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Abstract
Hodgkin's lymphoma is a highly treatable malignancy. It has high cure rates yet there are many patients who relapse or are refractory to treatment. Traditionally, treatment has been with conventional chemotherapy; however, the development of brentuximab vedotin and immune checkpoint inhibitors has revolutionized the care of Hodgkin's lymphoma. This is a review of the current advances in the management of Hodgkin's lymphoma and a review of ongoing clinical trials in the field.
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Affiliation(s)
- Joseph Vadakara
- Department of Hematology and Oncology, Geisinger Medical Center, Danville, PA 17822, USA
| | - Benjamin Andrick
- Department of Hematology and Oncology, Geisinger Medical Center, Danville, PA 17822, USA
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102
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Dahi PB, Moskowitz CH, Giralt SA, Lazarus HM. Novel agents positively impact chemotherapy and transplantation in Hodgkin lymphoma. Expert Rev Hematol 2019; 12:255-264. [PMID: 30874456 DOI: 10.1080/17474086.2019.1593135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Majority of patients with Hodgkin lymphoma (HL) can be successfully cured with frontline conventional therapeutics. Approximately 50-60% of those whose disease recur or is refractory to conventional treatment, can be cured with salvage therapies followed by autologous hematopoietic cell transplantation (AHCT). Conventional treatments, however, may cause significant long-term toxicities. Areas covered: This article reviews the treatment advances in HL with the incorporation of novel and targeted agents that are aimed to improve cure rates while reducing toxicities. Expert opinion: Brentuximab vedotin (BV) and checkpoint inhibitors have demonstrated clear clinical benefit in HL. Majority of patients receive BV before or directly after AHCT as part of salvage or maintenance regimens. In patients who relapse after AHCT, checkpoint inhibitors are the treatment of choice, either as a stand-alone therapy or more commonly as a bridge to a potentially curative allogeneic hematopoietic cell transplantation (alloHCT). A multitude of other targeted agents and combinations, as well as cellular and immunotherapeutic in HL, are under investigation.
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Affiliation(s)
- Parastoo B Dahi
- a Adult Bone Marrow Transplant Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , NY , USA.,b Department of Medicine , Weill Cornell Medical College , New York , NY , USA
| | - Craig H Moskowitz
- c Sylvester Comprehensive Cancer Center , University of Miami , Coral Gables , FL , USA
| | - Sergio A Giralt
- a Adult Bone Marrow Transplant Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , NY , USA.,b Department of Medicine , Weill Cornell Medical College , New York , NY , USA
| | - Hillard M Lazarus
- d Case Comprehensive Cancer Center , Case Western Reserve University , Cleveland , OH , USA
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103
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Casasnovas RO, Bouabdallah R, Brice P, Lazarovici J, Ghesquieres H, Stamatoullas A, Dupuis J, Gac AC, Gastinne T, Joly B, Bouabdallah K, Nicolas-Virelizier E, Feugier P, Morschhauser F, Delarue R, Farhat H, Quittet P, Berriolo-Riedinger A, Tempescul A, Edeline V, Maisonneuve H, Fornecker LM, Lamy T, Delmer A, Dartigues P, Martin L, André M, Mounier N, Traverse-Glehen A, Meignan M. PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study. Lancet Oncol 2019; 20:202-215. [DOI: 10.1016/s1470-2045(18)30784-8] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 11/16/2022]
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104
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Fitzgerald TJ. Optimisation of adaptive therapy for advanced Hodgkin lymphoma. Lancet Oncol 2019; 20:167-168. [PMID: 30658934 DOI: 10.1016/s1470-2045(19)30005-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Thomas J Fitzgerald
- Imaging and Radiation Oncology Core, Lincoln, RI, USA; Department of Radiation Oncology, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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105
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Bair SM, Strelec LE, Feldman TA, Ahmed G, Armand P, Shah NN, Singavi AN, Reddy N, Khan N, Andreadis C, Vu K, Huntington SF, Giri S, Ujjani C, Howlett C, Faheem M, Youngman MR, Nasta SD, Landsburg DJ, Schuster SJ, Svoboda J. Outcomes and Toxicities of Programmed Death-1 (PD-1) Inhibitors in Hodgkin Lymphoma Patients in the United States: A Real-World, Multicenter Retrospective Analysis. Oncologist 2018; 24:955-962. [PMID: 30568021 DOI: 10.1634/theoncologist.2018-0538] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/07/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Although classical Hodgkin lymphoma (cHL) is highly curable, 20%-30% of patients will not be cured with conventional treatments. The programmed death-1 (PD-1) inhibitors (PD-1i) nivolumab and pembrolizumab have been Food and Drug Administration-approved for relapsed/refractory (R/R) cHL. There is limited data on the real-world experience with PD-1i in cHL and it is unknown whether fewer selected patients treated with PD-1i derive benefits similar to those observed in published trials. MATERIALS AND METHODS We performed a multicenter, retrospective analysis of R/R cHL patients treated with PD-1i in the nontrial setting. The primary objective was to describe progression-free survival (PFS) and overall survival (OS) in this population. Secondary objectives were to characterize response rates, toxicities, discontinuation patterns, and post-PD-1i therapies. RESULTS The study included 53 patients from nine U.S. centers. Overall response rate (ORR), complete response (CR), and partial response (PR) to PD-1i were 68%, 45%, and 23%, respectively. Twelve-month OS and PFS were 89% and 75%, respectively; median PFS was 29 months. Ninety-six percent of patients with CR continue to respond at a median follow-up of 20 months. Toxicities were similar to those previously described. Seventy percent of patients treated with systemic therapy after PD-1i demonstrated objective responses. CONCLUSION To our knowledge, this analysis is the first describing real-world experience with PD-1i in cHL patients in the U.S. Here, we demonstrate similar response rates compared to prior studies. The toxicity profile of PD-1i was similar to that seen in previous studies; we further describe toxicity patterns in those with prior autoimmune disease or allogeneic transplant. Post-PD-1i systemic therapies appear active. These results support the effectiveness and tolerability of PD-1i therapy in R/R cHL in a real-world setting. IMPLICATIONS FOR PRACTICE Two PD-1 inhibitors have recently been approved for patients with relapsed/refractory classical Hodgkin lymphoma based on results from nonrandomized clinical trials. However, to date, there have been no studies evaluating the effectiveness and toxicity profile of these drugs in the real-world setting in the U.S. The present study demonstrates that patients treated in a real-world context experience similar rates of overall effectiveness compared with published clinical trials. Patients who discontinue PD-1 inhibitors may experience clinical responses to subsequent treatment with systemic chemotherapy or targeted therapy. This study provides clinicians with further insight into the effectiveness and tolerability of PD-1 inhibitors and suggests that when patients progress while on these drugs, conventional systemic chemotherapy may be an effective treatment option.
