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Outcomes in adolescents and young adults with Hodgkin lymphoma treated on US cooperative group protocols: An adult intergroup (E2496) and Children's Oncology Group (COG AHOD0031) comparative analysis. Cancer 2018 01 01;124(1):136-144

Date

09/14/2017

Pubmed ID

28902390

Pubmed Central ID

PMC5735034

DOI

10.1002/cncr.30979

Scopus ID

2-s2.0-85029357188   16 Citations

Abstract

BACKGROUND: There is no clear consensus between pediatric and adult providers about the treatment of adolescents and young adults (AYAs) with Hodgkin lymphoma (HL).

METHODS: Failure-free survival (FFS) and overall survival (OS) were compared between 114 patients ages 17 to 21 years with HL who were treated on the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Intergroup adult E2496 study and 391 similarly patients ages 17 to 21 years with HL who were treated on the pediatric Children's Oncology Group (COG) AHOD0031 study.

RESULTS: Comparing AYAs from the COG and E2496 studies, there were no significant differences in extralymphatic disease, anemia, or hypoalbuminemia. More AYAs in the E2496 trial had stage III and IV disease (63% vs 29%; P < .001) and B symptoms (63% vs 27%; P < .001), and fewer had bulk disease (33% vs 77%; P < .001). More AYAs on the COG trial received radiotherapy (76% vs 66%; P = .03), although in smaller doses. E2496 AYA The 5-year FFS and OS rates were 68% and 89%, respectively in the E2496 AYAs and 81% and 97%, respectively, in the COG AYAs, indicating a statistically superior compared in the COG AYAs (P = .001). In stratified multivariable analyses, E2496 AYAs had worse FFS than COG AYAs in all strata except patients who had stage I and II HL without anemia. Propensity score analysis (based on stage, anemia, and bulk disease) confirmed inferior FFS for E2496 AYAs compared with COG AYAs (P = .004). On the E2496 study, FFS was significantly divergent across age groups (P = .005), with inferior outcomes for those ages 17 to 21 years versus 22-44 years. There was no difference across age on the COG study.

CONCLUSIONS: Younger AYA patients with HL appear to have better outcomes when treated on a pediatric trial than patients of similar age on an adult trial. Prospective studies examining these differences are warranted. Cancer 2018;124:136-44. © 2017 American Cancer Society.

Author List

Henderson TO, Parsons SK, Wroblewski KE, Chen L, Hong F, Smith SM, McNeer JL, Advani RH, Gascoyne RD, Constine LS, Horning S, Bartlett NL, Shah B, Connors JM, Leonard JI, Kahl BS, Kelly KM, Schwartz CL, Li H, Friedberg JW, Friedman DL, Gordon LI, Evens AM

Author

Cindy L. Schwartz MD, MPH Chief, Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Antineoplastic Combined Chemotherapy Protocols
Bleomycin
Cyclophosphamide
Dacarbazine
Disease-Free Survival
Doxorubicin
Etoposide
Female
Hodgkin Disease
Humans
Male
Mediastinal Neoplasms
Neoplasm Staging
Prednisone
Radiotherapy
Retrospective Studies
Survival Rate
Treatment Outcome
United States
Vinblastine
Vincristine
Young Adult