Combination Chemotherapy in Treating Patients Classical Hodgkin Lymphoma
This is a phase II study using risk and response-adapted therapy for low, intermediate and high risk classical Hodgkin lymphoma. Chemotherapy regimens will be based on risk group assignment. Low-risk and intermediate- risk patients will be treated with bendamustine, etoposide, Adriamycin (doxorubicin), bleomycin, Oncovin (vincristine), vinblastine, and prednisone (BEABOVP) chemotherapy. High-risk patients will receive Adcetris (brentuximab vedotin), etoposide, prednisone and Adriamycin (doxorubicin) (AEPA) and cyclophosphamide, Adcetris (brentuximab vedotin), prednisone and Dacarbazine (DTIC) (CAPDac) chemotherapy. Residual node radiotherapy will be given at the end of all chemotherapy only to involved nodes that do not have an adequate response (AR) after 2 cycles of therapy for all risk groups.
- Histologically confirmed, previously untreated CD30+ classical Hodgkin lymphoma (HL). (Participants are still eligible if they received limited emergent radiation therapy [RT] or steroid therapy - maximum of 7 days if within the last month or as approved by principal investigator [PI])
- Age =< 21 years at the time of diagnosis (i.e., participants are eligible until their 22nd birthday) for low-risk and intermediate-risk. Age =< 18 years at the time of diagnosis (i.e., participants are eligible until their 19th birthday) for high-risk
- All Ann Arbor stages * Low-risk: IA, IIA (excluding patients with “E” lesions or mediastinal bulk) * Intermediate-risk: IA or IIA with “E” lesions or bulky mediastinal adenopathy (mediastinal mass to thoracic cavity ratio 33% or greater by chest radiograph) and IB, IIIA * High-risk: IIB, IIIB, IV
- Adequate renal function based on glomerular filtration rate (GFR) >= 70 ml/min/1.73m^2 OR serum creatinine adjusted for age and gender as follows: * Age: Maximum Serum Creatinine (mg/dL) * 1 to < 2 years: 0.6 (male and female) * 2 to < 6 years: 0.8 (male and female) * 6 to < 10 years: 1 (male and female) * 10 to < 13 years: 1.2 (male and female) * 13 to < 16 years: 1.5 (male), 1.4 (female) * >= 16 years: 1.7 (male), 1.4 (female)
- Total bilirubin =< 1.5 x upper limit of normal (ULN) for age
- Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 2.5 x ULN for age
- Absolute neutrophil count (ANC) >= 1000/uL (unless secondary to Hodgkin disease diagnosis)
- Platelets > 75,000/uL (unless secondary to Hodgkin disease diagnosis)
- Shortening fraction of >= 27% by echocardiogram, unless decreased function is due to large mediastinal mass or effusion related to HL
- No evidence of dyspnea at rest, no exercise intolerance, and a pulse oximetry > 92% on room air unless secondary to a large mediastinal mass or effusion related to HL
- Female participant who is post-menarchal must have a negative urine or serum pregnancy test
- Female or male participant of reproductive potential must agree to use an effective contraceptive method throughout duration of study treatment
- CD30 negative HL
- Has received prior therapy for Hodgkin lymphoma, except if they received limited emergent RT or steroid therapy - maximum of 7 days if within the last month or as approved by PI
- Inadequate organ function
- High-risk participants with a history of >= grade 2 peripheral neuropathy or any active neurologic disease, that in the opinion of the treating investigator, would impede ability to assess neurologic toxicities
- Inability or unwillingness of research participant or legal guardian / representative to give written informed consent
Locations & Contacts
Contact: Jamie E. Flerlage
Trial Objectives and Outline
I. To evaluate the efficacy (adequate response) after 2 cycles of bendamustine, etoposide, doxorubicin hydrochloride (adriamycin), bleomycin, vincristine sulfate (Oncovin), vinblastine, prednisone (BEABOVP) (bendamustine substitution for mechlorethamine in the original Stanford V chemotherapy backbone) in low-risk and intermediate-risk patients with classical Hodgkin lymphoma (cHL).
II. To estimate the event-free survival in high-risk patients with classical Hodgkin lymphoma (cHL).
I. To describe the acute hematologic and infectious toxicities of BEABOVP (bendamustine substitution for mechlorethamine in the original Stanford V chemotherapy backbone) in patients with low-risk and intermediate-risk cHL as they relate to transfusion requirements, hematopoietic growth factor support, episodes of febrile neutropenia and hospitalizations, according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), version 5.0.