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Affiliation(s)
- Steven M Bair
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lauren E Strelec
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Gulrayz Ahmed
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Nirav N Shah
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Nadia Khan
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | | | - Khoan Vu
- University of California, San Francisco, San Francisco, California, USA
| | | | - Smith Giri
- Yale University, New Haven, Connecticut, USA
| | | | - Christina Howlett
- Hackensack Medical Center, Hackensack, New Jersey, USA
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Malik Faheem
- Hackensack Medical Center, Hackensack, New Jersey, USA
| | - Matthew R Youngman
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sunita D Nasta
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel J Landsburg
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen J Schuster
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jakub Svoboda
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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106
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Zhang T, Yao Y, Feng F, Zhao W, Tian J, Zhou C, Wang X, Dong S, Li J, Qi L, Sun C. Comparative effectiveness of different chemotherapy regimens of advanced-stage Hodgkin lymphoma in adults: a network meta-analysis. Cancer Manag Res 2018; 10:6017-6028. [PMID: 30538551 PMCID: PMC6257076 DOI: 10.2147/cmar.s179356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Combined chemotherapy is the cornerstone treatment for patients with advanced Hodgkin lymphoma (HL). The objective of our study was to perform a network meta-analysis of the efficacy of different chemotherapy regimens in adults with advanced-stage HL. Materials and methods We searched for relevant randomized controlled trials (RCTs) in titles/abstracts in PubMed, Embase, and the Cochrane Library. The search was last updated on April 3, 2018. RCTs that assessed the effectiveness of one of the following treatments were included: doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD); four cycles of increased dose of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPescalated) followed by two or four cycles of standard dose of BEACOPP (4× BEACOPPescalated + 2 or 4× BEACOPPbaseline); brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine (A+AVD); doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone combined with radiation therapy (Stanford V); mechlorethamine (cyclophosphamide), vincristine, procarbazine, and prednisone (M[C] OPP); sequential or alternating chemotherapy regimens with ABVD as the footstone (eg, COPP/ABVD or mechlorethamine, vincristine, procarbazine, and prednisone [MOPP]/ABVD); eight cycles of BEACOPPescalated; hybrid MOPP/ABV; and M[C]EC (M[C]OPP with epidoxorubicin, bleomycin, vinblastine [EBV], and lomustine, doxorubicin, and vindesine [CAD]). Results Overall, we screened 3,564 citations and deemed 18 reports of 16 trials eligible and included them in our network meta-analysis. A total of 11,928 participants were randomly assigned to one of the 12 combinations of chemotherapy regimens, of which 11,476 participants were analyzed. For the overall survival (OS), no differences were observed within any interventions when the ABVD regimen was used as the reference treatment. Similarly, relative to A+AVD, 8× BEACOPPescalated and 6× BEACOPPescalated also showed no differences (HR =1.07, 95% credible interval (CrI): 0.58–1.95; HR =0.62, 95% CrI: 0.16–1.83; and HR =0.71, 95% CrI: 0.30–1.72, respectively). In terms of complete remission (CR), enough evidence exists to support a maximum clinical treatment effect for 6× BEACOPPescalated (OR =1.88, 95% CrI: 1.20–2.96; and OR =3.43, 95% CrI: 1.87–6.24). Conclusion When compared across the 12 combined chemotherapy regimens, six cycles of BEACOPPescalated may be the optimal treatment for patients with advanced-stage HL.
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Affiliation(s)
- Tingting Zhang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, People's Republic of China
| | - Yan Yao
- Clinical Medical College, Weifang Medical University, Weifang, Shandong Province, People's Republic of China
| | - Fubin Feng
- Department of Oncology, Weifang Traditional Chinese Hospital, Weifang, Shandong Province, People's Republic of China,
| | - Wenge Zhao
- Clinical Medical College, Weifang Medical University, Weifang, Shandong Province, People's Republic of China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu Province, People's Republic of China
| | - Chao Zhou
- Department of Oncology, Weifang Traditional Chinese Hospital, Weifang, Shandong Province, People's Republic of China,
| | - Xue Wang
- Clinical Medical Colleges, Qingdao University, Shinan District, Qingdao, Shandong Province, People's Republic of China
| | - Shengjie Dong
- Department of the Joint and Bone Surgery, Yantaishan Hospital, Yantai, Shandong Province, People's Republic of China
| | - Jia Li
- Clinical Medical College, Weifang Medical University, Weifang, Shandong Province, People's Republic of China
| | - Lingyu Qi
- College of First Clinical Medicine, Shandong University of Traditional Chinese Medicine, Ji'nan, People's Republic of China
| | - Changgang Sun
- Department of Oncology, Weifang Traditional Chinese Hospital, Weifang, Shandong Province, People's Republic of China, .,Department of Oncology, Affiliated Hospital of Weifang Medical University, Kuiwen District, Weifang, Shandong Province, People's Republic of China,
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Kreissl S, Goergen H, Müller H, Meissner J, Mehnert A, Bürkle C, Fuchs M, Engert A, Behringer K, Borchmann P. Survivors’ perspectives on risks and benefits of Hodgkin lymphoma treatment: results of a survey by the German Hodgkin Study Group. Leuk Lymphoma 2018; 60:1389-1398. [DOI: 10.1080/10428194.2018.1540781] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Stefanie Kreissl
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Helen Goergen
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Horst Müller
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | | | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Carolin Bürkle
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Michael Fuchs
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Andreas Engert
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Karolin Behringer
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - Peter Borchmann
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
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Spinner MA, Advani RH. Risk-adapted therapy for advanced-stage Hodgkin lymphoma. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2018; 2018:200-206. [PMID: 30504311 PMCID: PMC6245987 DOI: 10.1182/asheducation-2018.1.200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
More than 80% of patients with advanced-stage Hodgkin lymphoma are now cured with contemporary treatment approaches. The ongoing challenge is how to further improve outcomes by identifying both high-risk patients who may benefit from more intensive frontline therapy to reduce the risk of relapse as well as lower-risk patients who may do just as well with less intensive therapy. Numerous trials have used an interim positron emission tomography (PET) response-adapted approach to evaluate early escalation or deescalation of therapy for patients with a positive or negative interim PET scan, respectively. Recent trials have incorporated novel agents, including brentuximab vedotin (BV) and the immune checkpoint inhibitors, in the frontline setting. Based on results of the ECHELON-1 trial, the Food and Drug Administration approved BV in combination with adriamycin, vinblastine, and dacarbazine chemotherapy for stage III to IV Hodgkin lymphoma. Improved methods to assess higher risk at diagnosis using quantitative PET metrics, such as metabolic tumor volume and total lesion glycolysis, and incorporation of emerging biomarkers may further refine patient selection for more intensive upfront therapy. The ultimate goal is to achieve the highest level of efficacy for an individual patient while minimizing the short- and long-term toxicities.
