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Halving the chemotherapy and cutting the radiation dose by a third worked just as well for early Hodgkin lymphoma with favourable features, and caused fewer side effects.
HD10 is the trial that set the modern floor for early favourable Hodgkin lymphoma. 1,370 patients with newly diagnosed early-stage disease and a favourable prognosis were randomly assigned to one of four groups: four cycles of ABVD with 30 Gy of involved-field radiotherapy, four cycles with 20 Gy, two cycles with 30 Gy, or two cycles with 20 Gy. The primary endpoint was freedom from treatment failure.
Neither comparison showed a difference. Five-year freedom from treatment failure was 93.0 per cent (95 per cent confidence interval 90.5 to 94.8) with four cycles and 91.1 per cent (88.3 to 93.2) with two (p = 0.39); overall survival did not differ (p = 0.61). The two radiation doses were also indistinguishable (p = 1.00 for freedom from treatment failure, p = 0.61 for overall survival). Adverse events and acute toxic effects were most common in the group given four cycles and 30 Gy.
Two cycles of ABVD with 20 Gy became the standard for this group, and the question then moved on: HD16 tested whether the radiotherapy could be dropped altogether when the interim positron emission tomography scan was negative, and found that it could not without losing tumour control.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
1,370 enrolled.
95 per cent confidence interval 90.5 to 94.8 · 88.3 to 93.2
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Freedom from treatment failure at 5 yearsprimary | Four cycles of ABVD | - | 93% | - | 0.39 | link |
| Two cycles of ABVD | - | 91.1% |
The reason cardiac surveillance belongs in Hodgkin lymphoma survivorship care, the reason smoking cessation is a specific intervention for this group rather than general advice, and part of the reason modern protocols try to limit both mediastinal radiation and cumulative anthracycline dose.
The reason every current Hodgkin lymphoma trial is a de-escalation trial, and the reason survivors need lifelong surveillance rather than discharge at five years. It is also a warning about assuming that a gentler protocol is a safer one until a cohort has been followed long enough to say.
Patients with early favourable Hodgkin lymphoma are cured with two cycles of ABVD and 20 Gy of involved-site radiotherapy; later trials tested whether PET can spare radiotherapy altogether.
Shares GHSG HD10: reduced treatment intensity in early-stage favourable Hodgkin lymphoma, Andreas Engert, Peter Borchmann, German Hodgkin Study Group and the tag lymphoma-evidence.
Shares Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk, Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, GHSG HD16, EORTC/LYSA/FIL H10 and the tag lymphoma-evidence.
Shares Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, GHSG HD16, EORTC/LYSA/FIL H10, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens) and the tag lymphoma-evidence.
Shares GHSG HD16, EORTC/LYSA/FIL H10, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Dacarbazine and the tag lymphoma-evidence.
Shares Andreas Engert, Peter Borchmann, German Hodgkin Study Group, GHSG HD21 and the tag lymphoma-evidence.
Shares Andreas Engert, Peter Borchmann, German Hodgkin Study Group, GHSG HD21 and the tag lymphoma-evidence.
Shares Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk, Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma, Early-stage classical Hodgkin lymphoma (stage I to II), Radiotherapy and the tag lymphoma-evidence.
Shares GHSG HD21, ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens), Dacarbazine, Bleomycin and the tag lymphoma-evidence.