Hodgkin lymphoma, pediatric

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Wayne H. Liang, MD, MS, FAMIA
Children’s Healthcare of Atlanta/Emory
Atlanta, GA

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This page contains studies that were specific to pediatric populations. For the more general Hodgkin lymphoma page, follow this link.

Are you looking for a regimen but can't find it here? It is possible that we've moved it to the historical regimens page. For placebo or observational studies in this condition, please visit this page. If you still can't find it, please let us know so we can add it.

2 regimens on this page
2 variants on this page


Guidelines

NCCN

Upfront Therapy, High Risk

COG AHOD1331

Standard Arm (ABVE-PC COG AHOD1331)

Cycles 1 to 5

  • Doxorubicin (Adriamycin) 25 mg/m2 IV push or intermittent infusion once on days 1 & 2
    • Concentration not to exceed 2 mg/mL
    • IV push over 1 to 5 minutes or by intermittent infusion over 1 to 15 minutes; may prolong to 60 minutes if institutional policies mandate
  • Bleomycin (Blenoxane) 5 units/m2 IV over 10 to 20 minutes or SC once on day 1, then 10 units/m2 IV over 10 to 20 minutes or SC once on day 8
  • Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2.8 mg) IV once per day on days 1 & 8
  • Etoposide (Vepesid) 125 mg/m2 IV over 60 to 120 minutes once per day on days 1 to 3
    • Rate should not exceed 300 mg/m2
  • Cyclophosphamide (Cytoxan) 600 mg/m2 IV over 30 to 60 minutes once on day 1 & 2

Glucocorticoid therapy

Supportive medications

  • Filgrastim (Neupogen) 5 mcg/kg SC (preferred) or IV daily beginning on day 4, 5, 6, 7, 8, or 9, per institutional policy and continuing until ANC > 1000/μL
Response evaluation after cycle 2

21 day cycle

Experimental Arm (Bv-AVEPC)

Cycles 1 to 5

Glucocorticoid therapy

Supportive medications

  • Filgrastim (Neupogen) 5 mcg/kg SC (preferred) or IV daily beginning on day 4, 5, 6, 7, 8, or 9, per institutional policy and continuing until ANC > 1000/μL
Response evaluation after cycle 2

21 day cycle

References

  1. COG AHOD1331: Mailhot Vega RB, Castellino SM, Pei Q, Parsons S, Roberts KB, Hodgson D, Charpentier AM, Fitzgerald TJ, Kessel SK, Keller FG, Kelly K, and Hoppe BS. Evaluating Disparities in Proton Radiation Therapy Use in AHOD1331, A Contemporary Children's Oncology Group Trial for Advanced-Stage Hodgkin Lymphoma. Int J Part Ther. 2021 Oct 28;8(3):55-57. link to original article link to PMC article PubMed NCT02166463

Upfront Therapy, Intermediate Risk

ABVE-PC (COG AHOD0031)

Rapid Early Responders (Standard Arm)

ABVE-PC x 2 Cycles

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

Study Evidence
Friedman et al. 2014 (COG AHOD0031) Non-randomized portion of phase 3 RCT
Chemotherapy

Glucocorticoid therapy

21-day cycle for 2 cycles

References
  1. 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

Evaluate Response

ABVE-PC x 2 Cycles

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

Study Evidence
Friedman et al. 2014 (COG AHOD0031) Non-randomized portion of phase 3 RCT
Chemotherapy

Glucocorticoid therapy

21-day cycle for 2 cycles

References
  1. 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

Evaluate Response

Involved Field Radiation Therapy

Rapid Early Responders (Reduced Therapy Arm)

ABVE-PC x 2 Cycles

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

Study Evidence
Friedman et al. 2014 (COG AHOD0031) Non-randomized portion of phase 3 RCT
Chemotherapy

Glucocorticoid therapy

21-day cycle for 2 cycles

References
  1. 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

Evaluate Response

ABVE-PC x 2 Cycles

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

Study Evidence
Friedman et al. 2014 (COG AHOD0031) Non-randomized portion of phase 3 RCT
Chemotherapy

Glucocorticoid therapy

21-day cycle for 2 cycles

References
  1. 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

No Further Treatment

Slow Early Responders (Standard Arm)

ABVE-PC x 2 Cycles

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

Study Evidence
Friedman et al. 2014 (COG AHOD0031) Non-randomized portion of phase 3 RCT
Chemotherapy

Glucocorticoid therapy

21-day cycle for 2 cycles

References
  1. 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

Evaluate Response

ABVE-PC x 2 Cycles

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

Study Evidence
Friedman et al. 2014 (COG AHOD0031) Non-randomized portion of phase 3 RCT
Chemotherapy

Glucocorticoid therapy

21-day cycle for 2 cycles

References
  1. 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

Evaluate Response

Slow Early Responders (Augmented Therapy Arm)

ABVE-PC x 2 Cycles

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

Study Evidence
Friedman et al. 2014 (COG AHOD0031) Non-randomized portion of phase 3 RCT
Chemotherapy

Glucocorticoid therapy

21-day cycle for 2 cycles

References
  1. 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

Evaluate Therapy

DECA Therapy x 2 Cycles

Glucocorticoid therapy

Chemotherapy

21-day cycle for 2 cycles

References
  1. 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

ABVE-PC x 2 Cycles

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

Study Evidence
Friedman et al. 2014 (COG AHOD0031) Non-randomized portion of phase 3 RCT

Chemotherapy

Glucocorticoid therapy

21-day cycle for 2 cycles

References

  1. 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

Upfront Therapy, Low Risk

OEPA (GPOD-HD-2002)

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

Regimen

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

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

Glucocorticoid therapy

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

Radiation therapy

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 3 (C) Observation Superior EFS
Schwartz et al. 2009 (POG P9425) 1997-2001 Phase 2
Friedman et al. 2014 (COG AHOD0031) 2002-2009 Phase 3 (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