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Affiliation(s)
- Michael A Spinner
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA
| | - Ranjana H Advani
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA
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109
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Longley J, Johnson PWM. Current treatment paradigms for advanced stage Hodgkin lymphoma. Br J Haematol 2018; 184:60-71. [DOI: 10.1111/bjh.15622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Jemma Longley
- Cancer Research UK Centre; University of Southampton; Southampton UK
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110
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Grewal RK, Chetty M, Abayomi EA, Tomuleasa C, Fromm JR. Use of flow cytometry in the phenotypic diagnosis of hodgkin's lymphoma. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 96:116-127. [PMID: 30350336 DOI: 10.1002/cyto.b.21724] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/18/2018] [Accepted: 06/26/2018] [Indexed: 12/22/2022]
Abstract
Hodgkin's lymphoma (HL) has a unique immunophenotype derived from immunohistochemistry (positive for CD15, CD30, and Pax-5; negative for CD3, CD20 in most cases, and CD45). The knowledge gained over recent years enables better diagnosis, prognosis, and treatment of HL. Flow cytometry as a tool for the diagnosis of classic HL has not been useful in the past due to the difficulty in isolating Reed-Sternberg cells as they are admixed in a rich inflammatory background which consists mainly of T cells, B cells, eosinophils, histiocytes, and plasma cells. However, in the recent past, several studies have tried to identify Reed-Sternberg cells using flow cytometry on fine needle aspiration or tissue biopsy of lymph nodes to confirm or supplement immunohistochemistry staining in diagnosis. Newer and more sensitive tools such as flow cytometry can be used for diagnosis, technology that may have been difficult in the past for diagnosis of this lymphoma subtype. Using flow cytometry, diagnosis is faster and could lead to point-of-care technology especially where we have typical immunophenotype signatures. © 2018 International Clinical Cytometry Society.
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Affiliation(s)
- Ravnit-Kaur Grewal
- MBCHB South African National Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
| | - Manogari Chetty
- Department of Oral and Molecular Biology, Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa
| | | | - Ciprian Tomuleasa
- Department of Hematology/Research Center for Functional Genomics and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy-Ion Chiricuta Oncology Institute, Cluj Napoca, Romania
| | - Jonathan R Fromm
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
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111
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Agostinelli C. How can we better predict treatment outcomes in classical Hodgkin's lymphoma? Int J Hematol Oncol 2018; 6:65-68. [PMID: 30302226 DOI: 10.2217/ijh-2017-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/09/2017] [Indexed: 11/21/2022] Open
Affiliation(s)
- Claudio Agostinelli
- Section of Haematopathology, Institute of Haematology & Clinical Oncology 'L&A Seragnoli', S.Orsola-Malpighi Hospital, via Massarenti 9, 40138, Bologna, Italy
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112
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Huntington SF, von Keudell G, Davidoff AJ, Gross CP, Prasad SA. Cost-Effectiveness Analysis of Brentuximab Vedotin With Chemotherapy in Newly Diagnosed Stage III and IV Hodgkin Lymphoma. J Clin Oncol 2018; 36:JCO1800122. [PMID: 30285558 PMCID: PMC6241679 DOI: 10.1200/jco.18.00122] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE In a recent randomized, open-label trial (ECHELON-1), brentuximab vedotin (BV) combined with doxorubicin, vinblastine, and dacarbazine (AVD+BV) decreased the risk of progression in adults diagnosed with stage III or IV Hodgkin lymphoma (HL) compared with standard bleomycin-containing chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine [ABVD]). However, the cost effectiveness of incorporating BV (US$6,970 per 50-mg vial) into the first-line setting is unknown. PATIENTS AND METHODS We constructed a Markov decision-analytic model to measure the costs and clinical outcomes for AVD+BV compared with ABVD as first-line therapy in a cohort of patients with stage III or IV HL. Transition probabilities were estimated from ECHELON-1 by fitting parametric survival distributions. Lifetime direct health care costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for AVD+BV compared with ABVD from a US payer perspective. Our model was also used to estimate BV price reductions that would achieve more favorable cost effectiveness under indication-specific pricing. RESULTS AVD+BV was associated with an improvement of 0.56 QALYs compared with treatment with standard ABVD. However, incorporating BV into first-line therapy led to significantly higher lifetime health care costs ($361,137 v $184,291), causing the ICER for AVD+BV to be $317,254 per QALY. If indication-specific pricing were implemented, acquisition costs for BV used in the first-line setting would need to be reduced by 56% to 73% for ICERs of $150,000 to $100,000 per QALY, respectively. CONCLUSION Substituting BV for bleomycin during first-line therapy for stage III or IV HL is unlikely to be cost effective under current drug pricing. Should indication-specific pricing be implemented, significant price reductions for BV used in the first-line setting would be needed to reduce ICERs to more widely acceptable values.
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Affiliation(s)
- Scott F. Huntington
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Gottfried von Keudell
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Amy J. Davidoff
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Cary P. Gross
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Sapna A. Prasad
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
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Abstract
Hodgkin lymphoma (HL) is a B-cell-derived malignancy that mostly affects young adults. Pathologically, HL is divided into classical HL (cHL) and the rare entity of nodular lymphocyte-predominant HL. Classical HL is characterized by few malignant cells termed Hodgkin and Reed–Sternberg cells embedded in an inflammatory background. The treatment of cHL has consistently improved over the last decades so that current standard approaches result in long-term remission rates in excess of 80%. However, potentially lethal therapy-related late complications affect an increasing number of survivors. For this reason, issues regarding the optimal treatment of cHL patients are still fiercely debated. Questions under discussion include how treatment can be guided by interim positron emission tomography, the best initial treatment for advanced-stage disease and the use of targeted drugs such as the antibody–drug conjugate brentuximab vedotin and the anti-PD-1 antibodies nivolumab and pembrolizumab. The identification of patients who should undergo allogeneic stem cell transplantation is another unsolved issue. The present article highlights the most relevant clinical trials and addresses controversial open questions in the treatment of cHL.
