Karin Dieckmann, Presenter: Nothing to Disclose

Hajo Weitmann, Abstract Co-Author: Nothing to Disclose

Michaela Moestl, Abstract Co-Author: Nothing to Disclose

Gabriele Kandler, Abstract Co-Author: Nothing to Disclose

Richard Poetter MD, Abstract Co-Author: Nothing to Disclose

Purpose/Objective: In order to improve treatment in Hodgkin`s disease in young adults up to fourty, a pediatric Hodgkin`s disease protocol with OPPA/COPP (vincristine, procarbazine, prednisone, adriamycin, cyclophosphamide) in combination with a modified involved radiotherapy treatment has been evaluated according to local control, side effects and secondary malignancies. Materials/Methods: From 1/95 to 12/98, 37 pts (13 female, 24 male; median age 30 years (range: 16 to 39 years) with newly diagnosed Hodgkin's disease were enrolled in the Vienna Hodgkin`s Disease 1995. Based on the Ann Arbor classification, all patients were allocated to three treatment groups (TG). TG1 consisted of stages I and IIA without bulky disease (early disease); TG2 included stages IIA with bulky disease, IIB, IIIA, IE, and IIEA (intermediate disease); and TG3 included stages IIIB, IV, and IIEB, IIIE (advanced disease). All patients received induction chemotherapy with 2 cycles OPPA. Patients in TG2 and TG3 received another 2 or 4 cycles, respectively, of COPP. Stem cell mobilization and harvest was performed with G-CSF and cyclophosphamide in patients with stage IIB with bulky disease, in patients with stage III and IV after two cycles of COPP. All patients received an involved field RT to the initially involved lymph nodes 2-4 weeks after CT. RT doses were 35 Gy/ TG1, 30 Gy/TG2, 25 Gy/TG3. In case of minor response (50 cm3) after CT, a boost dose of 6 to 10 Gy was prescribed locally. Side effects as neurotoxcicity, hematotoxcicty, and infections were analyzed according the WHO criteria. Results: After CT observed neurotoxicity was: 26/37 grade 0/1; 6/37 grade 2; 5/37grade 3. In none of the patients neurologic symptoms were permanent. Hematotoxicity: 20/37 grade 1 or 2; 7/37 grade 3 or 4. No increase of hematotoxicity was observed after stem cell mobilization or radiotherapy. Infections 5/37 (grade I=3; grade II=1; grade III=1). After a median observation time of 88 months, EFS is 79.42%, OS is 94.09% Two patients of TG2 died 32 and 41 months after diagnosis due to tumor progression. After CT, 15/37 patients were in CR or good partial remission (4/11(36%) TG1; 4/15(26%) TG2; 7/11(63%) TG3). After RT, all patients of TG1 and TG2 were in CR or good partial remission, 9/11 (81%) patients of TG3 were in CR . 4/11 patients of TG3 relapsed, two patients11 months, one patient 20 months, one patient 28 months after CT/RT. All these patients got high dose chemotherapy and stem cell transplantation according to the protocol. Since then they are in CR. No secondary tumors are observed up to now. Conclusions: In conclusion OPPA/COPP treatment in combination with involved field radiotherapy is as highly effective and save standard treatment in Hodgkin`s disease. It is well accepted by young adults. Local control is excellent. Secondary tumors as leukemia or MDS could not be observed.

Dieckmann, K, Weitmann, H, Moestl, M, Kandler, G, Poetter, R, OPPA/COPP in Combination with Involved Field Radiotherapy, a Pediatric Hodgkin's Disease Treatment Concept, Applied to Young Adults Up to Forty Years.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4418032.html