Long-Term Follow-up of German Hodgkin Study Group Trials in Early-Stage Hodgkin Lymphoma
In an article in the Journal of Clinical Oncology, Sasse et al reported long-term follow-up of German Hodgkin Study Group trials in early-stage favorable and unfavorable Hodgkin lymphoma. The updates cover the HD7 and HD10 trials in favorable disease and the HD8 and HD11 trials in unfavorable disease conducted between 1993 and 2003.
Early-Stage Favorable Disease
In HD7 (N = 627; median follow-up = 120 months), patients were randomized to receive 30 Gy extended-field radiotherapy plus 10 Gy involved-field radiotherapy without (extended-field radiotherapy group) or with (combined-modality treatment group) previous chemotherapy with two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Combined-modality treatment was associated with improved 15-year progression-free survival vs extended-field radiotherapy (73% vs 52%, hazard ratio [HR] = 0.5, P < .001), with no significant difference in 15-year overall survival (77% vs 80%, HR = 0.8, P = .3).
In HD10 (N = 1,190; median follow-up = 98 months), patients were randomized to receive either four or two cycles of ABVD followed by either 30 or 20 Gy involved-field radiotherapy in a 2 x 2 factorial design. Noninferiority of two cycles of ABVD plus 20 Gy involved-field radiotherapy vs four cycles of ABVD plus 30 Gy involved-field radiotherapy was confirmed with 10-year progression-free survival of 87% vs 87% (HR = 1.0, 95% confidence interval [CI] = 0.6–1.5) and 10-year overall survival of 94% vs 94% (HR = 0.9, 95% CI = 0.5–1.6). No differences between treatment groups in second cancers were observed in either HD7 or HD10.
Early-Stage Unfavorable Disease
In HD8 (N = 1,064; median follow-up = 153 months), patients were randomized to 30 Gy of either extended-field radiotherapy or involved-field radiotherapy after two alternating cycles of cyclophosphamide, vincristine, procarbazine, and prednisone (COPP) and ABVD. Noninferiority of involved-field radiotherapy vs extended-field radiotherapy was confirmed for 15-year progression-free survival (74% vs 73%, HR = 1.0, 95% CI = 0.8–1.2) and 15-year overall survival (83% vs 81%, HR = 0.9, 95% CI = 0.7–1.2).
In HD11 (N = 1,395; median follow-up = 106 months), patients were randomized to four cycles of either ABVD or bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP-baseline) followed by 30 or 20 Gy involved-field radiotherapy in a 2 x 2 factorial design. No difference in 10-year progression-free survival was observed for BEACOPP-baseline vs ABVD with 30 Gy (83% vs 83%, HR = 1.1, P = .8) or with 20 Gy (82% vs 75%, HR = 0.8, P = .1) or for 30 Gy vs 20 Gy after BEACOPP-baseline (84% vs 84%, HR = 1.0, 95% CI = 0.7–1.5). After ABVD, 30 Gy was superior to 20 Gy (84% vs 76%, HR = 1.5, 95% CI = 1.0–2.1). No differences between groups in overall survival were observed, with 10-year rates of 90% to 91% in all four groups. No differences between groups in second cancers were observed in either HD8 or HD11.
The investigators concluded: “Long-term follow-up data of the four randomized trials largely support the current risk-adapted therapeutic strategies in early-stage [Hodgkin lymphoma]. Nevertheless, continued follow-up is necessary to assess the long-term safety of currently applied therapeutic strategies.”
The study was supported by a grant from German Cancer Aid.
Andreas Engert, MD, of the German Hodgkin Study Group, University Hospital of Cologne, is the corresponding author of the Journal of Clinical Oncology article.
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