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No excess long-term mortality in stage I-IIA Hodgkin lymphoma patients treated with ABVD and limited field radiotherapy

Lagerlöf, Ingemar ; Holte, Harald ; Glimelius, Ingrid ; Björkholm, Magnus ; Enblad, Gunilla ; Erlanson, Martin ; Fluge, Øystein ; Fohlin, Helena ; Fosså, Alexander and Goldkuhl, Christina , et al. (2020) In British Journal of Haematology 188(5). p.685-691
Abstract

When treating limited stage classical Hodgkin lymphoma (cHL), balancing treatment efficacy and toxicity is important. Toxicities after extended-field radiotherapy are well documented. Investigators have aimed at reducing toxicity without compromising efficacy, mainly by using combined modality treatment (CMT), i.e. chemotherapy and limited-field radiotherapy. In some clinical trials, radiotherapy has been omitted. We evaluated 364 patients with stage I-IIA cHL treated between 1999 and 2005. Patients were treated with two or four cycles of doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) according to presence of risk factors, followed by 30 Gy limited-field (reduced compared to involved-field) radiotherapy. After a median... (More)

When treating limited stage classical Hodgkin lymphoma (cHL), balancing treatment efficacy and toxicity is important. Toxicities after extended-field radiotherapy are well documented. Investigators have aimed at reducing toxicity without compromising efficacy, mainly by using combined modality treatment (CMT), i.e. chemotherapy and limited-field radiotherapy. In some clinical trials, radiotherapy has been omitted. We evaluated 364 patients with stage I-IIA cHL treated between 1999 and 2005. Patients were treated with two or four cycles of doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) according to presence of risk factors, followed by 30 Gy limited-field (reduced compared to involved-field) radiotherapy. After a median follow-up of 16 years for survival, freedom from progression at five and ten years was 93% and overall survival at 5 and 10 years was 98% and 96%, respectively. Only two relapses, out of 27, occurred after more than 5 years. There was no excess mortality compared to the general population. Of the analysed subgroups, only patients with progression within five years showed significant excess mortality. The absence of excess mortality questions the concept of omitting radiotherapy after short-term chemotherapy, a strategy that has been associated with an elevated risk of relapse but not yet with a proven reduced long-term excess mortality.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
hodgkin lymphoma, limited stage, relative survival
in
British Journal of Haematology
volume
188
issue
5
pages
7 pages
publisher
Federation of European Neuroscience Societies and Blackwell Publishing Ltd
external identifiers
  • pmid:31612478
  • scopus:85074358826
ISSN
0007-1048
DOI
10.1111/bjh.16232
language
English
LU publication?
yes
id
fa384877-963f-4142-b8a5-df19ce46d394
date added to LUP
2020-12-28 12:22:14
date last changed
2021-04-06 02:06:54
@article{fa384877-963f-4142-b8a5-df19ce46d394,
  abstract     = {<p>When treating limited stage classical Hodgkin lymphoma (cHL), balancing treatment efficacy and toxicity is important. Toxicities after extended-field radiotherapy are well documented. Investigators have aimed at reducing toxicity without compromising efficacy, mainly by using combined modality treatment (CMT), i.e. chemotherapy and limited-field radiotherapy. In some clinical trials, radiotherapy has been omitted. We evaluated 364 patients with stage I-IIA cHL treated between 1999 and 2005. Patients were treated with two or four cycles of doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) according to presence of risk factors, followed by 30 Gy limited-field (reduced compared to involved-field) radiotherapy. After a median follow-up of 16 years for survival, freedom from progression at five and ten years was 93% and overall survival at 5 and 10 years was 98% and 96%, respectively. Only two relapses, out of 27, occurred after more than 5 years. There was no excess mortality compared to the general population. Of the analysed subgroups, only patients with progression within five years showed significant excess mortality. The absence of excess mortality questions the concept of omitting radiotherapy after short-term chemotherapy, a strategy that has been associated with an elevated risk of relapse but not yet with a proven reduced long-term excess mortality.</p>},
  author       = {Lagerlöf, Ingemar and Holte, Harald and Glimelius, Ingrid and Björkholm, Magnus and Enblad, Gunilla and Erlanson, Martin and Fluge, Øystein and Fohlin, Helena and Fosså, Alexander and Goldkuhl, Christina and Gustavsson, Anita and Johansson, Ann Sofie and Linderoth, Johan and Nome, Ole and Palma, Marzia and Åkesson, Lisa and Østenstad, Bjørn and Raud, Cecilia and Glimelius, Bengt and Molin, Daniel},
  issn         = {0007-1048},
  language     = {eng},
  number       = {5},
  pages        = {685--691},
  publisher    = {Federation of European Neuroscience Societies and Blackwell Publishing Ltd},
  series       = {British Journal of Haematology},
  title        = {No excess long-term mortality in stage I-IIA Hodgkin lymphoma patients treated with ABVD and limited field radiotherapy},
  url          = {http://dx.doi.org/10.1111/bjh.16232},
  doi          = {10.1111/bjh.16232},
  volume       = {188},
  year         = {2020},
}