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114
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Eichenauer DA, Aleman BMP, André M, Federico M, Hutchings M, Illidge T, Engert A, Ladetto M. Hodgkin lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv19-iv29. [PMID: 29796651 DOI: 10.1093/annonc/mdy080] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- D A Eichenauer
- First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - B M P Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M André
- Université Catholique de Louvain, Yvoir
- Department of Hematology, CHU UCL Namur, Yvoir, Belgium
| | - M Federico
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - M Hutchings
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - T Illidge
- Division of Cancer Sciences, University of Manchester, Manchester
- The Christie NHS Foundation Trust, Manchester, UK
| | - A Engert
- First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - M Ladetto
- Hematology Division, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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115
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El-Galaly TC, Villa D, Gormsen LC, Baech J, Lo A, Cheah CY. FDG-PET/CT in the management of lymphomas: current status and future directions. J Intern Med 2018; 284:358-376. [PMID: 29989234 DOI: 10.1111/joim.12813] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
FDG-PET/CT is the current state-of-the-art imaging in lymphoma and plays a central role in treatment decisions. At diagnosis, accurate staging is crucial for appropriate therapy selection: FDG-PET/CT can identify areas of lymphoma missed by CT alone and avoid under-treatment of patients with advanced disease stage who would have been misclassified as having limited stage disease by CT. Particularly in Hodgkin lymphoma, positive interim FDG-PET/CT scans are adversely prognostic for clinical outcomes and can inform PET-adapted treatment strategies, but such data are less consistent in diffuse large B-cell lymphoma. The use of quantitative FDG-PET/CT metrics using metabolic tumour volume, possibly in combination with other biomarkers, may better define prognostic subgroups and thus facilitate better treatment selection. After chemotherapy, FDG-PET/CT response is predictive of outcome and may identify a subgroup who benefit from consolidative radiotherapy. Novel therapies, in particular immunotherapies, exhibit different response patterns than conventional chemotherapy, which has led to modified response criteria that take into account the risk of transient pseudo-progression. In relapsed lymphoma, FDG-PET/CT after second-line therapy and prior to high-dose therapy is also strongly associated with outcome and may be used to guide intensity of salvage therapy in relapsed Hodgkin lymphoma. Currently, FDG-PET/CT has no role in the routine follow-up after complete metabolic response to therapy, but it remains a powerful tool for excluding relapse if patients develop clinical features suggestive of disease relapse. In conclusion, FDG-PET/CT plays major roles in the various phases of management of lymphoma and constitutes a step towards the pursuit of personalized treatment.
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Affiliation(s)
- T C El-Galaly
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - D Villa
- Division of Medical Oncology and Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
| | - L C Gormsen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - J Baech
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - A Lo
- Division of Radiation Oncology, BC Cancer, Vancouver, BC, Canada
| | - C Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital and Pathwest Laboratory Medicine, Nedlands, WA, Australia
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117
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Interim Functional Imaging Is an Independent Predictor of Progression-free Survival in Advanced Classical Hodgkin Lymphoma - A Real-world Analysis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 19:e71-e79. [PMID: 30292737 DOI: 10.1016/j.clml.2018.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/15/2018] [Accepted: 08/21/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Response-adapted therapy in advanced classical Hodgkin lymphoma (cHL) using interim functional imaging (IFI) is under active investigation. PATIENTS AND METHODS We retrospectively examined patients with advanced cHL receiving 2 front-line regimens stratified by IFI results at our institution. Time to endpoint analysis was estimated using the method of Kaplan-Meier with log ranks. Cox regression modeling was computed for multivariable analysis. RESULTS A total of 124 patients with advanced cHL with a median follow up of 40.9 months were included. A total of 84 (67.7%) received ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine), whereas the remaining 40 (32.3%) received ABVD/eBEACOPP (escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone). A positive IFI was seen in 36 (29%) patients. The corresponding 3-year progression free survival (PFS) stratified by IFI was 81.7% (95% confidence interval [CI], 70.1%-88.8%) versus 48.3% (95% CI, 30.4%-64.1%) (P < .0001) for patients with negative or positive scan, respectively. Escalation to eBEACOPP from ABVD following a positive IFI resulted in a significantly higher 3-year PFS at 58.7% (95% CI, 0.3-0.79) versus 39.7% (95% CI, 0.18-0.61) respectively (P = .00015). Overall survival (OS) was similar across the groups (P = .44) irrespective of therapy received. At multivariable analysis, IFI was the only predictor of PFS with a hazard ratio of 4.6 (95% CI, 1.9-10.8; P = .0008) whereas therapy escalation had a hazard ratio of 0.66 (95% CI, 0.14-3.4; P = .62). CONCLUSION IFI is an independent predictor of PFS in advanced cHL and can guide therapeutic decisions in the real world. Given the inferior outcome seen in patients with a positive IFI, novel approaches of therapy are warranted.
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Vassilakopoulos TP, Johnson PWM. HD2000 Update in Hodgkin Lymphoma-ABVD or BEACOPP? J Clin Oncol 2018; 34:3584-3585. [PMID: 27528721 DOI: 10.1200/jco.2016.67.9431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Peter W M Johnson
- Cancer Research UK Centre and Southampton General Hospital, Southampton, England
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119
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Viviani S, Guidetti A. Efficacy of antibody-drug conjugate brentuximab vedotin in treating Hodgkin's lymphoma. Expert Opin Biol Ther 2018; 18:841-849. [PMID: 29999431 DOI: 10.1080/14712598.2018.1499723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Hodgkin's lymphoma (HL) patients refractory to first-line therapy or relapsed after autologous stem cell transplantation have a dismal prognosis, and their treatment represents an unmet medical need. Brentuximab vedotin (BV) is a second-generation antibody-drug conjugate (ADC) constituted by an anti-CD30 antibody linked to the cytotoxic drug monomethyl auristatin E. The first administration of BV in relapsed and refractory HL patients in a phase I study showed an impressive antilymphoma activity and prompted development of the drug. Areas covered: This article reviews pharmaceutical characteristics of ADC and specific chemical features of BV related to mechanism of action and mechanism of resistance. Administration recommendation and main toxicities will also be described. Antilymphoma efficacy of BV alone and in combination with conventional chemotherapy and new compounds in different settings of HL patients will be examined. Expert opinion: BV seems to be an effective and safe option for treatment of HL patients. BV alone or in association with chemotherapy as salvage regimen or as bridge to autologous or allogeneic transplant showed encouraging results. Exploration of new drug combinations and new settings of treatment is warranted in order to reduce long-term therapy-related toxicities and ameliorate survival of poor prognosis patients.
