This phase II trial studies how well combination chemotherapy and radiation therapy work in treating young patients with favorable-risk Hodgkin lymphoma. Drugs used in chemotherapy, such as doxorubicin hydrochloride, vinblastine, mechlorethamine hydrochloride, vincristine sulfate, bleomycin, etoposide, and prednisone, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving more than one drug (combination chemotherapy) may kill more cancer cells. Radiation therapy uses high-energy x-rays to kill cancer cells. Giving combination chemotherapy with radiation therapy may kill more cancer cells and allow doctors to save the part of the body where the cancer started.
Study sponsor and potential other locations can be found on ClinicalTrials.gov for NCT00846742.
PRIMARY OBJECTIVES:
I. To increase the complete response rate of favorable risk patients (excluding all patients with stage IA modular lymphocyte predominant Hodgkin lymphoma) after 8 weeks Stanford V by at least 20% compared to favorable risk patients on HOD 99 after 8 weeks vincristine, doxorubicin hydrochloride, methotrexate and prednisone (VAMP).
SECONDARY OBJECTIVES:
I. To estimate the disease failure rate within the radiation fields.
II. To examine patterns of treatment failure for children treated with low dose tailored field radiation therapy.
III. To describe acute hematologic and infectious toxicities as they relate to transfusion requirements, growth factor support, episodes of febrile neutropenia, and hospitalizations, according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), version 3.0.
IV. To compare the survival distributions (event-free and overall) and cumulative incidence of local failure and toxicities of favorable risk patients treated with 8 weeks of Stanford V chemotherapy and low-dose tailored-field radiation to those on the favorable risk group of the HOD 99 study that received VAMP and low-dose involved-field radiation.
V. To compare the survival distributions between patients that will not be prescribed radiotherapy after 8 weeks Stanford V and those patients on HOD 99 that did not receive radiotherapy after VAMP.
VI. To estimate the event-free survival distributions of favorable risk patients treated with Stanford V chemotherapy alone and patients treated with Stanford V chemotherapy plus low dose tailored field radiation.
OUTLINE:
Patients receive doxorubicin hydrochloride intravenously (IV) and vinblastine IV on day 1 of weeks 1, 3, 5, and 7; mechlorethamine hydrochloride IV on day 1 of weeks 1 and 5; vincristine sulfate IV and bleomycin IV on day 1 of weeks 2, 4, 6, and 8; etoposide IV on day 1 of weeks 3 and 7; and prednisone orally (PO) three times daily on days 1, 3, 5, and 7. Treatment repeats every 8 weeks in the absence of progressive disease or unacceptable toxicity. Beginning 2-3 weeks after chemotherapy, patients not achieving complete response undergo radiation therapy to individual nodal sites (tailored fields).
After completion of study treatment, patients are followed up every 3 months for 1 year, every 4 months for 2 years, and every 6 months for 1 year, and then annual for 6 years.
Lead OrganizationSaint Jude Children's Research Hospital
Principal InvestigatorMatthew J. Ehrhardt
