2008, Number 39
<< Back Next >>
Med Univer 2008; 10 (39)
Combined COPP/EBV treatment followed by low dose radiotherapy in 100 children with Hodgkin’s lymphoma
Insausti CL, García R, Acquatella G, Pereira A, Rojas N, Páez A
Language: Spanish
References: 36
Page: 63-74
PDF size: 274.73 Kb.
ABSTRACT
Objective: To evaluate the results of the efficacy and feasibility of the COPP/EBV protocol with low dose Rt in children with Hodgkin’s lymphoma treated in 13 health cooperative group centers in Venezuela.
Patients and Methods: From January 2000 to January 2006 the Pediatric Multidisciplinary Hemato-Oncological Cooperative Group in Venezuela treated 100 children who suffered from Hodgkin’s lymphoma. Their mean age was 11.5 years, with a male-female relation of 1.9:1. The prognostic factors were: male gender 66%; clinical stages IIB, IIIB, IVA or B 56%; mediastinal mass ‹ 30% (MMV) 17%; GB›13.5 x 10
9/L 8%; Hb ‹11 g/dl. Favorable group (FG): ‹ 3 prognostic factors, 42%; unfavorable group (UG): › 3 prognostic factors or clinical stage IV or MMV, 58% According to the clinical stage and the prognostic factors, three groups were classified.
Results: Total group: complete remission 88%, progression 7%, relapse 5%, mortality 10%. Group 1: free of events survival 80%, total survival 86%. Group 2: free of events survival 68%, total survival 85%. Group 3: free of events survival 70%, total survival 85%.
Conclusions: The COPP/EBV treatment plan associated to low doses of Rt in favorable cases produce results comparable to those reported in the literature, which is not the case in the unfavorable group. In these cases the combinations of chemotherapies has a higher effectiveness.
REFERENCES
Hamilton V, Norris C, Bunin N, Goldwein JW, et al. Cyclophosphamide- based, seven-drug hybrid and low dose involved field radiation for the treatment of childhood and adolescent Hodgkin disease. J Pediatr Hematol Oncol 2001;23:84-88.
Klimo P, Connors J. MOPP/ABV hybrid program: combination chemotherapy based on early introduction of seven effective drugs for advanced Hodgkin’s diseases. J Clin Oncol 1985;3:1174-82.
Hudson M, Constine L. Risk-adapted therapy for pediatric patients with Hodgkin’s disease, or tiptoeing along the efficacy- toxicity tightrope. Am Soc Clin Oncol Educational Book 2004;pp:645-52.
Oberlin O. When the quality of life is the mayor challenge. J Clin Oncol 2002;20:3051-3.
Lister TA, Crowther D, Sutcliffe SB, et al. Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin’s disease Costwold meeting. J Clin Oncol 1989;7:1630-6.
Harris NL, Jaffe ES, Stein H, Banks PM, et al. A revised European-American classification of lymphoid neoplasms: a proposal from international lymphoma Study Group. Blood 1994;84:1361-92.
Harris NL, Jaffe ES, Diebold J, Flandrin G, et al. World Health Organization Classification of neoplastic diseases of the hematopoietic and lymphoid tissue: Report of the clinical advisory committee meeting, Airlie House, Virginia November 1997. J Clin Oncol 1999;17:3835-49.
García Tamayo J. Estudio histológico e inmunohistoquímico de 600 casos de linfoma de Hodgkin y no Hodgkin. Avances de Patología 2004;pp:75-79.
Josting A, Katay I, Rueffer U, Winter S, et al. Favorable outcome of patients with relapsed or refractory Hodgkin disease, treated with high-dose chemotherapy and stem cell rescue at the time of maximal response to conventional salvage therapy DEXA–BEAM. Ann Oncol 1998;9:289-95.
Kaplan EL, Meier P. Non parametric estimation from incomplete observation. J Am Stat Assoc 1958;53:457-81.
Peto R, Peto J. Asymptomatically efficient rank in variant test procedure. J R Stat Soc 1972;135:185-98.
Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatments standardization World Health Organization. Cancer 1981;47:207-14.
Hainsworth JD, Johnson DH, Frazier SR, et al. Chronic daily administration of oral etoposide in refractory lymphoma. Eur J Cancer 1990;26:818-21.
Tseng A Jr, Jacobs C, Coleman CN, Horning SJ, et al. Third-line chemotherapy for resistant Hodgkin’s disease with lomustine, etoposide, and methotrexate. Cancer Treat Rep 1987;71:475-8.
Trippett TM. Therapeutic approach for the pediatric patient with refractory/relapsed Hodgkin’s disease. Am Soc Clin Oncol 2004;pp:653-7.
Yaniv I, Saab A, Cohen IJ, Goshen Y, et al. Hodgkin’s disease in children: reduced tailored chemotherapy for stage I-II disease. J Pediatr Hematol Oncol 1996;18:76-80.
