Hodgkin lymphoma, pediatric

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Wayne H. Liang, MD, MS, FAMIA
Children’s Healthcare of Atlanta/Emory
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This page contains studies that were specific to pediatric populations. For the more general Hodgkin lymphoma page, follow this link.

8 regimens on this page
13 variants on this page


Guidelines

NCCN

Untreated, induction

OEPA

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OEPA: Oncovin (Vincristine), Etoposide, Prednisone, Adriamycin (Doxorubicin)

Regimen

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

This regimen is meant for boys as it is potentially less gonadotoxic. The original protocol used three doses of dacarbazine per cycle but this was increased to four after a mid-protocol amendment. Patients with early-stage disease only received the OEPA portion, see text for details.

Chemotherapy

28-day cycle for 2 cycles

Subsequent treatment

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 verified protocol PubMed NCT00416832

OPPA

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

Regimen

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

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

Chemotherapy

28-day cycle for 2 cycles

Subsequent treatment

  • Treatment group 2: COPP x 2
  • Treatment group 3: COPP 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 verified protocol PubMed NCT00416832

Untreated, early-stage favorable (ESF)

VAMP (Methotrexate)

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

Regimen

Study Evidence
Metzger et al. 2012 (HOD99) Non-randomized portion of RCT

To be completed? This is to be distinguished from the VAMP protocols used in AML and multiple myeloma.

Chemotherapy

4 cycles

Subsequent treatment

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 PubMed

Untreated, intermediate risk

ABVE-PC

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

Regimen variant #1, 2 cycles with response adaptation

Study Evidence
Friedman et al. 2014 (COG AHOD0031) Non-randomized portion of RCT

This regimen is intended for pediatric patients, younger than 22 years old. This is the post-amendment dosing described by POG P9425; Friedman et al. 2014 does not contain dosing information.

Chemotherapy

21-day cycle for 2 cycles

Subsequent treatment

Regimen variant #2, 3 cycles with response adaptation

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

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

Supportive medications

21-day cycle for 3 cycles

Subsequent treatment

Regimen variant #3, 4 cycles with response adaptation

Study Evidence
Friedman et al. 2014 (COG AHOD0031) Non-randomized portion of RCT

This regimen is intended for pediatric patients, younger than 22 years old. This is the post-amendment dosing described by POG P9425; Friedman et al. 2014 does not contain dosing information.

Preceding treatment

Chemotherapy

21-day cycle for 4 cycles, including the first 2 cycles

Subsequent treatment

Regimen variant #4, 5 cycles

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

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

  • ABVE-PC x 3, with slow early response

Chemotherapy

Supportive medications

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

Subsequent treatment

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 verified protocol link to PMC article PubMed NCT00005578
  2. COG AHOD0031: Friedman DL, Chen L, Wolden S, Buxton A, McCarten K, FitzGerald TJ, Kessel S, De Alarcon PA, Chen AR, Kobrinsky N, Ehrlich P, Hutchison RE, Constine LS, Schwartz CL; Children's Oncology Group. Dose-intensive response-based chemotherapy and radiation therapy for children and adolescents with newly diagnosed intermediate-risk Hodgkin lymphoma: a report from the Children's Oncology Group Study AHOD0031. J Clin Oncol. 2014 Nov 10;32(32):3651-8. Epub 2014 Oct 13. link to original article does not contain protocol link to PMC article PubMed NCT00025259

Untreated, advanced stage

MOPP

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

Regimen variant #3, uncapped vincristine

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

Chemotherapy

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

Consolidation after upfront therapy

C-MOPP

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

Regimen variant #1, 2 cycles

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

Preceding treatment

Chemotherapy

28-day cycle for 2 cycles

Regimen variant #2, 4 cycles

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

Preceding treatment

Chemotherapy

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 verified protocol PubMed NCT00416832

COPDAC

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

Regimen variant #1, 2 cycles

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

Preceding treatment

Chemotherapy

28-day cycle for 2 cycles

Regimen variant #2, 4 cycles

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

Preceding treatment

Chemotherapy

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 verified protocol PubMed NCT00416832

Radiation therapy

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RT: Radiation Therapy

Regimen variant #2, 21 Gy of IFRT

Study Years of enrollment Evidence Comparator Comparative Efficacy
Nachman et al. 2002 (CCG 5942) 1995-1998 Phase III (C) Observation Superior EFS
Schwartz et al. 2009 (POG P9425) 1997-2001 Phase II
Friedman et al. 2014 (COG AHOD0031) 2002-2009 Phase III (C) Observation Did not meet primary endpoint of EFS48

This regimen is intended for pediatric patients, younger than 22 years old.

Preceding treatment

Radiotherapy

References

  1. CCG 5942: Nachman JB, Sposto R, Herzog P, Gilchrist GS, Wolden SL, Thomson J, Kadin ME, Pattengale P, Davis PC, Hutchinson RJ, White K; Children's Cancer Group. Randomized comparison of low-dose involved-field radiotherapy and no radiotherapy for children with Hodgkin's disease who achieve a complete response to chemotherapy. J Clin Oncol. 2002 Sep 15;20(18):3765-71. link to original article contains verified protocol PubMed NCT00592111
    1. Update: Wolden SL, Chen L, Kelly KM, Herzog P, Gilchrist GS, Thomson J, Sposto R, Kadin ME, Hutchinson RJ, Nachman J. Long-term results of CCG 5942: a randomized comparison of chemotherapy with and without radiotherapy for children with Hodgkin's lymphoma--a report from the Children's Oncology Group. J Clin Oncol. 2012 Sep 10;30(26):3174-80. Epub 2012 May 29. link to original article link to PMC article PubMed
  2. 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 verified protocol link to PMC article PubMed NCT00005578
  3. COG AHOD0031: Friedman DL, Chen L, Wolden S, Buxton A, McCarten K, FitzGerald TJ, Kessel S, De Alarcon PA, Chen AR, Kobrinsky N, Ehrlich P, Hutchison RE, Constine LS, Schwartz CL. Dose-intensive response-based chemotherapy and radiation therapy for children and adolescents with newly diagnosed intermediate-risk Hodgkin lymphoma: a report from the Children's Oncology Group Study AHOD0031. J Clin Oncol. 2014 Nov 10;32(32):3651-8. Epub 2014 Oct 13. link to original article does not contain protocol link to PMC article PubMed NCT00025259