Klin Padiatr 2014; 226 - O_16
DOI: 10.1055/s-0034-1371134

Treatment of Children and Adolescents with Classical Hodgkin Lymphoma: Final Results of SFCE MDH03 Study

E Seror 1, A Lambilliotte 2, H Pacquement 3, N Gaspar 4, M Schell 5, G Plat 6, C Curtillet 7, Y Reguerre 8, G Vaudre 9, S Haouy 10, S Helfre 3, S Gorde-Grosjean 11, C Schmitt 12, N Aladjidi 13, S Boudjemaah 9, L Claude 5, J Donadieu 9, J Landman-Parker 9, T Leblanc 1
  • 1Hôpital Robert Debré, Paris, France
  • 2CHU, Lille, France
  • 3Institut Curie, Paris, France
  • 4Institut Gustave Roussy, Villejuif, France
  • 5CAC Léon Bérard, Lyon, France
  • 6CHU, Toulouse, France
  • 7CHU La Timone, Marseille, France
  • 8CHU, Angers, France
  • 9Hôpital Trousseau, Paris, France
  • 10CHU, Montpellier, France
  • 11CHU, Reims, France
  • 12CHU, Nancy, France
  • 13CHU, Bordeaux, France

In 2003, the French Society of Cancer in Children (SFCE) elaborated recommendations for the treatment of classical Hodgkin lymphoma in children, based in part on the results of MDH 90 study (J Clin Oncol, 2000).

Patients and methods: Three groups of treatment were considered:

Chemotherapy

TDM evaluation

Good response

Radiotherapy2

GMH1 (localized)1

VBVPx 4

Post 4 cycles

75% reduction

20 Gy

GMH2 (intermediate)

COP/ABVx 4

Post 4 cycles

75% reduction

20 Gy

GMH3 (advanced)

OPPAx 3 + COPPx 3

Post 3 cycles

50% reduction

20 Gy

TDM: tomodensitometry (1) patient with nodular sclerosis were excluded from GMH1 if one of the following was present: bulky mediastinum (M/T > 0.45), Hb < 10.5 g/dl or ESR > 50. (2): for good responders

Parents gave their informed consent to this prospective study. 432 patients (pts) were included in 31 French pediatric centers from 01/2003 to 12/2007. Fifteen pts were excluded from this analysis because of missing data's. Among 417 pts there were 195 girls; median age was 14 years (3 – 18). Stages were IA n = 20; IB n = 9; IIA n = 135; IIB n = 58; IIIA n = 43; IIIB n = 44; IVA n = 47; IVB n = 61 within 13% E stage. Histology was nodular sclerosis for 84% of the pts and mixed cellularity for 12%.

Results: At our last analysis with a median follow-up of 32 months, 8/417 pts were dead (one in complete remission) and 3% patients had refractory disease. For all patients 5-years event free (EFS) and overall survival (OS) are 89 ± 1.6% and 96 ± 1.8%.

N

Good response

EFS

OS

GMH1

95 (23%)

88%

98%

100%

GMH2

184 (44%)

83%

84%

94%

GMH3

138 (33%)

94%

89%

96%

A new analysis has just been completed. 402 children are still alive. Updated complete results will be presented in Berlin.

Conclusion: These results confirm the good outcome of localized pts treated with VBVP, e.g. without alkylating agents and anthracyclins, and 20 Gy. Intensification for GMH3 pts with three OPPA courses instead of two allows a better outcome without increased toxicity.