Risk and Response Adapted Treatment Guidelines for Managing First Relapsed and Refractory Classical Hodgkin Lymphoma in Children and Young People. Recommendations from the EuroNet Pediatric Hodgkin Lymphoma Group

Overview

Journal Hemasphere

Publisher Wiley

Specialty Hematology

Date 2020 Feb 20

PMID 32072145

Citations 17

Authors

Stephen Daw

Dirk Hasenclever

Maurizio Mascarin

Ana Fernandez-Teijeiro

Walentyna Balwierz

Auke Beishuizen

Roberta Burnelli

Michaela Cepelova

Alexander Claviez

Karin Dieckmann

Judith Landman-Parker

Regine Kluge

Dieter Korholz

Christine Mauz-Korholz

William Hamish Wallace

Thierry Leblanc

Affiliations

Soon will be listed here.

Abstract

The objective of this guideline is to aid clinicians in making individual salvage treatment plans for pediatric and adolescent patients with first relapse or refractory (R/R) classical Hodgkin lymphoma (cHL). While salvage with standard dose chemotherapy followed by high dose chemotherapy and autologous stem cell transplant is often considered the standard of care in adult practice, pediatric practice adopts a more individualized risk stratified and response adapted approach to salvage treatment with greater use of non-transplant salvage. Here, we present on behalf of the EuroNet Pediatric Hodgkin Lymphoma group, evidence and consensus-based guidelines for standardized diagnostic, prognostic and response procedures to allocate children and adolescents with R/R cHL to stratified salvage treatments.

Citing Articles

Transplant-Free Salvage Therapy for Low-Risk Relapsed Pediatric Hodgkin Lymphoma: A Nonrandomized Clinical Trial.

Hoppe B, Milgrom S, Renfro L, Wu Y, Schwartz C, Constine L JAMA Oncol. 2025; .

PMID: 39745710 PMC: 11837869. DOI: 10.1001/jamaoncol.2024.5648.

Characteristics of relapsed and refractory paediatric Hodgkin lymphoma; a 10-year retrospective study of an LMIC.

Riaz Q, Gul R, Junaid V, Farooq W, Khayyam N Ecancermedicalscience. 2024; 18:1729.

PMID: 39421177 PMC: 11484679. DOI: 10.3332/ecancer.2024.1729.

Single-cell RNA sequencing of pediatric Hodgkin lymphoma to study the inhibition of T cell subtypes.

de Kanter J, Steemers A, Gonzalez D, van Ineveld R, Blijleven C, Groenen N Hemasphere. 2024; 8(9):e149.

PMID: 39233904 PMC: 11369206. DOI: 10.1002/hem3.149.

Late morbidity and mortality after autologous blood or marrow transplantation for lymphoma in children, adolescents and young adults-a BMTSS report.

Holmqvist A, Meng Q, Dai C, Hageman L, Landier W, Wu J Leukemia. 2024; 38(3):601-609.

PMID: 38374408 PMC: 10912019. DOI: 10.1038/s41375-024-02144-7.

Fluorodeoxyglucose-Positron Emission Tomography in Relapsed/Refractory Hodgkin Lymphoma: A Practical Approach.

Tomarchio V, Rigacci L Chemotherapy. 2023; 69(1):1-10.

PMID: 37708879 PMC: 10898808. DOI: 10.1159/000533766.

References

Specht L, Yahalom J, Illidge T, Berthelsen A, Constine L, Eich H . Modern radiation therapy for Hodgkin lymphoma: field and dose guidelines from the international lymphoma radiation oncology group (ILROG). Int J Radiat Oncol Biol Phys. 2013; 89(4):854-62. DOI: 10.1016/j.ijrobp.2013.05.005. View

Wray J, Flampouri S, Slayton W, Joyce M, Sandler E, Morris C . Proton Therapy for Pediatric Hodgkin Lymphoma. Pediatr Blood Cancer. 2016; 63(9):1522-6. DOI: 10.1002/pbc.26044. View

James N, Kingston J, Plowman P, Meller S, Pinkerton R, Barrett A . Outcome of children with resistant and relapsed Hodgkin's disease. Br J Cancer. 1992; 66(6):1155-8. PMC: 1978034. DOI: 10.1038/bjc.1992.426. View

Adams H, Kwee T . Prognostic value of pretransplant FDG-PET in refractory/relapsed Hodgkin lymphoma treated with autologous stem cell transplantation: systematic review and meta-analysis. Ann Hematol. 2016; 95(5):695-706. PMC: 4819743. DOI: 10.1007/s00277-016-2619-9. View

Moskowitz C, Matasar M, Zelenetz A, Nimer S, Gerecitano J, Hamlin P . Normalization of pre-ASCT, FDG-PET imaging with second-line, non-cross-resistant, chemotherapy programs improves event-free survival in patients with Hodgkin lymphoma. Blood. 2011; 119(7):1665-70. PMC: 3790950. DOI: 10.1182/blood-2011-10-388058. View

