RISK-ADAPTED TREATMENT OF CHILDHOOD HODGKIN’S LYMPHOMA
Journal Title: International Journal of Medical and Clinical Research - Year 2014, Vol 5, Issue 2
Abstract
Purpose: The comparative analysis of the efficacy and economic research of risk-adapted therapy with DAL-HD and with original protocol SPbHL-05 for childhood Hodgkin lymphoma (HL) was performed. Patients and Methods: The study consisted of 153 patients aged before 18 years old treated for HL between 1987 and 2011: 83 patients were treated according to DAL-HD and 70 - according to SPbHL-05. Patients assigned to DAL-HD were selected according to the stage of the disease and systemic “B†symptoms. Patients with stage IA, IB and IIA (TG1 - tumor group 1) received two cycles OPPA (27 patients or 32,5%); children with stages IIB and IIIA (TG2) received four cycles OPPA/OEPA and COPP (33 or 39,8%); remaining patients with stages IIIB and IV (TG3) received six cycles OPPA/OEPA and COPP (23 or 27,7%). Radiotherapy (RT) with total dose 25 Gy in TG1 and TG2, and 20 Gy in TG3 was administered to the initially involved areas. Patients treated according to SPbHL-05 were stratified for favorable, intermediate and unfavorable risk groups depending on the 6 unfavorable prognostic factors. Seventeen patients (24.3%) with 0-2 adverse factors (the favorable group) received two cycles of chemotherapy (VBVP), 27 children (38.6%) with 3-4 unfavorable signs (the intermediate group) received four alternating cycles (2 x VBVP, 2 x ABVD), 26 patient (37.8%) who had 5 or more unfavorable prognostic factors (the unfavorable group) received six alternating cycles (3 x VBVP, 3 x ABVD). Patients who achieved complete response or ≥ 75% reductions in all disease manifestation were administered total dose 25 Gy. Patients who did not reach these status were administered 36 Gy. Results: Patients in «DAL-HD» and «SPbHL-05» were similar in sex, stage, histological subtype and risk group. Event-free survival (EFS) and overall survival (OS) were similar for the two groups: 79.9% vs 81.7% (P=0.9 log-rank) and 93.3% vs 92.2% (P=0.44 log-rank) for «DAL-HD» and «SPbHL-05», respectively. According to the risk group division, the analysis showed that both arms produce equivalent superior results (EFS and OS) in TG1/favorable and TG2/intermediate risk groups: 84.4% vs 92.9% and 100% vs 100%, respectively, in TG1/favorable risk group, and 81.4% vs 95.7% and 96.7% vs 100%, respectively, in TG2/intermediate risk group. EFS and OS in TG3/unfavorable risk group were worse: 72.7% vs 59.9 and 87% vs 78.1% for «DAL-HD» and «SPbHL-05», respectively. Economic analysis stated that using SPbHL-05 was found to be cost-effective, with the profit of € 263.733 per child in the favorable risk group, € 438.303 per child in the intermediate risk group, and € 585.202 per child in the unfavorable risk group. Conclusion: SPbHL-05 represents an effective treatment strategy for Hodgkin’s lymphoma in children, and might be warranted the best results in favorable and intermediate risk groups, and should help to avoid overtreatment and reduce toxicity in patients. It is more cost-effective compared with DAL-HD for the Russian Federation population, and the most preferable method for the disease.
Authors and Affiliations
S. A. KULYOVA, A. P. KARITSKY, B. A. KOLYGIN
Keywords
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