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

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)332-337
Number of pages6
JournalJournal of Clinical Oncology
Volume25
Issue number3
DOIs
StatePublished - Jan 20 2007

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Vinblastine
Prednisone
Hodgkin Disease
Methotrexate
Doxorubicin
Radiotherapy
Clinical Trials
Radiation
Disease-Free Survival
Drug Therapy
Combined Modality Therapy
Ewing's Sarcoma
Alkylating Agents
Bleomycin
Etoposide
Hypothyroidism
Thyroid Neoplasms
Fertility
Survivors
Neoplasms

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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

In: Journal of Clinical Oncology, Vol. 25, No. 3, 20.01.2007, p. 332-337.

Research output: Contribution to journalArticle

Donaldson, SS, Link, MP, Weinstein, HJ, Rai, SN, Brain, S, Billett, AL, Hurwitz, CA, Krasin, M, Kun, LE, Marcus, KC, Tarbell, NJ, Young, JA & Hudson, MM 2007, 'Final results of a prospective clinical trial with VAMP and low-dose involved-field radiation for children with low-risk Hodgkin's disease', Journal of Clinical Oncology, vol. 25, no. 3, pp. 332-337. https://doi.org/10.1200/JCO.2006.08.4772
Donaldson, Sarah S. ; Link, Michael P. ; Weinstein, Howard J. ; Rai, Shesh N. ; Brain, Sam ; Billett, Amy L. ; Hurwitz, Craig A. ; Krasin, Matthew ; Kun, Larry E. ; Marcus, Karen C. ; Tarbell, Nancy J. ; Young, Jeffrey A. ; Hudson, Melissa M. / Final results of a prospective clinical trial with VAMP and low-dose involved-field radiation for children with low-risk Hodgkin's disease. In: Journal of Clinical Oncology. 2007 ; Vol. 25, No. 3. pp. 332-337.
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abstract = "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.",
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T1 - Final results of a prospective clinical trial with VAMP and low-dose involved-field radiation for children with low-risk Hodgkin's disease

AU - Donaldson, Sarah S.

AU - Link, Michael P.

AU - Weinstein, Howard J.

AU - Rai, Shesh N.

AU - Brain, Sam

AU - Billett, Amy L.

AU - Hurwitz, Craig A.

AU - Krasin, Matthew

AU - Kun, Larry E.

AU - Marcus, Karen C.

AU - Tarbell, Nancy J.

AU - Young, Jeffrey A.

AU - Hudson, Melissa M.

PY - 2007/1/20

Y1 - 2007/1/20

N2 - 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.

AB - 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.

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