Klin Padiatr 2020; 232(02): 100
DOI: 10.1055/s-0040-1701873
S-V
Session V: Relapse treatments
© Georg Thieme Verlag KG Stuttgart · New York

A New Model for Stratification of Treatment Intensity in Relapsed Pediatric Hodgkin Lymphoma

P Harker-Murray
1   Midwest Children’s Cancer Center, Pediatric Hematology/Oncology, Milwaukee, USA
,
Q Pei
2   Children’s Oncology Group, Data Center, Gainsville, USA
,
C Forlenza
3   Memorial Sloan Kettering Cancer Center, Pediatric Hematology/Oncology, New Yorl, USA
,
R Drachtman
4   Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital, Pediatric Hematology/Oncology, New Brunswick, USA
,
P Cole
4   Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital, Pediatric Hematology/Oncology, New Brunswick, USA
,
KM Kelly
5   Roswell Park Cancer Institute, Pediatric Hematology/Oncology, Buffalo, USA
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2020 (online)

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    Introduction High-dose chemotherapy and autologous hematopoietic stem cell transplantation (AHSCT) are standard for most relapsed/refractory Hodgkin lymphoma (R/R HL). Although some do not require AHSCT for cure, there is no standard therapy or inclusion criteria for this group. The ongoing trial CheckMate CA209-744 (NCT02927769) tests a risk-stratified, response-based algorithm for patients aged 5-30 years with R/R HL. In it, LR patients who attain complete metabolic response to chemoimmunotherapy receive consolidative radiation but omit AHSCT. Low risk (LR) relapse is defined as relapse of stage IA, IIA 3-12 months from completing ≤3 cycles of chemotherapy or stage I, II, and IIIA relapsing >1 year from therapy completion. Standard risk (SR) relapse includes all other relapses and all patients with B symptoms or extranodal disease at relapse or relapse in a prior radiation field. To broaden the definition of LR R/R HL, we retrospectively investigated the overall survival (OS) of pediatric patients with R/R HL using two novel definitions of LR relapse.

    Methods We proposed two new definitions of LR relapse (LR1, LR2) based on stage at diagnosis, initial treatment, time to relapse, and B symptoms and extranodal disease at relapse that are broader than used on CA209-744. LR1 included relapse of stage I, IIA, IIB, IIIA >3 months following ≤ 4 cycles of therapy, and relapse of stage IIBE, IIIAE, IIIB, IVA, IVB occurring >1 year off therapy. LR2 was identical except for the exclusion of relapse IIIB and IVB. We analyzed 261 R/R HL patients treated on pediatric clinical trials AHOD0431 (n=42, NCT00302003), AHOD0031 (n=192, NCT00025259), and AHOD0831 (n=27, NCT01026220). We compared survival of patients categorized as LR1, LR2 to SR and the change in proportion of patients who would be stratified as LR compared with CA209-744 stratification.

    Results Using CA209-744 criteria, 38% and 62% patients were stratified as LR and SR, respectively. In the LR1 stratification 74% of patients would be LR (94% increase). Five-year OS in LR and SR patients based on the LR1 stratification was 74.2% (95%CI 62-83%) and 80% (95%CI 66-88%) respectively (p=0.72). Five-year OS rates for LR and SR patients based on the LR2 stratification are 81% (95% CI 67%-90%) and 74% (95% CI 63-83%) respectively (p=0.72).

    Conclusion This analysis of outcomes of pediatric patients with R/R HL suggests that less intensive strategies beyond AHSCT may be considered for expanded subgroups of patients in future clinical trials.