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Affiliation(s)
- Simonetta Viviani
- a Division of Hematology and BMT Unit, Department of Medical Oncology and Hematology , Fondazione IRCCS Istituto Nazionale Tumori , Milano , Italy
| | - Anna Guidetti
- a Division of Hematology and BMT Unit, Department of Medical Oncology and Hematology , Fondazione IRCCS Istituto Nazionale Tumori , Milano , Italy.,b Department of Oncology and Hemato-Oncology , University of Milano , Milano , Italy
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120
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Meti N, Esfahani K, Johnson NA. The Role of Immune Checkpoint Inhibitors in Classical Hodgkin Lymphoma. Cancers (Basel) 2018; 10:cancers10060204. [PMID: 29914088 PMCID: PMC6025119 DOI: 10.3390/cancers10060204] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/04/2018] [Accepted: 06/12/2018] [Indexed: 01/06/2023] Open
Abstract
Hodgkin Lymphoma (HL) is a unique disease entity both in its pathology and the young patient population that it primarily affects. Although cure rates are high, survivorship can be linked with significant recent long-term morbidity associated with both chemotherapy and radiotherapy. The most significant advances have been with the use of the anti-CD30-drug conjugated antibody brentuximab vedotin (BV) and inhibitors of program death 1 (PD-1). HL is genetically wired to up-regulate program death ligand 1 (PD-L1) in >95% of cases, creating a state of so-called “T cell exhaustion”, which can be reversed with immune checkpoint-inhibitor blockade. The overall and complete response rates to PD-1 inhibitors in patients with relapsed or refractory HL are 70% and 20%, respectively, with a long median duration of response of ~16 months. In fact, PD-1 inhibitors can benefit a wide spectrum of relapsed HL patients, including some who have “progressive disease” by strict response criteria. We review the biology of HL, with a focus on the immune micro-environment and mechanisms of immune evasion. We also provide the rationale supporting the use of PD-1 inhibitors in HL and highlight some of the challenges of monitoring disease response in patients treated with this immunotherapy.
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Affiliation(s)
- Nicholas Meti
- Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
| | - Khashayar Esfahani
- Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
| | - Nathalie A Johnson
- Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
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121
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Carella AM, Corradini P, Mussetti A, Ricardi U, Vitolo U, Viviani S. Treatment of classical Hodgkin lymphoma in the era of brentuximab vedotin and immune checkpoint inhibitors. Ann Hematol 2018; 97:1301-1315. [PMID: 29802458 DOI: 10.1007/s00277-018-3366-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/06/2018] [Indexed: 12/19/2022]
Abstract
The majority of Hodgkin lymphoma patients are now cured with conventional first-line therapy; however, 10-15% of early-stage disease and less than 30% of advanced-stage patients are refractory(rare) or relapsed. Salvage second-line therapy combined with high-dose therapy and autologous stem-cell transplantation can cure 40-50% of patients. Recently novel agents (Brentuximab Vedotin and Immune Checkpoint inhibitors) have demonstrated evidence of therapeutic activity and are potential bridge to an allogeneic stem-cell transplantation. The review is aimed to present not only salvage strategies; indeed, the paper contains paragraphs about therapy and new treatment options at diagnosis.
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Affiliation(s)
- A M Carella
- Division of Hematology and BMT Unit, Ospedale Policlinico San Martino, Genoa, Italy.
| | - P Corradini
- Division of Hematology and BMT Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Mussetti
- Division of Hematology and BMT Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - U Ricardi
- Department of Oncology, Università di Torino, Turin, Italy
| | - U Vitolo
- AOU Citta' della Salute e della Scienza, Turin, Italy
| | - S Viviani
- Division of Hematology and BMT Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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122
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Keeping S, Wu E, Chan K, Mojebi A, Ferrante SA, Balakumaran A. Pembrolizumab versus the standard of care for relapsed and refractory classical Hodgkin's lymphoma progressing after brentuximab vedotin: an indirect treatment comparison. Expert Rev Hematol 2018; 11:503-511. [PMID: 29764245 DOI: 10.1080/17474086.2018.1475226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND There is significant unmet need among patients with relapsed and refractory classical Hodgkin's lymphoma (RRcHL) who have failed multiple lines of therapy, including brentuximab vedotin (BV). Pembrolizumab, an immune checkpoint inhibitor, is one possible treatment solution for this population. RESEARCH METHODS The objective of this study was to compare progression-free survival (PFS) with standard of care (SOC) versus pembrolizumab in previously BV treated RRcHL patients. A systematic literature review identified one observational study of SOC that was suitable for comparison with KEYNOTE-087, the principal trial of pembrolizumab in this population. Both naïve and population-adjusted (using outcomes regression) pairwise indirect comparisons were conducted. The primary analysis included all patients who had failed BV, with a secondary analysis conducted including only those known to have failed BV that was part of definitive treatment. RESULTS In the primary analysis, SOC was inferior to pembrolizumab in both the unadjusted comparison (HR 5.00 [95% confidence interval (CI) 3.56-7.01]) and the adjusted comparison (HR 6.35 [95% CI 4.04-9.98]). These HRs increased to 5.16 (95% CI 3.61-7.38) and 6.56 (95% CI 4.01-10.72), respectively, in the secondary analysis. CONCLUSION Pembrolizumab offers a significant improvement in PFS compared to SOC in this population.
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Affiliation(s)
- Sam Keeping
- a Evidence Synthesis and Decision Modeling , Precision Xtract , Vancouver , BC , Canada
| | - Elise Wu
- b Center for Observational & Real World Evidence , Merck & Co, Inc , Kenilworth , NJ , USA
| | - Keith Chan
- a Evidence Synthesis and Decision Modeling , Precision Xtract , Vancouver , BC , Canada
| | - Ali Mojebi
- a Evidence Synthesis and Decision Modeling , Precision Xtract , Vancouver , BC , Canada
| | - Shannon Allen Ferrante
- b Center for Observational & Real World Evidence , Merck & Co, Inc , Kenilworth , NJ , USA
| | - Arun Balakumaran
- b Center for Observational & Real World Evidence , Merck & Co, Inc , Kenilworth , NJ , USA
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123
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Ansell SM. Hodgkin lymphoma: 2018 update on diagnosis, risk-stratification, and management. Am J Hematol 2018; 93:704-715. [PMID: 29634090 DOI: 10.1002/ajh.25071] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW Hodgkin lymphoma (HL) is an uncommon B-cell lymphoid malignancy affecting 8500 new patients annually and representing approximately 10.2% of all lymphomas in the United States. DIAGNOSIS HL is composed of two distinct disease entities: classical HL and nodular lymphocyte predominant HL. Nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte-rich HL are subgroups of classical HL. RISK STRATIFICATION An accurate assessment of the stage of disease in patients with HL is critical for the selection of the appropriate therapy. Prognostic models that identify patients at low or high risk for recurrence, as well as the response to therapy as determined by positron emission tomography scan, are used to optimize therapy. RISK-ADAPTED THERAPY Initial therapy for HL patients is based on the histology of the disease, the anatomical stage and the presence of poor prognostic features. Patients with early stage disease are typically treated with combined modality strategies utilizing abbreviated courses of combination chemotherapy followed by involved-field radiation therapy, while those with advanced stage disease receive a longer course of chemotherapy often without radiation therapy. Newer agents including brentuximab vedotin are now being incorporated into frontline therapy and these new combinations are becoming a standard of care. MANAGEMENT OF RELAPSED/REFRACTORY DISEASE High-dose chemotherapy (HDCT) followed by an autologous stem cell transplant (ASCT) is the standard of care for most patients who relapse following initial therapy. For patients who fail HDCT with ASCT, brentuximab vedotin, PD-1 blockade, nonmyeloablative allogeneic transplant or participation in a clinical trial should be considered.
