Introduction
Hodgkin Lymphoma (HL) in children is treated via a number of separate protocols in the low, intermediate and high risk stratums.1,2 In adults with HL however, ABVD has been considered the de-facto standard of care for several decades due to its effectiveness and excellent toxicity profile.3,4 Late effects including cardiotoxicity and reduced fertility remain a concern although overall the late effects profile is favorable.5–7 There is also evidence that radiotherapy can be eliminated in the low risk stratum, which is an attractive approach to reduce risk of organ toxicities and secondary malignancies.8
In the pediatric patient population, ABVE-PC, a dose-dense regimen has been more commonly used, especially in trials conducted by the Children’s Oncology Group (COG). 1,2,9 ABVE-PC therapy is often risk-adapted and based on interim disease response.9,10 Given the ability of children to tolerate more short-term toxicities, ABVE-PC is able to reduce exposure to anthracyclines and alkylators.9 The COG study AHOD0031 has also shown that external beam radiation treatment (XRT) can be safely eliminated in patients with interim rapid early response .9
An abstract presented findings comparing AYA patients in two different clinical trials, and the results suggest that AYA patients do worse on adult protocols (ABVD vs Stanford V) when compared to pediatric protocol (ABVE-PC), with worse failure-free survival (FFS) and overall survival (OS).11 We conducted a study to directly compare the efficacy and toxicity of ABVD to ABVE-PC for patients with HL within different disease risk strata. We hypothesized that ABVE-PC has a similar outcome as measured by EFS and OS when compared to ABVD in pediatric patients with newly diagnosed HL at our institution.