By Will Boggs MD
NEW YORK (Reuters Health) - Many children with low-risk lymphocyte-predominant Hodgkin lymphoma (LPHL) may be spared chemotherapy and radiotherapy after surgical resection alone, according to a new report from the Children's Oncology Group.
"It is very interesting to see that 75% of the surgery-only patients were spared further treatment," Dr. Burton E. Appel from Hackensack University Medical Center in New Jersey told Reuters Health by email.
Most children with LPHL are asymptomatic and have non-bulky, localized disease involving peripheral lymph nodes. There is no established standard of care for treatment of low-stage LPHL.
Dr. Appel and colleagues treated patients with resectable disease limited to a single lymph node using a surgery-only/observation strategy. Chemotherapy with CHOP (cyclophosphamide, vincristine, doxorubicin and prednisolone) was used for those who required chemotherapy at diagnosis or at relapse following observation alone, and radiotherapy was reserved for children who had less than a complete response to chemotherapy.
Of the 183 eligible patients, 52 underwent complete resection of a single node. Overall, 135 patients received CHOP, including 126 treated at diagnosis and nine at relapse after surgery only. Eleven chemotherapy patients who had less than complete responses received involved-field radiotherapy.
Thirteen of the 52 total resection patients relapsed, for a five-year event-free survival (EFS) of 77.1%, the researchers report in the Journal of Clinical Oncology, online May 16.
Among the 135 children who received chemotherapy, 124 (92%) were in complete remission and did not receive radiotherapy. This group had 12 relapses and two developed non-Hodgkin lymphoma as a first event after a median follow-up of 28.1 months. The five-year EFS rate for this group was 88.8%.
Chemotherapy was well-tolerated, with only seven patients experiencing grade 3 or 4 fever and neutropenia.
Three second malignant neoplasms have been reported, including the two patients who developed non-Hodgkin lymphoma.
"A high percentage of highly-selected patients may be cured with surgery alone, and most patients can be spared radiation," Dr. Appel said. "However, it is very important to note that this surgery-only approach was limited to patients who had a single node that was completely resected. The study results do not support extending the surgery-only approach to patients with more than a single node or stage II disease."
"During the first 2 years, it is important to evaluate them every 3 months, at least with physical exams," he said. "Since there were relapses beyond 2 years, it is still important to maintain regular contact with physical exams, every 4 to 6 months."
"Future clinical trials should address the success of this approach in patients with more than a single node," Dr. Appel added.
Dr. Robert J. Vasquez from Ochsner Medical Center for Children in New Orleans, Louisiana, told Reuters Health by email, "Most children and young adults with localized lymphocyte-predominant Hodgkin lymphoma can be cured with surgical resection alone (75% in this study), and if they relapse, the less-intense chemotherapy used in this study is highly effective at achieving remission."
"Given that this study was accruing patients from 2006 through 2010, it does not address the potential role of immunotherapies (e.g., rituximab) in the treatment of this disease," he noted.
J Clin Oncol 2016.
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