Classical Hodgkin lymphoma, pediatric - historical

The purpose of this page is to provide references to regimens that are obsolete, outdated, or of historical interest only. Is there a regimen missing from this list? See the main pediatric Hodgkin lymphoma page for current regimens.

7 regimens on this page 10 variants on this page

Untreated

ABVE

ABVE: Adriamycin (Doxorubicin), Bleomycin, Vincristine, Etoposide

Regimen

Study	Dates of enrollment	Evidence
Tebbi et al. 2012 (POG P9426)	1996-2001	Non-randomized (see note)

Note: this trial had a randomization to receive or not receive dexrazoxane. Labeled here as non-randomized because this drug does not have antineoplastic properties.

Chemotherapy

• Doxorubicin (Adriamycin) 25 mg/m² IV once per day on days 1 & 15
• Bleomycin (Blenoxane) 10 units/m² IV once per day on days 1 & 15
• Vincristine (Oncovin) 1.5 mg/m² (maximum dose of 2 mg) IV once per day on days 1 & 15
• Etoposide (Vepesid) 100 mg/m² IV once per day on days 1 to 5

Supportive therapy

• Filgrastim (Neupogen) 5 mcg/kg SC once per day on days 6 to 14, then once per day on days 16 until ANC greater than 1000/μL

28-day cycle for 2 cycles

Subsequent treatment

• POG P9426, CR: IFRT consolidation
• POG P9426, other than CR: ABVE x 2, then IFRT consolidation

References

1. POG P9426: Tebbi CK, Mendenhall NP, London WB, Williams JL, Hutchison RE, Fitzgerald TJ, de Alarcón PA, Schwartz C, Chauvenet A. Response-dependent and reduced treatment in lower risk Hodgkin lymphoma in children and adolescents, results of P9426: a report from the Children's Oncology Group. Pediatr Blood Cancer. 2012 Dec 15;59(7):1259-65. Epub 2012 Aug 21. link to original article link to PMC article contains dosing details in manuscript PubMed NCT00002827

ABVE-PC

ABVE-PC: Adriamycin (Doxorubicin), Bleomycin, Vincristine, Etoposide, Prednisone, Cyclophosphamide

Regimen variant #2, 3 cycles with response adaptation

Study	Evidence
Schwartz et al. 2009 (POG P9425)	Phase 2

Note: This regimen is intended for pediatric patients, younger than 22 years old. Note that first day of chemotherapy is day 0. Bleomycin and prednisone dosing is post-amendment.

Chemotherapy

• Doxorubicin (Adriamycin) 30 mg/m² IV once per day on days 0 & 1
• Bleomycin (Blenoxane) 10 units/m² IV or SC once per day on days 0 & 7
• Vincristine (Oncovin) 1.4 mg/m² (maximum dose of 2.8 mg) IV once per day on days 0 & 7
• Etoposide (Vepesid) 75 mg/m² IV once per day on days 0 to 4
• Cyclophosphamide (Cytoxan) 800 mg/m² IV once on day 0

Glucocorticoid therapy

• Prednisone (Sterapred) 40 mg/m² PO once per day on days 0 to 7

Supportive therapy

• Dexrazoxane (Zinecard) 300 mg/m² IV once per day on days 0, 1, 7 (this was a randomization)
• Filgrastim (Neupogen) 5 mcg/kg IV or SC once per day from day 5 until neutrophil recovery (held on day 7)

21-day cycle for 3 cycles

Subsequent treatment

• POG P9425, rapid early responders: IFRT consolidation x 2100 cGy
• POG P9425, slow early responders: ABVE-PC continuation x 2 (5 cycles total), then IFRT consolidation x 2100 cGy

Regimen variant #4, 5 cycles

Study	Evidence
Schwartz et al. 2009 (POG P9425)	Phase 2

Note: This regimen is intended for pediatric patients, younger than 22 years old, who are slow early responders. Note that first day of chemotherapy is day 0. Bleomycin and prednisone dosing is post-amendment.

Preceding treatment

• Induction ABVE-PC x 3, with slow early response

Chemotherapy

• Doxorubicin (Adriamycin) 30 mg/m² IV once per day on days 0 & 1
• Bleomycin (Blenoxane) 10 units/m² IV or SC once per day on days 0 & 7
• Vincristine (Oncovin) 1.4 mg/m² (maximum dose of 2.8 mg) IV once per day on days 0 & 7
• Etoposide (Vepesid) 75 mg/m² IV once per day on days 0 to 4
• Cyclophosphamide (Cytoxan) 800 mg/m² IV once on day 0

Glucocorticoid therapy

• Prednisone (Sterapred) 40 mg/m² PO once per day on days 0 to 7

Supportive therapy

• Dexrazoxane (Zinecard) 300 mg/m² IV once per day on days 0, 1, 7 (this was a randomization)
• Filgrastim (Neupogen) 5 mcg/kg IV or SC once per day from day 5 until neutrophil recovery (held on day 7)

