Early pediatric HL: adding RT after chemotherapy boosts OS

  • Jhawar SR & al.
  • JAMA Oncol
  • 3 Jan 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • Combined modality therapy (CMT) with chemotherapy followed by radiotherapy (RT) is associated with a better 5-year survival than chemotherapy alone in children with early-stage Hodgkin lymphoma (HL).
  • Despite this, CMT's use has declined by 24.8% since 2004 over concerns about long-term sequelae of RT.

Why this matters

  • Findings support the use of CMT as the standard of care, or at least as standard for clinical trials.

Study design

  • Retrospective observational cohort (n=5657) of pediatric patients (age, 0.1-21 years) with stage I or II classic HL in the US National Cancer Database.
  • Funding: None disclosed.

Key results

  • Median follow-up was 5.1 years.
  • CMT was associated with superior 5-year OS (97.3% vs 94.5% with chemotherapy alone), which on multivariate analysis had an adjusted HR (aHR) of 0.57 (P<.001>
  • The greatest survival benefit of CMT, based on sensitivity analysis, was for adolescent and young adults (aHR, 0.47; P<.001 and low-risk i-iia patients ci>
  • From 2004 to 2015, CMT's use declined by 24.8% (from 59.7% to 34.9%).

Limitations

  • Retrospective observational design.
  • Did not examine toxicity.

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