Although there has been a nationwide decrease in the use of combined modality therapy (CMT) for treatment of pediatric patients with early-stage Hodgkin lymphoma (HL), patients who received CMT appeared to achieve better overall survival 5 years after treatment compared with patients who received chemotherapy alone, according to a study published in JAMA Oncology.
The research team hypothesized that the use of radiotherapy within the CMT regimen would improve outcomes of patients with pediatric HL compared with those of patients who received chemotherapy alone. Therefore, they tested for associations between outcomes in pediatric HL and CMT using data from the National Cancer Database. Five-year overall survival (OS) was the primary end point.
The observational cohort data included 5657 pediatric patients (average age, 17.1 years; range, 0.1-21) who received a diagnosis of stage I or II HL in the United States from January 1, 2004, to December 31, 2015. Of these patients, 50.3% (2845/5657) received CMT.
The 5-year overall survival rate was 97.3% (95% CI, 96.4-97.9) for patients who received CMT compared with 94.5% (95% CI, 93.8-95.8) for patients who received chemotherapy alone (P <.001). This difference remained significant in the intention-to-treat analysis and a multivariate analysis (CMT adjusted hazard ratio [HR], 0.57; 95% CI, 0.42-0.78; P <.001). Furthermore, in the sensitivity analysis, those who appeared to benefit the most from CMT were the low-risk cohort (stage I-IIA) and adolescent and young adult patients (HR, 0.47; 95% CI, 0.40-0.56; P <.001). However, the use of CMT decreased from 59.7% (271/454) to 34.9% (153/438) of cases between 2004 and 2015.
The authors suggested that “consolidation radiotherapy as part of CMT may be considered in future clinical trials for patients with early-stage disease” to identify which patients may benefit most from CMT.
1. Jhawar SR, Rivera-Núñez Z, Drachtman R, Cole PD, Hoppe BS, Parikh RR. Association of combined modality therapy vs chemotherapy alone with overall survival in early-stage pediatric Hodgkin lymphoma [published online January 3, 2019]. JAMA Oncol. doi:10.1001/jamaoncol.2018.5911