Chemotherapy With Low-Dose Radiation for Pediatric Hodgkin Lymphoma

Treatment Plan Description:

Adriamycin 25 mg/m2 IV Day 1 of weeks 1, 3, 5, 7, 9, 11

Vinblastine 6 mg/m2 IV Day 1 of weeks 1, 3, 5, 7, 9, 11

Nitrogen Mustard 6mg/m2 IV on Day 1 of weeks 1, 5, and 9

Cyclophosphamide 650 mg/m2 IV Day 1 of weeks 1, 5, 9(when Nitrogen Mustard was not available
due to national shortage)

Vincristine 1.4 mg/m2 IV Day 1 of weeks 2, 4, 6, 8, 10, 12

Bleomycin 5 units/m2 IV Day 1 of weeks 2, 4, 6, 8, 10, 12

Etoposide 60 mg/m2 IV Days 1,2 of weeks 3, 7, 11

Prednisone* 40 mg/m2/day divided in 3 doses PO Every other day of weeks 1-12

G-CSF (only as needed in case of severe myelo-suppression requiring treatment delay) 5 mcg/kg
SC Days 3-13, 16-26, 29-39, 42-52, 55-65, 68-78 (as clinically indicated)

* Prednisone taper is foreseen for the last 2 weeks of therapy. Patients will be treated with
12 weeks of Stanford V chemotherapy in the schedule outlined above. Patients will then
receive radiation therapy after completion of 12 weeks of chemotherapy. The radiation dose to
individual nodal sites will be based on response after 8 weeks of chemotherapy: 15 Gy for
areas achieving a complete response and 25.5 Gy achieving less than a complete response, or
patients with bulky mediastinal mass.

Inclusion Criteria:

- Patient is less than or equal to 21 years of age

- Patient has a confirmed diagnosis of previously untreated Hodgkin lymphoma

- Has Ann Arbor stage IB, IIIA, or IA/IIA with extranodal extension, multiple nodal
involvement (3 or more sites), or bulky mediastinal adenopathy.

Exclusion Criteria:

- Patients with favorable risk features

- Patients with unfavorable risk features

- Patients who have received prior therapy for Hodgkin lymphoma.