A Novel Approach to the Treatment of Early Stage Hodgkin Lymphoma with a Mitoxantrone-Based Regimen Followed by Involved Field Radiotherapy: A 12 Year Follow up

Abstract 4901

Early stage Hodgkin Lymphoma (HL) has been conventionally treated with radiotherapy alone or abbreviated chemotherapy along with involved field radiation therapy. The role of combined modality therapy was investigated to study the favorable effects of lower doses of radiation on acute and long term toxicities without compromising response and cure rates. The goal of this study was to evaluate the role of combined chemotherapy, which incorporated mitoxantrone in place of doxorubicin and dexamethasone in place of dacarbazine, and involved field radiation therapy in patients with early stage, non-bulky (I and II) HL.

The patients enrolled in this trial were originally enrolled in 1997–2002 and treated with 4 cycles of chemotherapy with mitoxantrone 6 mg/m2 IV, vinblastine 5 mg/m2 IV, bleomycin 5 units/m2 on day 1 and day 15, and dexamethasone 6 mg/m2 PO on days 1–5 and days 15–19 on a 28 day cycle (MBVD). Restaging was done following 4 cycles of chemotherapy. Subsequently patients received involved field radiation with total dose of 30 Gy at 150 cGy per fraction. Patients were followed for response, duration, toxicity and survival.

Results: 15 patients were enrolled, 10 were evaluable. All completed treatment. 7 patients were stage II and 3 were stage I at diagnosis. 4 were males and 6 were females between the ages of 20 to 52 years with a median age 33.5 years. Following completion of treatment with chemotherapy and radiation, 8 patients achieved a complete response and 2 patients remained in partial remission. Duration of response in patients in follow up ranged between 9 and 149 months with a median of 75 months. 2 relapses occurred at 8 and 23 months with increase in size of the mediastinal lymph nodes. 7/10 patients experienced grade 1 toxicities which included anemia, leukopenia, neutropenia, thrombocytopenia, GI upset or cardiomyopathy. 4/10 patients experienced grade 2 toxicities. 2/10 patients had grade 3 toxicities with severe neutropenia. All patients experienced grade 1 skin changes following radiation. One patient's left ventricle ejection fraction decreased from 65% to 52% following therapy. At last follow up, 9/10 patients were alive with 9/10 patients still in remission. 1 patient underwent bone marrow transplant after relapse at 8 months and was lost to follow up. 1 patient experienced recurrence of disease at 23 months and underwent bone marrow transplant at 29 months and was in remission at 73 month follow up.

Although the number of patients in this study is small, treatment appears to be well tolerated and acute toxicities less compared to standard therapy with ABVD chemotherapy followed by radiotherapy. At last follow up 9/10 are in remission, with 2 patients in remission for 12 years. No patients have experienced MDS or other long term sequelae. Confirmatory studies should be done to determine the safety of the MBVD regimen compared to standard ABVD.