Deca

IV Days 1 and 2 IV Days 1 and 2 IV Days 1 and 2 IV Day 1

5 |rg/kg/day subcutaneously to start day 3 and to continue until ANC >1500/mm3 post nadir.

Abbreviations: RER, rapid early response: at least 60% reduction in the sum of the products of the perpendicular diameters (SPPD) of measurable disease with negative FDG-PET/gallium scan, after 2 cycles of ABVE-PC. CR, complete response: at least 80% regression in their SPPD after 4 cycles of ABVE-PC. PR, <80% regression in their SPPD after 4 cycles of ABVE-PC. SER, slow early response: <60% reduction in SPPD after 2 cycles of ABVE-PC.

aThe benefit of IFRT in RER in CR has not yet been determined. bOptimum regime for SER has not yet been determined.

intensity with response-based augmentation and reduction in therapy to improve the outcome for all intermediate-risk pediatric patients with HD and decrease the risk of delayed effects of treatment.

The standard arm for this protocol is two cycles of ABVE-PC, followed by an evaluation with CT and FDG-PET/gallium scans to determine if the patient is a rapid early responder (RER) or slow early responder (SER). Rapid early responders then continue to complete two further cycles of chemotherapy (for a total of four cycles) and receive IFRT (ongoing study randomizes IFRT or no RT). SERs are randomized to the standard arm, or the augmented therapy arm (Table 15-15).

Treatment for High-Risk Patients

Treatment for high-risk patients is the same as that for intermediate-risk patients, but all patients receive IFRT (21 Gy).

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