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RATHL Trial Summary

The document discusses treatment guidelines for Hodgkin's lymphoma based on disease stage and interim PET-CT scan results. For advanced stage disease, patients receive ABVD or escalated BEACOPP depending on interim PET-CT results. For early stage favorable risk disease, combined modality therapy with 2-4 cycles of ABVD and involved-site radiation is most effective but comes with long term risks from radiation. Chemotherapy alone of 4-6 cycles of ABVD may be sufficient for early stage patients who achieve complete response after 2 cycles.

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42 views5 pages

RATHL Trial Summary

The document discusses treatment guidelines for Hodgkin's lymphoma based on disease stage and interim PET-CT scan results. For advanced stage disease, patients receive ABVD or escalated BEACOPP depending on interim PET-CT results. For early stage favorable risk disease, combined modality therapy with 2-4 cycles of ABVD and involved-site radiation is most effective but comes with long term risks from radiation. Chemotherapy alone of 4-6 cycles of ABVD may be sufficient for early stage patients who achieve complete response after 2 cycles.

Uploaded by

Dr.Imaan
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin’s

Lymphoma

 Only CHL

 Advanced stage was defined as an Ann Arbor stage of IIB to IV, or stage IIA

with adverse features: bulky disease (>33% of the transthoracic diameter or

>10 cm elsewhere) or at least three involved sites

 A score of 1, 2, or 3 was regarded as indicating negative findings, and a

score of 4 or 5 was regarded as indicating positive findings

 Patients with negative PET findings after two cycles were randomly

assigned to continue ABVD (ABVD group) or omit bleomycin (AVD group)

for further 4 cycles (In all total 6 cycles). Patients with negative findings on

the interim PET-CT scan did not undergo repeat PET-CT evaluation at the

completion of therapy

 Patients with a positive PET (PET score of 4 or 5) received either BEACOPP-

14 or escalated BEACOPP

o Those receiving BEACOPP-14 had a third PET-CT scan after four

cycles, and those receiving escalated BEACOPP were reassessed after

three cycles.
o Patients with negative findings on the third PET-CT scan completed

either two further cycles of BEACOPP-14 or one more cycle of

escalated BEACOPP

o Patients who had positive findings on the third PET-CT scan

underwent further salvage treatment in accordance with local

protocols

 Conclusion: The omission of bleomycin from the ABVD regimen after

negative findings on interim PET resulted in a lower incidence of pulmonary

toxic effects than with continued ABVD but not significantly lower efficacy.
Treatment of Early stage favourable Risk Group

 Combined modality therapy: Combination chemotherapy plus involved-

site radiation therapy (ISRT) yields the highest rates of initial disease

control, but no difference in overall survival

( Hay AE, Klimm B, Chen BE, et al. An individual patient-data comparison of combined

modality therapy and ABVD alone for patients with limited-stage Hodgkin

lymphoma. Ann Oncol. 2013;24(12):3065-3069. doi:10.1093/annonc/mdt389)

  ISRT which requires two to four weeks, usually begins three to four weeks

after the completion of chemotherapy

 German Hodgkin Study Group (GHSG) HD10 Trial:

o The results of this trial suggest that two cycles of ABVD followed by 20

Gy ISRT, may be sufficient treatment for patients with favorable

presentations of stage I to II HL, as defined by the GHSG.

o Three to four cycles of ABVD followed by 30 Gy ISRT can be used for

patients with favorable risk early stage disease that would not fit the

enrollment criteria for the GHSG study (eg, those with three sites of

disease)
 Disease control with combined therapy is superior compared with

chemotherapy alone, but this must be weighed against the risks of

radiotherapy including cardiac disease and secondary malignancies,

particularly in young women who are at high risk for the development of

breast cancer after chest irradiation.

Chemotherapy alone:

 For patients receiving chemotherapy without RT, we administer six cycles

of ABVD. If a complete response is achieved on PET CT after two cycles, a

total of four cycles is sufficient

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