Weiner M, Leventhal BG, Marcus R, Brecher M, et al. Intensive chemotherapy and low dose radiation for the treatment of advanced- stage Hodgkin’s disease in pediatric patients. Pediatric Oncology Group Study. J Clin Oncol 1991;9:1591-8.
Schellong G, Riepenhausen M, Creutzig U, et al. Low risk of secondary leukemia after chemotherapy without meclorethamina in childhood Hodgkin’s disease. German- Austrian pediatric Hodgkin’s Disease Group. J Clin Oncol 1997;15:2247-53.
O’Brien ME, Pinkerton CR, Kingston J, et al. VEEP in children with Hodgkin’s disease, a regimen to decrease late sequels. Br J Cancer 1992;65:756-60.
Bhatia S, Robinson LL, Oberlin O, Greeberg M, et al. Breast cancer and other second neoplasms alter childhood Hodgkin’s disease. N Engl J Med 1996;334:745-51.
Peerboom P, Hassink E, Melker R. Thyroid function 10-18 years after mantle field irradiation for Hodgkin’s disease. Eur J Cancer 1992;28:1716-8.
Landman Parker J, Pacquement H, Leblanc T, Habrand JL, et al. Localized childhood Hodgkin’s disease: response-adapted chemotherapy with etoposide, bleomycin, vinblastine and prednisone before low dose radiation therapy. Results of the French Society of Pediatric Oncology Study MDH90. J Clin Oncol 2000;18:1500-7.
Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin’s disease. N Engl J Med 1998;339:1506-14.
Smith RS, Chen Q, Hudson MM, Link MP, et al. Prognostic factors for children with Hodgkin’s disease, treated with combined- modality therapy. J Clin Oncol 2003;21:2026-33.
Donaldson SS, Hudson MM, Lamborn KR, Link MP, et al. VAMP and low-dose, involved field radiation for children and adolescent with favorable, early-stage Hodgkin’s disease: Results of a prospective clinical trial. J Clin Oncol 2002;20:3081-7.
Schellong G, Pötter R, Brämswig J, Wagner W, et al. High cure rate and reduced long term-toxicity in pediatric Hodgkin’s disease: the German-Austrian multicenter trial DAL-HD-90. J Clin Oncol 1990;17:3736-44.
Nachman JB, Sposto R, Herzog P, Gilchrist GS, et al, for the 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;20:3765-71.
Insausti CL, Acquatella G, Carneiro M, Martínez M, et al. Evaluación de dos protocolos de quimioterapia (EBV-1 y EBV- 2) más radioterapia en niños con enfermedad de Hodgkin. Revista Venezolana de Oncología 1999;4:105-15.
Fryer C, Hutchinson RJ, Krailo M. Efficacy and toxicity of 12 courses of ABVD chemotherapy followed by low-dose regional radiation in advanced Hodgkin’s disease in children: a report from the Children’s Cancer Study Group. J Clin Oncol 1990;8:1971-80.
Diehl V, Franklin J, Hasenclever D. BEACOPP, a new dose-escalated protocol accelerated regimen, is at least as effective as COPP/ABVD in patients with advance-stage Hodgkin’s lymphoma: interin report from a trial of the German Hodgkin’s lymphoma study group. J Clin Oncol 1998;16:3810-21.
Friedmann AM, Hudson MM, Weinstein HJ, Donaldson SS, et al. Treatment of unfavourable childhood Hodgkin’s disease with VEPA and low-dose, involved-field radiation. J Clin Oncol 2002;20:3088-94.
Dörffel W, Lüders H, Rühl U, et al. Preliminary results of the multicenter trial GPOH-HD 95 for the treatment of Hodgkin disease in children an adolescents. Analysis and outlook. Klin Padiatric 2003;215:139-45.
Loeffler M, Brosteanu O, Hasenclever D, Sextro M, et al. Meta-analysis of chemotherapy versus combined modality treatment trials in Hodgkin’s disease. International data base on Hodgkin’s disease overview study group. J Clin Oncol 1998;16:818-29.
Kelly KM, Hutchinson RJ, Sposto R, et al. Feasibility of upfront dose-intensive chemotherapy in children with advanced-stage Hodgkin’s lymphoma: preliminary results from the Children’s cancer group Study CCG59704. Ann Oncol 2002;13:107-11.
Serrano JC, Contreras K, Insausti CL, Figueroa L, Acquatella G. Alteraciones funcionales y morfológicas de la glándula tiroides en pacientes con enfermedad de Hodgkin tratados con radioterapia y quimioterapia. Revista de la Facultad de Medicina 2002;23:44-49.
Doria R, Holford T, Farber LR. Second solid malignance after combined modality therapy for Hodgkin’s disease. J Clin Oncol 1995;13:2016-22.