Chemotherapy Based on Positron Emission Tomography Scan in Treating Patients With Stage I or Stage II Hodgkin Lymphoma

• Progression-free survival (PFS) at 36 months [ Designated as safety issue: No ]
  
• PFS after 2 courses of ABVD [ Designated as safety issue: No ]
  

• Complete response rate [ Designated as safety issue: No ]
  
• FDG/PET uptake [ Designated as safety issue: No ]
  
• Volumetric changes on CT scan after courses 2 and 4 of ABVD [ Designated as safety issue: No ]
  
• Changes in metabolic parameters [ Designated as safety issue: No ]
  

OBJECTIVES:

Primary

• To determine the progression-free survival (PFS) of patients with non-bulky stage I or II Hodgkin lymphoma treated with ABVD alone or followed by escalated BEACOPP and involved-field radiation therapy.
• To compare the PFS of patients who are PET positive versus PET negative after 2 courses of ABVD.

Secondary

• To evaluate the complete response rate in patients treated with these regimens.
• To determine the predictive value of semiquantitative evaluation of FDG/PET uptake using various approaches at baseline, after 2 courses of AVBD, and at completion of therapy.
• To determine the predictive value of volumetric changes on CT scan after courses 2 and 4 of ABVD and compare with PET parameters with and without combination analyses (PET+dedicated CT data).
• To compare the predictive value of metabolic parameters/changes both visual and quantitative, IHP criteria, volumetric CT changes, molecular parameters, and conventional parameters, including initial prognostic score.
• To assess whether elevated baseline serum soluble CD30 (sCD30), IL10, CCL17, and CCL22 correlate with clinical response and PFS.
• To assess whether persistent or recurrent elevated serial serum sCD30, IL10, CCL17, or CCL22 correlate with relapse/progression or PET scan results.
• To confirm independently useful tissue biomarkers for risk stratification in patients with non-bulky stage I and II Hodgkin lymphoma treated with these regimens.
• To compare mediastinal bulk on standing PA and lateral chest x-ray (> 0.33 maximum chest diameter) with chest CT (mass > 10 cm).

OUTLINE: This is a multicenter study.

• ABVD chemotherapy: Patients receive doxorubicin hydrochloride IV over 3-5 minutes, bleomycin sulfate IV over 3-5 minutes, vinblastine IV over 3-5 minutes, and dacarbazine IV over 30 minutes on days 1 and 15. Treatment repeats every 28 days for 2 courses. Patients then undergo PET scan. Patients achieving complete response (CR), partial response (PR), or stable disease (SD) with a negative PET scan receive 2 additional courses of ABVD chemotherapy in the absence of disease progression or unacceptable toxicity. Patients achieving CR, PR, or SD with a positive PET scan proceed to escalated BEACOPP chemotherapy.
• Escalated BEACOPP* chemotherapy: Patients receive doxorubicin hydrochloride IV over 3-5 minutes and cyclophosphamide IV over 60 minutes on day 1, etoposide IV over 45-60 minutes on days 1-3, oral procarbazine on days 1-7, oral prednisone on days 1-14, and bleomycin sulfate IV and vincristine IV on day 8. Treatment repeats every 21 days for 2 courses in the absence of disease progression or unacceptable toxicity. Within 4-6 weeks after completion of BEACOPP chemotherapy, patients undergo involved-field radiotherapy (IFRT) 5 days a week for 3½ weeks.

NOTE: * HIV-positive patients receive standard BEACOPP instead of escalated BEACOPP.

Patients undergo fludeoxyglucose F^18 PET/CT scan at baseline, and within 8-10 days after completion of chemotherapy. Patients also undergo additional PET/CT scans within 3-4 weeks after completion of ABVD or within 12 weeks after completion of BEACOPP and IFRT. Patients with a negative PET scan proceed to follow up. Patients with a positive PET scan undergo biopsy**. Patients with a negative biopsy proceed to follow up, and patients with a positive biopsy are treated at the discretion of the investigator.

NOTE: ** Patients for whom biopsy is neither clinically appropriate nor medically feasible proceed to follow-up. Patients for whom biopsy is neither clinically indicated nor medically appropriate undergo a repeat PET/CT scan after 3 months. If PET/CT scan remains positive, patients undergo biopsy as above.

Patients may undergo blood sample collection for biomarker studies.

After completion of study therapy, patients are followed up every 3 months for 1 year, every 6 months for 2-3 years, and then annually for a maximum of 5 years.