42                                                                                                                           Hodgkin’s Lymphoma(HL) ______________________________________________________________________________________

 

8.             Hodgkin’s Lymphoma (HL)

8.3               Childhood Hodgkin’s lymphoma

8.3.1      General considerations

As for adults, HL is curable in the majority of cases in childhood and adolescense.

A number of therapeutic regimens are in use and the main challenge today is to minimize late toxicity without compromising the excellent survival rate. Over the last decade combined modality therapy permitted a reduction in the dose and field size of radiation as well as a reduction in the cumulative doses of cytotoxic agents.

 

Literature: for review and representative group studies e.g.

            KOBRINSKY et al, J. Clin. Oncol. 19 (2001): 2390 – 2396 (Children’s Cancer

            Group study CCG-5912: salvage therapy with dexamethasone, etoposide,

 

 

Hodgkin’s Lymphoma (HL)                                                                                                                         49

                       

cisplatin, cytarabine and asparaginase – DECAL – followed by maintenance    

                        chemotherapy and transplantation)

                        LANDMAN-PARKER et al, J. Clin. Oncol. 18 (2000): 1500 – 1507 (French Society

                       of Pediatric Oncology study MDH 90: response- adapted chemotherapy with

 etoposide, bleomycin, vinblastine, and prednisolone before low-dose radiation therapy in localized childhood HL)

THOMSON and WALLACE, Eur. J. Cancer 38 (2002): 468 – 477 (review)

 

8.3.2      Studies GPOH-HD 90 and GPOH-HD 95

In stages l-llA 2 x OPPA (girls) resp. 2 x OEPA (boys)

In stages llB-lllA, lE, llEA 2 x OPPA (girls) resp. 2 x  DEPA (boys), and 2 x COPP

In stages lllB-lV, llEB, lllEA, lllEB 2 x OPPA (girls) resp. 2 x OEPA (boys)*, and 4 x COPP

Plus involved fiels radiotherapy (in study HD 95 only in patients with incomplete tumor

regression)

         * In stages lllB and lllEB OPPA was reintroduced for boys in study HD 95

 

           OPPA

Vincristine                           1.5 mg/m ²                 i.v.                        d 1, 8, 15

                                             (max 2 mg)

Procarbazine                        100 mg/m²                 p.o.                       d 1 – 15

                                             (max 150 mg)

Prednisone                            60 mg/m²                  p.o.                       d 1 – 15

Doxorubicin                          40 mg/m ²                 i.v.                        d 1, 15

                                      (max cumulative dose 160 mg/m²)

 

           OEPA
           As OPPA with procarbazine replaced by

Etoposide                               125 mg/m²               i.v.                          d 3 – 6

To reduce gonodatoxicity

 

COPP

Cyclophosphamide                  500 mg/m²            i.v.                           d 1 +8

Vincristine                               1.5 mg/m²             i.v.                           d 1 +8

                                             (max 2 mg)

Procarbazine                          100 mg/m²              p.o.                          d 1 –14

                                               (max 150 mg)

Prednisone                               40 mg/m ²             p.o.                          d 1 – 14

 

            Literature:

                        GERRES et al, Cancer 83 (1998): 2217 – 2222

                        SCHELLONG, Ann. Oncol. 9 (Suppl 5) ( 1998): 115-119 and J. Clin. Oncol 19

 (1999): 3736 – 3744