Salvage Therapy of Progressive and Recurrent Hodgkin’s Disease- ASH study

The American Society of Haematology (ASH) had its annual meeting earlier this month. Haematologists from around the world gathered at the San Diego Convention Centre to provide a forum for discussing critical issues in haematology. Nearly 20,000 clinicians, scientists, and others attended the four-day meeting, which consisted of an educational program and cutting-edge scientific sessions. The following was one of the presentations given at the meeting.

The aim of the study was to evaluate the efficacy of a salvage therapy (ST-HD-86) developed for children and adolescents with progressive or relapsed Hodgkin’s disease (HD) who were primarily treated in the pediatric DAL/GPOH studies. The essential chemotherapeutic elements were ifosfamide, etoposide, prednisone (IEP) and doxorubicine, bleomycin, vinblastine, dacarbazine (ABVD). 176 patients with progression (N=51) or first relapse (N=125) were enrolled by 67 centers from six countries between 1986 and 2003. The median time from initial diagnosis to progression/relapse was 1.1 (range, 0.02-17.1) years and the median patients age at the diagnosis of progression/relapse was 14.7 (range, 4.3-24.5) years. Salvage therapy consisted of 3-5 alternating cycles of IEP and ABVD, supplemented in part by 1-2 cycles of cyclophosphamide, vincristine, procarbazine, prednisone (COPP) or CCNU, etoposide, prednimustine (CEP). Radiotherapy was given to involved areas using individualized dosages. In the 1990ies, high-dose high dose chemotherapy with stem cell support was introduced for patients with unfavorable prognostic criteria. Disease-free survival (DFS) and overall survival (OS) at 10 years after initiation of salvage therapy are 63±4% and 74±4%. Second events occurred in 70 of 176 pts (40%). Risk factor analysis revealed the time until progression/relapse as the most discriminating prognostic factor (p=.0001). Patients with progression had an inferior outcome (DFS 41±7%, OS 51±8%), whereas patients with late relapses (>12 months after end of therapy) do very well (DFS 87±4%, OS 90±4%). The result of study ST-HD-86 with a long-term survival of 74% in this large cohort of patients with progressive or relapsed HD can be considered favorable. While the salvage strategy for patients with progression has to be further optimized, a reduction of intensity might be considered for those patients with late relapses following HD in childhood or adolescence.(Source: American Society of Haematology (ASH): Blood, Volume 104, issue 11, November 16, 2004.)