallick S, Raina V. Kumar S, et al. Indian J Hematol Blood Transfus. 2024 Apr;40(2):181-189. doi: 10.1007/s12288-023-01690-x. Epub 2023 Sep 1. Indian J Hematol Blood Transfus. 2024. PMID: 38708163 - The Gut Connection: Exploring the Possibility of Implementing Gut Microbial Metabolites in Lymphoma Treatment.
Al-Khazaleh AK, Chang D, Münch GW, Bhuyan DJ. Al-Khazaleh AK, et al. Cancers (Basel). 2024 Apr 11;16(8):1464. doi: 10.3390/cancers16081464. Cancers (Basel). 2024. PMID: 38672546 Free PMC article. Review.
Publication types
MeSH terms
Substances
Supplementary concepts
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical