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Treatment of Pediatric Hodgkin Lymphoma

  • Pediatric Malignancies
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

We are increasingly successful in the treatment of Hodgkin lymphoma. Current risk adapted trials seek to maintain the excellent efficacy of older therapies, while simultaneously limiting their late toxicities. Current management of early stage/favorable disease involves the use of two to four cycles of tailored chemotherapy, often followed by low-dose, involved field radiation. Those with intermediate and advanced stage disease require more intense chemotherapy and radiation regimens. Functional imaging using [18F]-2 fluoro-D-2-deoxyglucose is increasingly used to determine complete vs. partial response and to detect relapse. Given the success of primary therapy, retrieval of patients remains a highly individualized challenge. The majority of children failing combined-modality treatment undergo high-dose chemotherapy followed by autologous hematopoietic stem cell rescue, oftentimes with consolidative radiotherapy.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Bennett MH, MacLennan KA, Vaughan Hudson G, Vaughan Hudson B: Non-Hodgkin’s lymphoma arising in patients treated for Hodgkin’s disease in the BNLI: a 20-year experience. British National Lymphoma Investigation. Ann Oncol 1991, 2(Suppl 2):83–92

    PubMed  Google Scholar 

  2. Karayalcin G, Behm FG, Gieser PW, et al.: Lymphocyte predominant Hodgkin disease: clinico-pathologic features and results of treatment – the Pediatric Oncology Group experience. Med Pediatr Oncol 1997, 29(6):519–525

    Article  PubMed  CAS  Google Scholar 

  3. Pellegrino B, Terrier-Lacombe MJ, Oberlin O, et al.: Lymphocyte-predominant Hodgkin’s lymphoma in children: therapeutic abstention after initial lymph node resection – a Study of the French Society of Pediatric Oncology. J Clin Oncol 2003, 21(15):2948–2952

    Article  PubMed  CAS  Google Scholar 

  4. Mauz-Korholz C, Gorde-Grosjean S, Hasenclever D, et al.: Resection alone in 58 children with limited stage, lymphocyte-predominant Hodgkin lymphoma-experience from the European network group on pediatric Hodgkin lymphoma. Cancer 2007, 110(1):179–185

    Article  PubMed  Google Scholar 

  5. Donaldson SS, Hudson MM, Lamborn KR, et al.: VAMP and low-dose, involved-field radiation for children and adolescents with favorable, early-stage Hodgkin’s disease: results of a prospective clinical trial. J Clin Oncol 2002, 20(14):3081–3087

    Article  PubMed  CAS  Google Scholar 

  6. Donaldson SS, Link MP, Weinstein HJ, et al.: Final results of a prospective clinical trial with VAMP and low-dose involved-field radiation for children with low-risk Hodgkin’s disease. J Clin Oncol 2007, 25(3):332–337 Final results of our own response-adapted trial in favorable stage Hodgkin lymphoma

    Article  PubMed  CAS  Google Scholar 

  7. Dorffel W, Luders H, Ruhl U, et al.: Preliminary results of the multicenter trial GPOH-HD 95 for the treatment of Hodgkin’s disease in children and adolescents: analysis and outlook. Klin Padiatr 2003, 215(3):139–145 One of the best examples of a large, multicenter trial utilizing a modern response-adapted approach to the treatment of all stages of pediatric Hodgkin lymphoma

    Article  PubMed  CAS  Google Scholar 

  8. Ruhl U, Albrecht M, Dieckmann K, et al.: Response-adapted radiotherapy in the treatment of pediatric Hodgkin’s disease: an interim report at 5 years of the German GPOH-HD 95 trial. Int J Radiat Oncol Biol Phys 2001, 51(5):1209–1218

    PubMed  CAS  Google Scholar 

  9. Ruhl U, Albrecht MR, Lueders H, et al.: Abstract at ASTRO, 46th annual meeting: The German multinational GPOH-HD 95 trial: Treatment results and analysis of failures in pediatric Hodgkins disease using combination chemotherapy with and without radiation. Int J Radiat Oncol Biol Phys 2004, 60:S131

    Article  Google Scholar 

  10. Landman-Parker J, Pacquement H, Leblanc T, et al.: Localized childhood Hodgkin’s disease: response-adapted chemotherapy with etoposide, bleomycin, vinblastine, and prednisone before low-dose radiation therapy-results of the French Society of Pediatric Oncology Study MDH90. J Clin Oncol 2000, 18(7):1500–1507. An excellent example of response-adapted therapy applied to early stage Hodgkin lymphoma

    PubMed  CAS  Google Scholar 

  11. Willman KY, Cox RS, Donaldson SS: Radiation induced height impairment in pediatric Hodgkin’s disease. Int J Radiat Oncol Biol Phys 1994, 28(1):85–92

    PubMed  CAS  Google Scholar 

  12. Tebbi CK, Mendenhall N, London WB, et al.: Treatment of stage I, IIA, IIIA1 pediatric Hodgkin disease with doxorubicin, bleomycin, vincristine and etoposide (DBVE) and radiation: a Pediatric Oncology Group (POG) study. Pediatr Blood Cancer 2006, 46(2):198–202

    Article  PubMed  CAS  Google Scholar 

  13. Chow LM, Nathan PC, Hodgson DC, et al.: Survival and late effects in children with Hodgkin’s lymphoma treated with MOPP/ABV and low-dose, extended-field irradiation. J Clin Oncol 2006, 24(36):5735–5741

    Article  PubMed  CAS  Google Scholar 

  14. Hancock SL, Hoppe RT: Long-term complications of treatment and causes of mortality after Hodgkin’s disease. Semin Radiat Oncol 1996, 6(3):225–242

    Article  PubMed  Google Scholar 

  15. Hancock SL, Donaldson SS, Hoppe RT: Cardiac disease following treatment of Hodgkin’s disease in children and adolescents. J Clin Oncol 1993, 11(7):1208–1215

    PubMed  CAS  Google Scholar 

  16. Bhatia S, Robison LL, Oberlin O, et al.: Breast cancer and other second neoplasms after childhood Hodgkin’s disease. N Engl J Med 1996, 334(12):745–751. An excellent overview of late effects resulting from treatment for Hodgkin lymphoma

    Article  PubMed  CAS  Google Scholar 

  17. Bhatia S, Meadows AT, Robison LL: Second cancers after pediatric Hodgkin’s disease. J Clin Oncol 1998, 16(7):2570–2572

    PubMed  CAS  Google Scholar 

  18. Lin HM, Teitell MA: Second malignancy after treatment of pediatric Hodgkin disease. J Pediatr Hematol Oncol 2005, 27(1):28–36

    Article  PubMed  Google Scholar 

  19. Wolden SL, Lamborn KR, Cleary SF, et al.: Second cancers following pediatric Hodgkin’s disease. J Clin Oncol 1998, 16(2):536–544

    PubMed  CAS  Google Scholar 

  20. Hudson MM, Poquette CA, Lee J, et al.: Increased mortality after successful treatment for Hodgkin’s disease. J Clin Oncol 1998, 16(11):3592–3600

    PubMed  CAS  Google Scholar 

  21. Kung FH, Schwartz CL, Ferree CR, et al.: POG 8625: a randomized trial comparing chemotherapy with chemoradiotherapy for children and adolescents with stages I, IIA, IIIA1 Hodgkin disease: a report from the Children’s Oncology Group. J Pediatr Hematol Oncol 2006, 28(6):362–368

    Article  PubMed  CAS  Google Scholar 

  22. Nachman JB, Sposto P., Herzog, et al.: Randomized comparison of low-dose involved-field radiotherapy and no radiotherapy for children with Hodgkin’s disease who achieve a complete response to chemotherapy. J Clin Oncol 2002, 20(18):3765–3771. An excellent trial highlighting the central debate in treatment of pediatric Hodgkin lymphoma—whether or not radiotherapy should be employed

    Article  PubMed  Google Scholar 

  23. Glick JH, Young ML, Harrington D, et al.: MOPP/ABV hybrid chemotherapy for advanced Hodgkin’s disease significantly improves failure-free and overall survival: the 8-year results of the intergroup trial. J Clin Oncol 1998, 16(1):19–26. A study highlighting the trade-off between the use of radiation therapy and the decreased event-free survival of its omission

    PubMed  CAS  Google Scholar 

  24. Armata J, Balwierz W, Moryl-Bujakowska A, et al.: Childhood stage IV Hodgkin disease: therapeutic results of the Polish pediatric leukemia/lymphoma study group. Med Pediatr Oncol 1999, 33(4):382–387

    Article  PubMed  CAS  Google Scholar 

  25. Hudson MM, Greenwald C, Thompson E, et al.: Efficacy and toxicity of multiagent chemotherapy and low-dose involved-field radiotherapy in children and adolescents with Hodgkin’s disease. J Clin Oncol 1993, 11(1):100–108

    PubMed  CAS  Google Scholar 

  26. Hudson MM, Krasin M, Link MP, et al.: Risk-adapted, combined-modality therapy with VAMP/COP and response-based, involved-field radiation for unfavorable pediatric Hodgkin’s disease. J Clin Oncol 2004, 22(22):4541–4550

    Article  PubMed  CAS  Google Scholar 

  27. Friedmann AM, Hudson MM, Weinstein HJ, et al.: Treatment of unfavorable childhood Hodgkin’s disease with VEPA and low-dose, involved-field radiation. J Clin Oncol 2002, 20(14):3088–3094

    Article  PubMed  CAS  Google Scholar 

  28. Weiner MA, Leventhal B, Brecher ML, et al.: Randomized study of intensive MOPP-ABVD with or without low-dose total-nodal radiation therapy in the treatment of stages IIB, IIIA2, IIIB, and IV Hodgkin’s disease in pediatric patients: a Pediatric Oncology Group study. J Clin Oncol 1997, 15(8):2769–2779

    PubMed  CAS  Google Scholar 

  29. Fryer CJ, Hutchinson RJ, Krailo M, et al.: Efficacy and toxicity of 12 courses of ABVD chemotherapy followed by low-dose regional radiation in advanced Hodgkin’s disease in children: a report from the Children’s Cancer Study Group. J Clin Oncol 1990. 8(12):1971–1980

    PubMed  CAS  Google Scholar 

  30. Halperin, EC: Hodgkin’s disease: technical aspects. in␣Pediatric Radiation Oncology Congress. 2007, Barcelona, Spain. www.intpros.org

  31. Goldie JH, AJ Coldman, GA Gudauskas: Rationale for the use of alternating non-cross-resistant chemotherapy. Cancer Treat Rep, 1982. 66(3):439–449

    PubMed  CAS  Google Scholar 

  32. Diehl V, J Franklin, D Hasenclever, et al.: BEACOPP, a new dose-escalated and accelerated regimen, is at least as effective as COPP/ABVD in patients with advanced-stage Hodgkin’s lymphoma: interim report from a trial of the German Hodgkin’s Lymphoma Study Group. J Clin Oncol, 1998. 16(12):3810–3821

    PubMed  CAS  Google Scholar 

  33. Diehl V, J Franklin, M Pfreundschuh, et al.: Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin’s disease. N Engl J Med, 2003 348(24):2386–2395

    Article  PubMed  CAS  Google Scholar 

  34. Kelly KM, RJ Hutchinson, R Sposto, et al.: Feasibility of upfront dose-intensive chemotherapy in children with advanced-stage Hodgkin’s lymphoma: preliminary results from the Children’s Cancer Group Study CCG-59704. Ann Oncol, 2002. 13 Suppl 1:107–111

    PubMed  Google Scholar 

  35. Aversa SM, L Salvagno, M Soraru, et al.: Stanford V regimen plus consolidative radiotherapy is an effective therapeutic program for bulky or advanced-stage Hodgkin’s disease. Acta Haematol, 2004. 112(3):141–147

    Article  PubMed  Google Scholar 

  36. Horning SJ, RT Hoppe, S Breslin, et al.: Stanford V and radiotherapy for locally extensive and advanced Hodgkin’s disease: mature results of a prospective clinical trial. J Clin Oncol 2002. 20(3):630–637

    Article  PubMed  Google Scholar 

  37. Hudson MM, SS Donaldson: Treatment of pediatric Hodgkin’s lymphoma. Semin Hematol 1999. 36(3):313–323

    PubMed  CAS  Google Scholar 

  38. Lieskovsky YE, SS Donaldson, MA Torres, et al. High-dose therapy and autologous hematopoietic stem-cell transplantation for recurrent or refractory pediatric Hodgkin’s disease: results and prognostic indices. J Clin Oncol, 2004. 22(22):4532–4540

    Article  PubMed  Google Scholar 

  39. Oberlin O, G Leverger, H Pacquement, et al., Low-dose radiation therapy and reduced chemotherapy in childhood Hodgkin’s disease: the experience of the French Society of Pediatric Oncology. J Clin Oncol, 1992. 10(10):1602–1608

    PubMed  CAS  Google Scholar 

  40. Vecchi V, S Pileri, R Burnelli, et al. Treatment of pediatric Hodgkin disease tailored to stage, mediastinal mass, and age. An Italian (AIEOP) multicenter study on 215 patients. Cancer, 1993. 72(6):2049–2057

    Article  PubMed  CAS  Google Scholar 

  41. Ekert H, T Fok, L Dalla-Pozza, et al. A pilot study of EVAP/ABV chemotherapy in 25 newly diagnosed children with Hodgkin’s disease. Br J Cancer, 1993. 67(1):159–162

    PubMed  CAS  Google Scholar 

  42. van den Berg H, J Zsiros, H Behrendt, Treatment of childhood Hodgkin’s disease without radiotherapy. Ann Oncol, 1997 8 (Suppl 1):15–17

    Article  PubMed  Google Scholar 

  43. Lobo-Sanahuja F, I Garcia, JC Barrantes, et al., Pediatric Hodgkin’s disease in Costa Rica: twelve years’ experience of primary treatment by chemotherapy alone, without staging laparotomy. Med Pediatr Oncol, 1994. 22(6):398–403

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Sarah S. Donaldson MD.

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Olson, M.R., Donaldson, S.S. Treatment of Pediatric Hodgkin Lymphoma. Curr. Treat. Options in Oncol. 9, 81–94 (2008). https://doi.org/10.1007/s11864-008-0058-0

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