Aznar M, Girinsky T, Berthelsen A, Aleman B, Beijert M, Hutchings M . Interobserver delineation uncertainty in involved-node radiation therapy (INRT) for early-stage Hodgkin lymphoma: on behalf of the Radiotherapy Committee of the EORTC lymphoma group. Acta Oncol. 2017; 56(4):608-613. DOI: 10.1080/0284186X.2017.1279750. View

Wirth A, Corry J, Laidlaw C, Matthews J, Liew K . Salvage radiotherapy for Hodgkin's disease following chemotherapy failure. Int J Radiat Oncol Biol Phys. 1997; 39(3):599-607. DOI: 10.1016/s0360-3016(97)00352-0. View

Brice P, Bouabdallah R, Moreau P, Divine M, Andre M, Aoudjane M . Prognostic factors for survival after high-dose therapy and autologous stem cell transplantation for patients with relapsing Hodgkin's disease: analysis of 280 patients from the French registry. Société Française de Greffe de Moëlle. Bone Marrow Transplant. 1997; 20(1):21-6. DOI: 10.1038/sj.bmt.1700838. View

Chen R, Palmer J, Martin P, Tsai N, Kim Y, Chen B . Results of a Multicenter Phase II Trial of Brentuximab Vedotin as Second-Line Therapy before Autologous Transplantation in Relapsed/Refractory Hodgkin Lymphoma. Biol Blood Marrow Transplant. 2015; 21(12):2136-2140. PMC: 4639410. DOI: 10.1016/j.bbmt.2015.07.018. View

10.

Thomson K, Kayani I, Ardeshna K, Morris E, Hough R, Virchis A . A response-adjusted PET-based transplantation strategy in primary resistant and relapsed Hodgkin Lymphoma. Leukemia. 2012; 27(6):1419-22. DOI: 10.1038/leu.2012.318. View

11.

Metzger M, Hudson M, Krasin M, Wu J, Kaste S, Kun L . Initial response to salvage therapy determines prognosis in relapsed pediatric Hodgkin lymphoma patients. Cancer. 2010; 116(18):4376-84. PMC: 2936658. DOI: 10.1002/cncr.25225. View

12.

Linch D, Winfield D, Goldstone A, Moir D, Hancock B, McMillan A . Dose intensification with autologous bone-marrow transplantation in relapsed and resistant Hodgkin's disease: results of a BNLI randomised trial. Lancet. 1993; 341(8852):1051-4. DOI: 10.1016/0140-6736(93)92411-l. View

13.

Proctor S, Jackson G, Lennard A, Angus B, Wood K, Lucraft H . Strategic approach to the management of Hodgkin's disease incorporating salvage therapy with high-dose ifosfamide, etoposide and epirubicin: a Northern Region Lymphoma Group study (UK). Ann Oncol. 2003; 14 Suppl 1:i47-50. DOI: 10.1093/annonc/mdg710. View

14.

El-Galaly T, DAmore F, Mylam K, de Nully Brown P, Bogsted M, Bukh A . Routine bone marrow biopsy has little or no therapeutic consequence for positron emission tomography/computed tomography-staged treatment-naive patients with Hodgkin lymphoma. J Clin Oncol. 2012; 30(36):4508-14. DOI: 10.1200/JCO.2012.42.4036. View

15.

Josting A, Rudolph C, Reiser M, Mapara M, Sieber M, Kirchner H . Time-intensified dexamethasone/cisplatin/cytarabine: an effective salvage therapy with low toxicity in patients with relapsed and refractory Hodgkin's disease. Ann Oncol. 2002; 13(10):1628-35. DOI: 10.1093/annonc/mdf221. View

16.

Daw S, Wynn R, Wallace H . Management of relapsed and refractory classical Hodgkin lymphoma in children and adolescents. Br J Haematol. 2010; 152(3):249-60. DOI: 10.1111/j.1365-2141.2010.08455.x. View

17.

Poen J, Hoppe R, Horning S . High-dose therapy and autologous bone marrow transplantation for relapsed/refractory Hodgkin's disease: the impact of involved field radiotherapy on patterns of failure and survival. Int J Radiat Oncol Biol Phys. 1996; 36(1):3-12. DOI: 10.1016/s0360-3016(96)00277-5. View

18.

Ozuah N, Dahmoush H, Grant F, Lehmann L, LaCasce A, Billett A . Pretransplant functional imaging and outcome in pediatric patients with relapsed/refractory Hodgkin lymphoma undergoing autologous transplantation. Pediatr Blood Cancer. 2017; 65(1). DOI: 10.1002/pbc.26707. View

19.

Moskowitz A, Hamlin Jr P, Perales M, Gerecitano J, Horwitz S, Matasar M . Phase II study of bendamustine in relapsed and refractory Hodgkin lymphoma. J Clin Oncol. 2012; 31(4):456-60. PMC: 3862960. DOI: 10.1200/JCO.2012.45.3308. View

20.

Fleckenstein J, Boda-Heggemann J, Siebenlist K, Gudzheva T, Prakofyeva N, Lohr F . Non-coplanar VMAT combined with non-uniform dose prescription markedly reduces lung dose in breath-hold lung SBRT. Strahlenther Onkol. 2018; 194(9):815-823. DOI: 10.1007/s00066-018-1316-0. View