A risk-adapted, response-based approach using ABVE-PC for children and adolescents with intermediate- and high-risk Hodgkin lymphoma: The results of P9425

Cindy L. Schwartz, Louis S. Constine, Doojduen Villaluna, Wendy B. London, Robert E. Hutchison, Richard Sposto, Steven E Lipshultz, Charles S. Turner, Pedro A. DeAlarcon, Allen Chauvenet

Research output: Contribution to journalArticle

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Abstract

Current treatment strategies for Hodgkin lymphoma result in excellent survival but often confer significant long-term toxicity. We designed ABVE-PC (doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide) to (1) enhance treatment efficacy by dose-dense drug delivery and (2) reduce risk of long-term sequelae by response-based reduction of cumulative chemotherapy. Efficient induction of early response by dose-dense drug delivery supported an early-response-adapted therapeutic paradigm. The 216 eligible patients were younger than 22 years with intermediate-or high-risk Hodgkin lymphoma. ABVE-PC was administered every 21 days. Rapid early responders (RERs) to 3 ABVE-PC cycles received 21 Gy radiation to involved regions; RER was documented in 63% of patients. Slow early responders received 2 additional ABVE-PC cycles before 21 Gy radiation. Five-year event free-survival was 84%: 86% for the RER and 83% for the slow early responders (P = .85). Only 1% of patients had progressive disease. Five-year overall survival was 95%. With this regimen, cumulative doses of alkylators, anthracyclines, and epipodophyllotoxins are below thresholds usually associated with significant long-term toxicity. ABVE-PC is a dose-dense regimen that provides outstanding event-free survival/overall survival with short duration, early-response-adapted therapy. This trial was registered at www.clinicaltrials.gov as #NCT00005578.

Original languageEnglish
Pages (from-to)2051-2059
Number of pages9
JournalBlood
Volume114
Issue number10
DOIs
StatePublished - Nov 20 2009

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Hodgkin Disease
Drug delivery
Toxicity
Radiation Dosage
Podophyllotoxin
Radiation
Disease-Free Survival
Chemotherapy
Survival
Alkylating Agents
Anthracyclines
Bleomycin
Vincristine
Etoposide
Prednisone
Doxorubicin
Cyclophosphamide
Pharmaceutical Preparations
Therapeutics
Drug Therapy

ASJC Scopus subject areas

  • Hematology
  • Biochemistry
  • Cell Biology
  • Immunology

Cite this

Schwartz, C. L., Constine, L. S., Villaluna, D., London, W. B., Hutchison, R. E., Sposto, R., ... Chauvenet, A. (2009). 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, 114(10), 2051-2059. https://doi.org/10.1182/blood-2008-10-184143

A risk-adapted, response-based approach using ABVE-PC for children and adolescents with intermediate- and high-risk Hodgkin lymphoma : The results of P9425. / Schwartz, Cindy L.; Constine, Louis S.; Villaluna, Doojduen; London, Wendy B.; Hutchison, Robert E.; Sposto, Richard; Lipshultz, Steven E; Turner, Charles S.; DeAlarcon, Pedro A.; Chauvenet, Allen.

In: Blood, Vol. 114, No. 10, 20.11.2009, p. 2051-2059.

Research output: Contribution to journalArticle

Schwartz, CL, Constine, LS, Villaluna, D, London, WB, Hutchison, RE, Sposto, R, Lipshultz, SE, Turner, CS, DeAlarcon, PA & Chauvenet, A 2009, '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, vol. 114, no. 10, pp. 2051-2059. https://doi.org/10.1182/blood-2008-10-184143
Schwartz, Cindy L. ; Constine, Louis S. ; Villaluna, Doojduen ; London, Wendy B. ; Hutchison, Robert E. ; Sposto, Richard ; Lipshultz, Steven E ; Turner, Charles S. ; DeAlarcon, Pedro A. ; Chauvenet, Allen. / A risk-adapted, response-based approach using ABVE-PC for children and adolescents with intermediate- and high-risk Hodgkin lymphoma : The results of P9425. In: Blood. 2009 ; Vol. 114, No. 10. pp. 2051-2059.
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abstract = "Current treatment strategies for Hodgkin lymphoma result in excellent survival but often confer significant long-term toxicity. We designed ABVE-PC (doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide) to (1) enhance treatment efficacy by dose-dense drug delivery and (2) reduce risk of long-term sequelae by response-based reduction of cumulative chemotherapy. Efficient induction of early response by dose-dense drug delivery supported an early-response-adapted therapeutic paradigm. The 216 eligible patients were younger than 22 years with intermediate-or high-risk Hodgkin lymphoma. ABVE-PC was administered every 21 days. Rapid early responders (RERs) to 3 ABVE-PC cycles received 21 Gy radiation to involved regions; RER was documented in 63{\%} of patients. Slow early responders received 2 additional ABVE-PC cycles before 21 Gy radiation. Five-year event free-survival was 84{\%}: 86{\%} for the RER and 83{\%} for the slow early responders (P = .85). Only 1{\%} of patients had progressive disease. Five-year overall survival was 95{\%}. With this regimen, cumulative doses of alkylators, anthracyclines, and epipodophyllotoxins are below thresholds usually associated with significant long-term toxicity. ABVE-PC is a dose-dense regimen that provides outstanding event-free survival/overall survival with short duration, early-response-adapted therapy. This trial was registered at www.clinicaltrials.gov as #NCT00005578.",
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