Progressive or relapsed Hodgkin lymphoma has demonstrated responsiveness to salvage radiotherapy in pediatric patients, according to findings of a study presented at the American Society for Radiation Oncology (ASTRO) annual meeting (September 24-27, 2017; San Diego, CA).
Survival rates of pediatric patients with Hodgkin lymphoma are exceptionally high. However, 15% of pediatric patients experience disease progression or recurrence later in life. The role of radiotherapy in patients with progressive or relapse Hodgkin lymphoma is not well researched.
A group of US radiation oncologists led by N L Williams, MD, Sidney Kimmel Medical College (Philadelphia, PA), studied treatment patterns and disease outcomes for pediatric patients with progressive or relapsed Hodgkin lymphoma treated with curative-intent radiotherapy after initial treatment failure. A total of 46 pediatric patients were retrospectively reviewed from 1999 to 2015, all of whom were treated with risk-adapted, response-based frontline therapy and were retrieved with intense cytoreductive treatment regimens followed by radiotherapy to failure sites, with or without autologous stem cell transplantation (ASCT).
Ten patients (22%) had favorable-risk disease, eight (17%) had intermediate-risk, and 28 (61%) had unfavorable-risk.
After a median follow-up from the end of salvage radiotherapy of 3.8 years, eight patients had experienced subsequent disease progression and two patients died without progression.
Researchers reported that the 5-year overall cumulative incidence of local failure following salvage radiotherapy was 17.7% (95% CI, 8.2%-30.2%) and the 5-year freedom from subsequent treatment failure and overall survival was 80.1% (95% CI, 69.2%-92.6%) and 88.5% (95% CI, 79.5%-98.6%), respectively.
Univariate analysis showed that inadequate response to salvage therapy was significantly associated with local failure following radiotherapy (P = .0038).
Researchers concluded that progressive or relapsed Hodgkin lymphoma in pediatric patients is responsive to salvage radiotherapy, with a relatively low local failure rate following moderate radiotherapy doses. Additionally, they noted that response to initial salvage therapy likely predicts subsequent local failure.—Zachary Bessette