Survival With Combined Modality Therapy vs Chemotherapy Alone in Early-Stage Pediatric Hodgkin Lymphoma


Key Points

  • Use of CMT vs chemotherapy alone was associated with improved 5-year overall survival.
  • The greatest benefit of CMT appeared to be derived in patients aged ≥ 15 years.

In an observational cohort study reported in JAMA Oncology, Jhawar et al found that combined modality therapy (CMT) with chemotherapy followed by radiotherapy was associated with a survival advantage vs chemotherapy alone in early-stage pediatric Hodgkin lymphoma. The authors noted that use of radiotherapy in pediatric disease has been decreasing, with such a strategy remaining controversial.

Study Details

The study involved analysis of National Cancer Database data from 5,657 patients aged 0.1 to 21 years diagnosed with stage I or II Hodgkin lymphoma from January 2004 through December 2015. Patients received definitive treatment with chemotherapy or CMT, defined as chemotherapy followed by radiotherapy. A total of 2,845 (50.3%) received CMT. Overall survival was assessed using Kaplan-Meier analysis and multivariate Cox proportional hazards regression models.

Use of CMT and Survival Outcomes

Use of CMT vs chemotherapy alone was associated with younger age (38.7% vs 30.4% < 16 years, P < .001), male sex (48.1% vs 43.6%, P < .001), stage II disease (86.7% vs 84.5%, P = .02), and private health insurance (72.6% vs 69.3%, P = .002). In the cohort, the use of CMT decreased from 59.7% of cases in 2004 to 34.9% of cases in 2015 (24.8% decrease).  

Median follow-up was 5.1 years. Overall survival at 5 years was 97.3% in the CMT group vs 94.5% in the chemotherapy group (hazard ratio [HR] = 0.58, P < .001). On multivariate analysis, use of CMT remained significantly associated with improved overall survival (adjusted HR = 0.57, P < .001). In sensitivity analysis, adolescent and young adult patients (aged ≥ 15 years) derived the greatest survival benefit from CMT (adjusted HR = 0.47, P < .001).

The investigators concluded, “In this study, pediatric patients with early-stage [Hodgkin lymphoma] receiving CMT experienced improved overall survival 5 years after treatment. There is a nationwide decrease in the use of CMT, perhaps reflecting the bias of ongoing clinical trials designed to avoid consolidation radiotherapy. This study represents the largest data set to date examining the role of CMT in pediatric [Hodgkin lymphoma].

Rahul R. Parikh, MD, of the Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, is the corresponding author for the JAMA Oncology article.

Disclosure: The study authors’ full disclosures can be found at

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