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Guo X, Wang J, Jin J, Chen H, Zhen Z, Jiang W, Lin T, Huang H, Xia Z, Sun X. High Serum Level of Soluble Programmed Death Ligand 1 is Associated With a Poor Prognosis in Hodgkin Lymphoma. Transl Oncol 2018; 11:779-785. [PMID: 29698935 PMCID: PMC6058012 DOI: 10.1016/j.tranon.2018.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/14/2018] [Accepted: 03/19/2018] [Indexed: 01/06/2023] Open
Abstract
Blockade of the programmed cell death 1-programmed cell death ligand 1 pathway is a new and promising therapeutic approach in Hodgkin lymphoma (HL). To our knowledge, the impact of soluble programmed cell death ligand 1 (sPD-L1) serum levels on HL patient prognosis has not yet been investigated. In this study, the prognostic value of sPD-L1 was assessed in patients with HL. We measured serum sPD-L1 levels and identified their prognostic value in 108 newly diagnosed HL patients using an enzyme-linked immunosorbent assay (ELISA). We found higher serum sPD-L1 concentrations in HL patients than in healthy controls. The best sPD-L1 cutoff value for predicting disease progression risk was 25.1674 ng/ml. The 4-year progression-free survival (PFS) rates for the high-sPD-L1 and low-sPD-L1 groups were 78.8% and 93.3%, respectively. Multivariate survival analysis showed that advanced stage and higher sPD-L1 levels (>25.1674 ng/ml) were independent prognostic factors for shorter PFS. In addition, higher sPD-L1 levels were positively correlated with advanced stage and negatively correlated with peripheral blood monocyte number. The serum sPD-L1 level is an independent prognostic factor for PFS in HL patients and may allow identification of a subgroup of patients who require more intensive therapy and who may benefit from anti-PD-1 agents.
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Affiliation(s)
- Xiaofang Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Pediatric Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; The Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Juan Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Pediatric Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jietian Jin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hao Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Clinical Laboratory, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zijun Zhen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Pediatric Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Wenqi Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Tongyu Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Huiqiang Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zhongjun Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Hematology Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Xiaofei Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Pediatric Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
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Adams HJA, Kwee TC. An evidence-based review on the value of interim FDG-PET in assessing response to therapy in lymphoma. Semin Oncol 2018; 44:404-419. [PMID: 29935902 DOI: 10.1053/j.seminoncol.2018.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/11/2018] [Accepted: 01/21/2018] [Indexed: 11/11/2022]
Abstract
Assessing response to therapy in lymphoma is important for determining patients' prognosis, guiding subsequent treatment, and may be used as an outcome measure of prognostic and therapeutic trials. Traditionally, computed tomography was the mainstay for response assessment and was predominantly performed at the end of treatment, whereas the most recent guidelines propose 18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) for this purpose. However, the value of FDG-PET performed during treatment (interim FDG-PET) is still a topic of debate. The purpose of this scientific communication is to provide an evidence-based overview of the value of interim FDG-PET in patients with lymphoma. The article first describes the development of imaging-based response assessment in lymphoma, the rationale and limitations of using FDG-PET for this purpose, and continues with the evidence-based clinical utility of interim FDG-PET in three major lymphoma subtypes (Hodgkin lymphoma, diffuse large B-cell lymphoma, and follicular lymphoma), and finishes with conclusions and recommendations for standard care and future research.
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Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, Deventer Ziekenhuis, Deventer, The Netherlands.
| | - Thomas C Kwee
- Department of Radiology and Nuclear Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Curcumin formulated in solid lipid nanoparticles has enhanced efficacy in Hodgkin's lymphoma in mice. Arch Biochem Biophys 2018; 648:12-19. [PMID: 29679536 DOI: 10.1016/j.abb.2018.04.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 04/13/2018] [Accepted: 04/13/2018] [Indexed: 11/23/2022]
Abstract
Curcumin reduces Hodgkin's lymphoma (HL) cell growth in vitro, but its unfavorable pharmacokinetics highlight the need for novel in vivo delivery systems. Thus, we explored whether formulation of curcumin in solid lipid nanoparticles (SLN-curc) or d-α-Tocopheryl polyethylene glycol 1000 succinate (TPGS) nanoparticles (TPGS-curc) could enhance its efficacy in mice. Curcumin formulated in SLN and in TPGS resulted in higher curcumin plasma levels in mice. Compared to vehicle-treated controls, SLN-curc and TPGS-curc reduced HL xenograft growth by 50.5% (p < 0.02) and 43.0% (p < 0.04), respectively, while curcumin reduced it by 35.8% (p < 0.05). In addition, SLN-curc reduced the expression of proteins involved in cell proliferation and apoptosis (XIAP and Mcl-1) in HL tumor extracts. In HL cells in culture, curcumin decreased the expression of relevant anti-inflammatory cytokines (IL-6 and TNF-α) in a concentration-dependent manner. Moreover, when given in combination with bleomycin, doxorubicin and vinblastine, curcumin showed an additive growth inhibitory effect. In conclusion, SLNs appear as an appropriate and effective drug delivery system for curcumin. Given the efficacy of SLN-curc and the enhanced growth inhibitory effect when combined with chemotherapeutic drugs, we speculate that curcumin, when appropriately formulated, is a promising adjuvant agent for the treatment of HL and merits further evaluation.