II. To describe the acute hematologic, neuropathic, and infectious toxicities of brentuximab vedotin (Adcetris), etoposide, prednisone, adriamycin (AEPA)/cyclophosphamide, Adcetris, prednisone, dacarbazine (CAPDac) in patients with high-risk cHL as they relate to transfusion requirements, hematopoietic growth factor support, episodes of grade 3 and 4 sensory or motor neuropathy, episodes of febrile neutropenia and hospitalizations, according to the NCI Common Terminology Criteria for Adverse Events (CTCAE), version 5.0.
III. To evaluate patterns of failure in irradiated and non-irradiated patients.
IV. To estimate the event-free survival (EFS) functions of low risk (LR) and intermediate risk (IR) patients, and compare with those in previously published studies.
V. To estimate the response rate in high risk (HR) patients and compare with historical and literature rates.
VI. To compare response rates in LR and IR patients with historical and literature rates.
VII. To compare the EFS function of HR patients with that in previously published studies.
I. To evaluate the plasma pharmacokinetics of bendamustine along with predictors of its variability when used as part of BEABOVP regimen for pediatric classical HL patients.
II. To explore the patterns and dynamics of T-cell clonality in classical Hodgkin lymphoma.
III. To explore the association between thymus and activation regulated chemokine (TARC), total metabolic tumor volume, stage, risk group and treatment response.
IV. To obtain baseline testing by St. Jude Lifetime Study (SJLIFE) to allow for enhanced survivorship follow-up.
OUTLINE: Participants are assigned to 1 of 3 arms.
ARM I (LOW-RISK): Patients receive BEABOVP regimen consisting of bendamustine intravenously (IV) on day 1, etoposide IV on day 15, doxorubicin hydrochloride IV on days 1 and 15, bleomycin IV on days 8 and 22, vincristine sulfate IV on days 8 and 22, vinblastine IV on days 1 and 15, and prednisone orally (PO) twice daily (BID) or thrice daily (TID) every other day for 14 days. Treatment repeats every 28 days for 2 cycles. Patients with involved nodes that do not have an adequate response (AR) after 2 courses of therapy undergo radiation at the end of 2 cycles of chemotherapy for 3-4 weeks.
ARM II (INTERMEDIATE-RISK): Patients receive BEABOVP regimen consisting of bendamustine IV on day 1, etoposide IV on day 15, doxorubicin hydrochloride IV on days 1 and 15, bleomycin IV on days 8 and 22, vincristine sulfate IV on days 8 and 22, vinblastine IV on days 1 and 15, and prednisone PO BID or TID every other day for 14 days for 3 cycles. However, patients with an AR at early response assessment (ERA) do not continue prednisone in cycle 3. Treatment repeats every 28 days for 3 cycles. Patients with involved nodes that do not have an AR after 2 courses of therapy undergo radiation at the end of all chemotherapy for 3-4 weeks.
ARM III (HIGH-RISK): Patents receive AEPA regimen consisting of brentuximab vedotin on days 1, 8 and 15, etoposide IV on days 1-5, prednisone PO BID or TID on days 1-15, and doxorubicin hydrochloride IV days 1 and 15. Treatment repeats every 28 days for 2 cycles. Patients then receive CAPDac regimen consisting of cyclophosphamide IV on days 1 and 8, brentuximab vedotin IV on days 1 and 8, prednisone PO BID or TID on days 1-15, and dacarbazine IV on days 1-3. Prednisone will be eliminated for cycles 3-6 in patients with an AR after ERA. Treatment repeats every 21 days for up to 4 courses. Patients with involved nodes that do not have an AR after 2 courses of therapy undergo radiation at the end of all chemotherapy therapy for 3-4 weeks.
In all arms, patients may receive filgrastim subcutaneously (SC) or IV if they become neutropenic until absolute neutrophil count (ANC) is acceptable.
After completion of study treatment, patients are followed up every 4 months for 2 years, every 6 months for 3 years, then annually thereafter.
Trial Phase & Type
St. Jude Children's Research Hospital
Jamie E. Flerlage
Secondary IDs NCI-2018-02924
Clinicaltrials.gov ID NCT03755804