21-day cycle for 5 cycles, including the first 3 cycles

Subsequent treatment

• IFRT consolidation x 2100 cGy

References

1. POG P9425: Schwartz CL, Constine LS, Villaluna D, London WB, Hutchison RE, Sposto R, Lipshultz SE, Turner CS, deAlarcon PA, Chauvenet A. A risk-adapted, response-based approach using ABVE-PC for children and adolescents with intermediate- and high-risk Hodgkin lymphoma: the results of P9425. Blood. 2009 Sep 3;114(10):2051-9. Epub 2009 Jul 7. Erratum: in Blood 2016 128:605 link to original article contains dosing details in manuscript link to PMC article PubMed NCT00005578

MOPP

MOPP: Mechlorethamine, Oncovin (Vincristine), Procarbazine, Prednisone

Regimen variant #3, uncapped vincristine

Study	Dates of enrollment	Evidence
Young et al. 1973a	1964-NR	Non-randomized (RT)
Kolygin 1976	1970-1975	Non-randomized (RT)

Chemotherapy

• Mechlorethamine (Mustargen) 6 mg/m² IV once per day on days 1 & 8
• Vincristine (Oncovin) 1.4 mg/m² IV once per day on days 1 & 8
• Procarbazine (Matulane) 100 mg/m² PO once per day on days 1 to 14

Glucocorticoid therapy

• Prednisone (Sterapred) 40 mg/m² PO once per day on days 1 to 14

28-day cycle for 6 to 8 cycles

References

1. Young RC, DeVita VT, Johnson RE. Hodgkin's disease in childhood. Blood. 1973 Aug;42(2):163-74. link to original article PubMed
2. Kolygin BA. Combination chemotherapy of Hodgkin's disease in children. Cancer. 1976 Oct;38(4):1494-7. link to original article PubMed

OPPA

OPPA: Oncovin (Vincristine), Procarbazine, Prednisone, Adriamycin (Doxorubicin)

Regimen

Study	Dates of enrollment	Evidence
Mauz-Körholz et al. 2010 (GPOH-HD-2002)	2002-2005	Phase 2

Note: This regimen is meant for girls. Patients with early-stage disease only received the OPPA portion, see text for details.

Chemotherapy

• Vincristine (Oncovin) 1.5 mg/m² IV once per day on days 1, 8, 15
• Procarbazine (Matulane) 100 mg/m² PO once per day on days 1 to 15
• Doxorubicin (Adriamycin) 40 mg/m² IV once per day on days 1 & 15

Glucocorticoid therapy

• Prednisone (Sterapred) 60 mg/m² PO once per day on days 1 to 15

28-day cycle for 2 cycles

Subsequent treatment

• GPOH-HD-2002, treatment group 2: COPP consolidation x 2
• GPOH-HD-2002, treatment group 3: COPP consolidation x 4

References

1. GPOH-HD-2002: Mauz-Körholz C, Hasenclever D, Dörffel W, Ruschke K, Pelz T, Voigt A, Stiefel M, Winkler M, Vilser C, Dieckmann K, Karlén J, Bergsträsser E, Fosså A, Mann G, Hummel M, Klapper W, Stein H, Vordermark D, Kluge R, Körholz D. Procarbazine-free OEPA-COPDAC chemotherapy in boys and standard OPPA-COPP in girls have comparable effectiveness in pediatric Hodgkin's lymphoma: the GPOH-HD-2002 study. J Clin Oncol. 2010 Aug 10;28(23):3680-6. Epub 2010 Jul 12. link to original article contains dosing details in manuscript PubMed NCT00416832

VAMP (Methotrexate)

VAMP: Vinblastine, Adriamycin (Doxorubicin), Methrotrexate, Prednisone

Regimen

Study	Dates of enrollment	Evidence
Metzger et al. 2012 (HOD99)	2000-03-03 to 2008-12-09	Phase 2

Note: This is to be distinguished from the VAMP protocols used in AML and multiple myeloma.

Chemotherapy

• Vinblastine (Velban) 6 mg/m² IV once per day on days 1 & 15
• Doxorubicin (Adriamycin) 25 mg/m² IV once per day on days 1 & 15
• Methotrexate (MTX) 20 mg/m² IV once per day on days 1 & 15

Glucocorticoid therapy

• Prednisone (Sterapred) 40 mg/m² PO once per day on days 1 to 14

28-day cycle for 4 cycles

Subsequent treatment

• HOD99, early responders: Observation versus RT consolidation

References

1. HOD99: Metzger ML, Weinstein HJ, Hudson MM, Billett AL, Larsen EC, Friedmann A, Howard SC, Donaldson SS, Krasin MJ, Kun LE, Marcus KJ, Yock TI, Tarbell N, Billups CA, Wu J, Link MP. Association between radiotherapy vs no radiotherapy based on early response to VAMP chemotherapy and survival among children with favorable-risk Hodgkin lymphoma. JAMA. 2012 Jun 27;307(24):2609-16. link to original article link to PMC article contains dosing details in manuscript PubMed

