Combination Chemotherapy in Treating Patients With Newly Diagnosed Stage I or Stage II Hodgkin’s Lymphoma

Documentation of Disease:

1.1 Histologically documented Hodgkin lymphoma subclassified according to the WHO modification of the Rye Classification and staged according to the modified Ann Arbor Staging Classification system. Patients must have clinical stage IA, IB, IIA or IIB. Patients with "E" extensions will be eligible if all other criteria have been met. Nodular lymphocyte predominant Hodgkin lymphoma is excluded.

Core biopsies are acceptable if they contain adequate tissue for primary diagnosis and immunophenotyping. Fine needle aspirate (FNA) cytologies and bone marrow biopsies as the sole means of diagnosis are not acceptable.
Note: Failure to submit pathology slides within 60 days of patient registration will result in patient being declared ineligible.

1.2 Patients may not have a mediastinal mass > 0.33 maximum intrathoracic diameter on standing postero-anterior chest x-ray or peripheral or retroperitoneal adenopathy > 10 cm in its largest diameter.

1.3 Bone marrow biopsy is required for pretreatment evaluation. Bilateral biopsies are preferred but not required.

No prior treatment (chemotherapy or radiation therapy) for Hodgkin lymphoma.

Measurable disease must be present either on physical examination or imaging studies. Any tumor mass measurable in two dimensions and > 2 cm is acceptable (or 1.5 cm if 0.5 cm slices are used as in spiral CT scans). Lesions that are considered intrinsically non-measurable include the following:

bone lesions
leptomeningeal disease
ascites
pleural/pericardial effusion
inflammatory breast disease
lymphangitis cutis/pulmonis
abdominal masses that are not confirmed and followed by imaging techniques
cystic lesions
lesions that are situated in a previously irradiated area
Age ≥ 16 years
Performance status 0-2
LVEF by ECHO or MUGA within institutional normal limits
DLCO ≥ 60% with no symptomatic pulmonary disease
No known HIV infection. Patients with a history of intravenous drug abuse or any behavior associated with an increased risk of HIV infection should be tested for exposure to the HIV virus. Patients who test positive or who are known to be infected are not eligible due to an increased risk of infection with this chemotherapy regimen. An HIV test is not required for entry on this protocol, but is required if the patient is perceived to be at risk.
Non-pregnant and non-lactating. Due to the teratogenic potential of the agents used in this study, pregnant or nursing women may not be enrolled. Women and men of reproductive potential should agree to use an effective means of birth control.

Initial Required Laboratory Data:

ANC ≥ 1000/μL
Platelet count ≥ 100,000/μL
Serum Creatinine ≤ 2 mg/dL
Bilirubin ≤ 2 mg/dL
AST ≤ 2 x upper limit of normal