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127
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Shah GL, Moskowitz CH. Transplant strategies in relapsed/refractory Hodgkin lymphoma. Blood 2018; 131:1689-1697. [PMID: 29500170 PMCID: PMC5897866 DOI: 10.1182/blood-2017-09-772673] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/28/2017] [Indexed: 02/07/2023] Open
Abstract
The majority of patients with Hodgkin lymphoma (HL) are cured with initial therapy. However, high-dose therapy with autologous hematopoietic cell transplant (AHCT) allows for the cure of an additional portion of patients with relapsed or primary refractory disease. Positron emission tomography-negative complete remission before AHCT is critical for long-term disease control. Several salvage options are available with comparable response rates, and the choice can be dependent of comorbidities and logistics. Radiation therapy can also improve the remission rate and is an important therapeutic option for selected patients. Brentuximab vedotin (BV) maintenance after AHCT is beneficial in patients at high risk for relapse, especially those with more than 1 risk factor, but can have the possibility of significant side effects, primarily neuropathy. Newer agents with novel mechanisms of action are under investigation to improve response rates for patients with subsequent relapse, although are not curative alone. BV and the checkpoint inhibitors nivolumab and pembrolizumab are very effective with limited side effects and can bridge patients to curative allogeneic transplants (allo-HCT). Consideration for immune-mediated toxicities, timing of allogeneic hematopoietic cell transplant based on response, and the potential for increased graft-versus-host disease remain important. Overall, prospective investigations continue to improve outcomes and minimize toxicity for relapsed or primary refractory HL patients.
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Affiliation(s)
- Gunjan L Shah
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
| | - Craig H Moskowitz
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY; and
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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128
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Lim SH, Johnson PWM. Optimizing therapy in advanced-stage Hodgkin lymphoma. Blood 2018; 131:1679-1688. [PMID: 29500173 DOI: 10.1182/blood-2017-09-772640] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/25/2017] [Indexed: 02/07/2023] Open
Abstract
The treatment of Hodgkin lymphoma has evolved continuously since the introduction of extended-field radiotherapy in the 1960s to involved-field and then involved-node radiotherapy, multiagent chemotherapy, combined chemoradiotherapy, risk-adapted and response-adapted modulation, and, most recently, introduction of antibody-drug conjugates and immune checkpoint-blocking antibodies. These changes have translated into progressively increasing cure rates, so that 10-year survival figures now exceed 80%, compared with <50% 40 years ago. The challenge now is how to improve upon success while maintaining, or if possible improving, the quality of life for survivors. Steering between undertreatment, with the risk of avoidable recurrences, and overtreatment, with the risk of unnecessary toxicity, remains complex because control of the lymphoma and the probability of survival are no longer closely linked. This requires trials with long follow-up and continuous reappraisal of the interaction between the illness; the method used to define risk, and the type of treatment involved. One important factor in this is age: outcomes in older patients have not improved at the same rate as those in the population under 60 years of age, reflecting the need for different approaches. Recently, treatment has moved from being primarily risk-based, using baseline characteristics such as anatomical stage and severity of the illness, to a more dynamic approach that takes account of the response to therapy, using functional imaging to make an early appraisal, with the option to modulate subsequent treatment. The results of several trials indicate that this has advantages, but a combination of risk- and response-adaptation is probably ideal.
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Affiliation(s)
- Sean H Lim
- Antibody and Vaccine Group and
- Cancer Sciences Unit, Cancer Research UK Centre, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| | - Peter W M Johnson
- Cancer Sciences Unit, Cancer Research UK Centre, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
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129
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Shanbhag S, Ambinder RF. Hodgkin lymphoma: A review and update on recent progress. CA Cancer J Clin 2018; 68:116-132. [PMID: 29194581 PMCID: PMC5842098 DOI: 10.3322/caac.21438] [Citation(s) in RCA: 254] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 12/29/2022] Open
Abstract
Hodgkin lymphoma (HL) is a unique hematopoietic neoplasm characterized by cancerous Reed-Sternberg cells in an inflammatory background. Patients are commonly diagnosed with HL in their 20s and 30s, and they present with supradiaphragmatic lymphadenopathy, often with systemic B symptoms. Even in advanced-stage disease, HL is highly curable with combination chemotherapy, radiation, or combined-modality treatment. Although the same doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapeutic regimen has been the mainstay of therapy over the last 30 years, risk-adapted approaches have helped de-escalate therapy in low-risk patients while intensifying treatment for higher risk patients. Even patients who are not cured with initial therapy can often be salvaged with alternate chemotherapy combinations, the novel antibody-drug conjugate brentuximab, or high-dose autologous or allogeneic hematopoietic stem cell transplantation. The programmed death-1 inhibitors nivolumab and pembrolizumab have both demonstrated high response rates and durable remissions in patients with relapsed/refractory HL. Alternate donor sources and reduced-intensity conditioning have made allogeneic hematopoietic stem cell transplantation a viable option for more patients. Future research will look to integrate novel strategies into earlier lines of therapy to improve the HL cure rate and minimize long-term treatment toxicities. CA Cancer J Clin 2018;68:116-132. © 2017 American Cancer Society.
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Affiliation(s)
- Satish Shanbhag
- Assistant Professor of Medicine, Departments of Medicine and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Richard F Ambinder
- Director, Division of Hematologic Malignancies and Professor of Oncology, Departments of Medicine and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
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Gallamini A, Tarella C, Viviani S, Rossi A, Patti C, Mulé A, Picardi M, Romano A, Cantonetti M, La Nasa G, Trentin L, Bolis S, Rapezzi D, Battistini R, Gottardi D, Gavarotti P, Corradini P, Cimminiello M, Schiavotto C, Parvis G, Zanotti R, Gini G, Ferreri AJ, Viero P, Miglino M, Billio A, Avigdor A, Biggi A, Fallanca F, Ficola U, Gregianin M, Chiaravalloti A, Prosperini G, Bergesio F, Chauvie S, Pavoni C, Gianni AM, Rambaldi A. Early Chemotherapy Intensification With Escalated BEACOPP in Patients With Advanced-Stage Hodgkin Lymphoma With a Positive Interim Positron Emission Tomography/Computed Tomography Scan After Two ABVD Cycles: Long-Term Results of the GITIL/FIL HD 0607 Trial. J Clin Oncol 2018; 36:454-462. [DOI: 10.1200/jco.2017.75.2543] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To investigate the progression-free survival (PFS) of patients with advanced Hodgkin lymphoma (HL) after a risk-adapted treatment strategy that was based on a positive positron emission tomography scan performed after two doxorubicin, vinblastine, vincristine, and dacarbazine (ABVD) cycles (PET2). Patients and Methods Patients with advanced-stage (IIB to IVB) HL were consecutively enrolled. After two ABVD cycles, PET2 was performed and centrally reviewed according to the Deauville five-point scale. Patients with a positive PET2 were randomly assigned to four cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) followed by four cycles of standard BEACOPP with or without rituximab. Patients with a negative PET2 continued ABVD, and those with a large nodal mass at diagnosis (≥ 5 cm) in complete remission with a negative PET at the end of chemotherapy were randomly assigned to radiotherapy or no further treatment. The primary end point was 3-year PFS. Results Of 782 enrolled patients, 150 (19%) had a positive and 630 (81%) a negative PET2. The 3-year PFS of all patients was 82%. The 3-year PFS of those with a positive and negative PET2 was 60% and 87%, respectively ( P < .001). The 3-year PFS of patients with a positive PET2 assigned to BEACOPP with or without rituximab was 63% versus 57% ( P = .53). In 296 patients with both interim and post-ABVD–negative PET who had a large nodal mass at diagnosis, radiotherapy was randomly added after chemotherapy without a significant PFS improvement (97% v 93%, respectively; P = .29). The 3-year overall survival of all 782 patients was 97% (99% and 89% for PET2 negative and positive, respectively). Conclusion The PET-driven switch from ABVD to escalated BEACOPP is feasible and effective in high-risk patients with advanced-stage HL.