Consolidation after upfront therapy

C-MOPP

C-MOPP: CyclophosphaMide, Oncovin (Vincristine), Procarbazine, Prednisone
COPP: Cyclophosphamide, Oncovin (Vincristine), Procarbazine, Prednisone

Regimen variant #1, 2 cycles

Study	Dates of enrollment	Evidence
Mauz-Körholz et al. 2010 (GPOH-HD-2002)	2002-2005	Phase 2

Preceding treatment

• Induction OPPA x 2

Chemotherapy

• Cyclophosphamide (Cytoxan) 500 mg/m² IV once per day on days 1 & 8
• Vincristine (Oncovin) 1.5 mg/m² IV once per day on days 1 & 8
• Procarbazine (Matulane) 100 mg/m² PO once per day on days 1 to 15

Glucocorticoid therapy

• Prednisone (Sterapred) 40 mg/m² PO once per day on days 1 to 15

28-day cycle for 2 cycles

Regimen variant #2, 4 cycles

Study	Dates of enrollment	Evidence
Mauz-Körholz et al. 2010 (GPOH-HD-2002)	2002-2005	Phase 2

Preceding treatment

• Induction OPPA x 2

Chemotherapy

• Cyclophosphamide (Cytoxan) 500 mg/m² IV once per day on days 1 & 8
• Vincristine (Oncovin) 1.5 mg/m² IV once per day on days 1 & 8
• Procarbazine (Matulane) 100 mg/m² PO once per day on days 1 to 15

Glucocorticoid therapy

• Prednisone (Sterapred) 40 mg/m² PO once per day on days 1 to 15

28-day cycle for 4 cycles

References

1. GPOH-HD-2002: Mauz-Körholz C, Hasenclever D, Dörffel W, Ruschke K, Pelz T, Voigt A, Stiefel M, Winkler M, Vilser C, Dieckmann K, Karlén J, Bergsträsser E, Fosså A, Mann G, Hummel M, Klapper W, Stein H, Vordermark D, Kluge R, Körholz D. Procarbazine-free OEPA-COPDAC chemotherapy in boys and standard OPPA-COPP in girls have comparable effectiveness in pediatric Hodgkin's lymphoma: the GPOH-HD-2002 study. J Clin Oncol. 2010 Aug 10;28(23):3680-6. Epub 2010 Jul 12. link to original article contains dosing details in manuscript PubMed NCT00416832

COPDAC

COPDAC: Cyclophosphamide, Oncovin (Vincristine), Prednisone, DACarbazine

Regimen variant #1, 2 cycles

Study	Dates of enrollment	Evidence
Mauz-Körholz et al. 2010 (GPOH-HD-2002)	2002-2005	Phase 2

Preceding treatment

• Induction OEPA x 2

Chemotherapy

• Cyclophosphamide (Cytoxan) 500 mg/m² IV once per day on days 1 & 8
• Vincristine (Oncovin) 1.5 mg/m² IV once per day on days 1 & 8
• Dacarbazine (DTIC) 250 mg/m² IV once per day on days 1 to 4

Glucocorticoid therapy

• Prednisone (Sterapred) 40 mg/m² PO once per day on days 1 to 15

28-day cycle for 2 cycles

Regimen variant #2, 4 cycles

Study	Dates of enrollment	Evidence
Mauz-Körholz et al. 2010 (GPOH-HD-2002)	2002-2005	Phase 2

Preceding treatment

• Induction OEPA x 2

Chemotherapy

• Cyclophosphamide (Cytoxan) 500 mg/m² IV once per day on days 1 & 8
• Vincristine (Oncovin) 1.5 mg/m² IV once per day on days 1 & 8
• Dacarbazine (DTIC) 250 mg/m² IV once per day on days 1 to 4

Glucocorticoid therapy

• Prednisone (Sterapred) 40 mg/m² PO once per day on days 1 to 15

28-day cycle for 4 cycles

References

1. GPOH-HD-2002: Mauz-Körholz C, Hasenclever D, Dörffel W, Ruschke K, Pelz T, Voigt A, Stiefel M, Winkler M, Vilser C, Dieckmann K, Karlén J, Bergsträsser E, Fosså A, Mann G, Hummel M, Klapper W, Stein H, Vordermark D, Kluge R, Körholz D. Procarbazine-free OEPA-COPDAC chemotherapy in boys and standard OPPA-COPP in girls have comparable effectiveness in pediatric Hodgkin's lymphoma: the GPOH-HD-2002 study. J Clin Oncol. 2010 Aug 10;28(23):3680-6. Epub 2010 Jul 12. link to original article contains dosing details in manuscript PubMed NCT00416832