Survival of pediatric Hodgkin lymphoma patients treated with
doxorubicin, bleomycin, vincristine, etoposide, prednisone, and
cyclophosphamide (ABVE-PC) versus Adriamycin, bleomycin, vinblastine,
and dacarbazine (ABVD) at a single institution
Abstract
Background: ABVD, the standard-of-care in adult Hodgkin lymphoma (HL),
has not been directly compared to ABVE-PC, a pediatric regimen designed
to reduce late-effects. We aimed to compare the effectiveness and
associated toxicities of these two regimens used in the same
institution. Methods: This retrospective cohort study evaluated a total
of 224 patients diagnosed with HL between 1999 and 2018 at Children’s
Hospital Los Angeles (CHLA), of which 93 patients were eligible having
received ABVD (n=46) or ABVE-PC (n=47) chemotherapy as their initial
treatment. Descriptive analyses were performed using the Student’s
t-test or Fisher’s exact test. Survival analysis used the Kaplan-Meier
method. Events included: death, relapse, secondary malignancy, need for
radiation therapy, pulmonary toxicity and cardiomyopathy determined by
shortening fraction <29%. Analyses followed an
intention-to-treat principle. Results: There was no difference in
baseline characteristics between the patients receiving ABVE-PC or ABVD
in regard for stage, risk group or prognostic variables, such as the
presence or absence of “B” symptoms, bulky disease, and extra-nodal
involvement. A greater proportion of patients treated with ABVE-PC
received consolidating external beam radiation treatment (XRT) either by
randomization or by response compared to ABVD (59.6% vs 32.6%
respectively, p=0.01). While not statistically significant, response to
therapy, assessed by PET/CT where available, mirrored the need for
radiation (rapid response 58.3% vs 90.0%, n=34, p=0.11). There was no
difference in event-free survival (p=0.63) or overall survival (p=0.37)
with a median follow up length of 3.9 years. Conclusion: ABVD and
ABVE-PC achieved similar survival outcomes in our single-institution
cohort