High incidence of treatment failure with vincristine, etoposide, epirubicin, and prednisolone chemotherapy with successful salvage in childhood Hodgkin disease

Background and Procedure. In an attempt to further reduce the long-term tox icity of chemotherapy for childhood Hodgkin disease (HD), the Australian an d New Zealand Children's Cancer Study Group between 1990 and 1996 enrolled 53 children with biopsy-proven and imaging-staged HD into a chemotherapy-on ly treatment regimen using 5-6 courses of vincristine, etoposide, epirubici n, and prednisolone (VEEP). Results. There were 23 events in these children with 3 progressive disease (PD), 8 partial remissions (PR), and 12 relapse s. In the stage I patients, there were 8 events (35%). There was no associa tion between the number of events and the stage of HD. Massive mediastinal disease at diagnosis was present in 16 patients, 11 of whom had an event wi th 3 PD, 3 PR, and 5 relapses. For all patients with an event at 6-24-month follow-up, all but two patients were salvaged with either alkylating agent -based chemotherapy alone or with irradiation and chemotherapy. The event-f ree survival for the whole group with median followup of 33 months was 59%, but only 31% for massive mediastinal disease. Disease-free survival was 78 % and overall survival at 60 months was 92%, with one death due to drug-ind uced aplasia and another from acute myeloid leukemia. Conclusions. We concl ude that VEEP chemotherapy in childhood HD used as the only treatment modal ity has an unacceptably high treatment failure rate in patients with massiv e mediastinal disease and 35% incidence of treatment failure in stage I dis ease. Med. Pediatr. Oncol. 32:255-258, 1999. (C) 1999 Wiley-Liss, Inc.