Response-guided ABVD chemotherapy plus involved-field radiation therapy for intermediate-stage hodgkin lymphoma in the pre-positron emission tomography era: A Gruppo Italiano Studio Linfomi (GISL) prospective trial

Emilio Iannitto, Viviana Minardi, Paolo Gobbi, Giuseppina Calvaruso, Claudio Tripodo, Luigi Marcheselli, Stefano Luminari, Francesco Merli, Luca Baldini, Caterina Stelitano, Vincenzo Callea, Mario Petrini, Francesco Angrilli, Giovanni Quarta, Daniele Vallisa, Stefano Molica, Eliana Liardo, Giuseppe Polimeno, Maura Brugiatelli, Massimo Federico

Research output: Contribution to journalArticle

Abstract

Purpose: In the pre-positron emission tomography era, the Gruppo Italiano Studio Linfomi (GISL) investigated the feasibility and efficacy of a treatment based on a response-tailored number of doxorubicin/bleomycin/vinblastine/ dacarbazine (ABVD) courses in 218 intermediate-stage Hodgkin lymphoma patients. Patients and Methods: Patients with stage I/II showing at least one adverse prognostic factor and stage IIIA without adverse prognostic factors were recruited. Treatment included a first step of 3 ABVD courses, followed by an early-restaging. Patients in CR/CRu received 1 additional ABVD cycle, patients in PR received 3 more ABVD, and nonresponder patients went off study. Involved-field radiation therapy (RT) was recommended on chemotherapy completion. Results: The median age was 30 years (range, 15-68 years) and 131 patients (61%) were female. Seven percent of patients were in stage I, 78% in stage II, and 15% in stage III; B-symptoms, bulky tumor and erythrocyte sedimentation rate > 30 were recorded in 20%, 26%, and 43% of cases, respectively. The CR/CRu rate was 62% at early restaging, 72% at the end of chemotherapy, and 95% following RT. With a median follow-up of 74 months (range, 6-193 months), 7-year overall survival, relapse-free survival, and freedom from treatment failure were 91.8% (95% CI, 86%-95.5%), 89.2% (95% CI, 82.8%-93.3%), and 81.8% (95% CI, 75.2%-86.7%), respectively. Patients in CR/CRu on early restaging, receiving 4 ABVD, had an excellent outcome with 7-year RFS and cause-specific survival similar to those of the late responders treated with 6 ABVD (RFS, 87.5% vs. 90.5% and CSS, 96.6% vs. 92.7%, respectively). Conclusion: The response-guided ABVD program we report, based on standard clinical staging procedures, proved to be feasible and safe in patients with intermediate-stage Hodgkin lymphoma.

Original languageEnglish
Pages (from-to)138-144
Number of pages7
JournalClinical Lymphoma and Myeloma
Volume9
Issue number2
DOIs
Publication statusPublished - 2009

Keywords

  • Bleomycin
  • Dacarbazine
  • Doxorubicin
  • Early restaging
  • Vinblastine

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Hematology

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    Iannitto, E., Minardi, V., Gobbi, P., Calvaruso, G., Tripodo, C., Marcheselli, L., Luminari, S., Merli, F., Baldini, L., Stelitano, C., Callea, V., Petrini, M., Angrilli, F., Quarta, G., Vallisa, D., Molica, S., Liardo, E., Polimeno, G., Brugiatelli, M., & Federico, M. (2009). Response-guided ABVD chemotherapy plus involved-field radiation therapy for intermediate-stage hodgkin lymphoma in the pre-positron emission tomography era: A Gruppo Italiano Studio Linfomi (GISL) prospective trial. Clinical Lymphoma and Myeloma, 9(2), 138-144. https://doi.org/10.3816/CLM.2009.n.034