Radiation can be avoided in early Hodgkin's lymphoma

NEW YORK (Reuters Health) - Young patients with early Hodgkin's lymphoma can be spared from radiotherapy by the so-called ABVD chemotherapy regimen, Harvard researchers say.

The basic regimen involves six cycles of doxorubicin, bleomycin, vinblastine and dacarbazine.

"Thus far no trial in North America or Europe has shown an inferior survival when radiation is omitted," although patients with large bulky nodes are still irradiated, lead author Dr. George Canellos of the Dana-Farber Cancer Institute, Boston, told Reuters Health by e-mail.

In a retrospective study reported February 16th in the Journal of Clinical Oncology, he and his colleagues found that their experience aligns with those earlier trials. "Certain presentations of the disease can be treated with...ABVD with a very good disease-free survival," Dr. Canellos said.

Their analysis covered 75 patients, all with stage I or II disease without bulky lymph nodes. Most had stage IIA disease; all were younger than 45 years old (mean age, 29). They were treated at Dana Farber and at the Massachusetts General Hospital.

Fifty-five patients received six cycles of ABVD. The others received only four cycles or a modified combination of drugs. No one received consolidation radiotherapy.

All patients had clinical complete remission from chemotherapy alone. At a median of at least 60 months later, 69 (92%) were still in remission. The other 6 patients relapsed at 6 to 58 months after chemotherapy, but all are still alive after salvage therapy with radiation, chemotherapy and autologous stem-cell transplants. The median progression-free survival after relapse is 36 months, according to the article.

Overall, the authors conclude, these findings "support the emerging experience" that ABVD chemotherapy can provide a durable complete response to a majority of patients with nonbulky, limited-stage Hodgkin's lymphoma.

They noted that while complementary radiation therapy might slightly increase the complete response rate, "this comes at cost for the potential of long-term radiation-induced toxicity."

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