Casey DL, Renfro LA, Wu Y, McCarten K, Pei Q, Milgrom SA, Belsky JA, Cho S, Keller FG, Punnett A, Hodgson DC, Hoppe BS, Kelly KM, Castellino SM. Patterns of presentation and outcomes in stage IV Hodgkin lymphoma: A report from the Children’s Oncology Group (COG) AHOD1331 trial. Br J Haematol. 2026 Jul 8:10.1111/bjh.70625. doi: 10.1111/bjh.70625. Epub ahead of print. PMID: 42419755; PMCID: PMC13386275.
Publication Citation
Abstract
Outcomes for high-risk pediatric classic Hodgkin lymphoma (cHL) improved with the addition of brentuximab vedotin (Bv) to AVEPC chemotherapy. We evaluated the prognostic implications of distant extranodal sites contributing to stage IV disease. On AHOD1331 (NCT02166463), patients aged 2–21 years with high-risk cHL (stage IIB with bulk/IIIB/IVA/IVB) were randomized to 5 cycles of ABVE-PC versus Bv-AVE-PC. Patients with stage IV disease, determined by protocol-defined and centrally reviewed PET-CT, were identified. Baseline characteristics and progression-free survival (PFS) were compared by pattern of stage IV involvement (lung, bone, bone marrow, multiple sites, other). 340 patients (median age 15 years) with stage IV disease were included. 173 (51%) received ABVE-PC and 167 (49%) Bv-AVE-PC. PFS was highest with lung-only involvement (4-year PFS 88.6%) and lowest with bone marrow-only involvement (4-year PFS 71.9%). Compared to ABVE-PC, Bv-AVE-PC improved PFS among all stage IV patients (HR 0.53, 90% CI 0.33–0.85) and in lung-only and bone-only subgroups. However, no PFS benefit was observed in those with bone marrow-only involvement. Among pediatric patients with stage IV cHL, Bv-AVE-PC improved PFS across most patterns of stage IV disease, except in those with bone marrow involvement. These results will guide efforts to improve outcomes among children with stage IV cHL.