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Affiliation(s)
- Andrea Gallamini
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Corrado Tarella
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Simonetta Viviani
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Andrea Rossi
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Caterina Patti
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Antonino Mulé
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Marco Picardi
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Alessandra Romano
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Maria Cantonetti
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Giorgio La Nasa
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Livio Trentin
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Silvia Bolis
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Davide Rapezzi
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Roberta Battistini
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Daniela Gottardi
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Paolo Gavarotti
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Paolo Corradini
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Michele Cimminiello
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Corrado Schiavotto
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Guido Parvis
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Roberta Zanotti
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Guido Gini
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Andrés J.M. Ferreri
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Piera Viero
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Maurizio Miglino
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Atto Billio
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Abraham Avigdor
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Alberto Biggi
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Federico Fallanca
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Umberto Ficola
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Michele Gregianin
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Agostino Chiaravalloti
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Giuseppe Prosperini
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Fabrizio Bergesio
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Stephane Chauvie
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Chiara Pavoni
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Alessandro Massimo Gianni
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
| | - Alessandro Rambaldi
- Andrea Gallamini, Centre Antoine Lacassagne, Nice, France; Corrado Tarella, Istituto Europeo di Oncologia; Daniela Gottardi, Ospedale Mauriziano Umberto I di Torino; Paolo Gavarotti, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin; Simonetta Viviani and Paolo Corradini, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Paolo Corradini, Alessandro Massimo Gianni, and Alessandro Rambaldi, Università degli Studi di Milano
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Carras S, Dubois B, Senecal D, Jais JP, Peoc'h M, Quittet P, Foussard C, Bouabdallah K, Gastinne T, Jourdan E, Sanhes L, Ertault M, Lamy T, Molina L. Interim PET Response-adapted Strategy in Untreated Advanced Stage Hodgkin Lymphoma: Results of GOELAMS LH 2007 Phase 2 Multicentric Trial. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:191-198. [PMID: 29502594 DOI: 10.1016/j.clml.2018.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/02/2018] [Accepted: 01/16/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with advanced stage Hodgkin lymphoma still present unsatisfactory outcomes. PATIENTS AND METHODS The Groupe d'étude des Leucémies Aigues et des Maladies du Sang (GOELAMS) group conducted a prospective multicentric trial (NCT00920153) for advanced stage Hodgkin lymphoma to evaluate a positron emission tomography (PET)-adapted strategy. Patients received an intensive regimen (VABEM [vindesine, doxorubicin, carmustine, etoposide, and methylprednisolone]) in front-line and interim 18FFDG-PET evaluation after 2 courses (PET-2). Patients with negative PET-2 findings received 1 additional course. Patients with positive PET-2 findings underwent early salvage therapy followed by high-dose therapy/autologous stem cell transplantation. RESULTS Fifty-one patients were included. The final complete remission rate was 88%. With a median follow up of 5.3 years, 5-year event-free survival and overall survival rates were 75.3% and 85.3%, respectively, for the whole cohort. Patients who were PET-2-negative had 5-year event-free survival and overall survival rates of, respectively, 77.8% and 88.2% versus 85.1% and 91.7% for patients who were PET-2-positive. CONCLUSION A PET-guided strategy with early salvage therapy and high-dose therapy/autologous stem cell transplantation for patients with interim PET-2-positive findings is safe and feasible and provide similar outcome as patients with a negative PET-2.
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Affiliation(s)
- Sylvain Carras
- Hematology Department, Grenoble University Hospital, Grenoble, France
| | - Benjamin Dubois
- Nuclear Medicine Department, Grenoble University Hospital, Grenoble, France
| | | | | | - Michel Peoc'h
- Anatomopathology Department, St Etienne University Hospital, Saint-Etienne, France
| | - Philippe Quittet
- Hematology Department, Montpellier University Hospital, Montpellier, France
| | - Charles Foussard
- Hematology Department, Angers University Hospital, Angers, France
| | | | - Thomas Gastinne
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Eric Jourdan
- Hematology Department, Nimes University Hospital, Nimes, France
| | - Laurence Sanhes
- Hematology Department, Perpignan Hospital, Perpignan, France
| | - Marjan Ertault
- Hematology Department, Tours University Hospital, Tours, France
| | - Thierry Lamy
- Hematology Department, Rennes University Hospital, Rennes, France
| | - Lysiane Molina
- Hematology Department, Grenoble University Hospital, Grenoble, France
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Collins GP, Rueda A, Salles G, von Tresckow B, Zaja F. Management of Hodgkin lymphoma in the era of brentuximab vedotin: real-world data from five European countries. Leuk Lymphoma 2018; 59:2113-2120. [PMID: 29334819 DOI: 10.1080/10428194.2017.1421762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We examined real-world data on management of relapsed/refractory Hodgkin lymphoma (R/R HL) in five European countries and the consistency of these data with guideline recommendations. Retrospective clinical and epidemiologic data for 509 patients with R/R HL treated between January 2014 and March 2015 were collected at centers in France, Germany, Italy, Spain, and the United Kingdom. Mean age was 46.3 years; 73.3% were receiving second-line therapy for a first relapse during the reporting period. Most patients received ABVD as front-line chemotherapy, except in Germany where escalated BEACOPP was used more often. The proportion of patients receiving stem cell transplantation (SCT) was 44%; 85% of transplants occurred at first relapse. Brentuximab vedotin (BV) was usually administered after autologous SCT, and was initiated for 65% of patients following SCT failure. Our findings suggest that R/R HL management across these countries is broadly consistent with guideline recommendations and that BV is well-integrated into treatment pathways.
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Affiliation(s)
- Graham P Collins
- a Oxford Cancer and Haematology Centre , Churchill Hospital , Oxford , UK
| | - Antonio Rueda
- b Department of Medical Oncology , Hospital Costa del Sol , Málaga , Spain
| | - Gilles Salles
- c Department of Haematology , Hospices Civils de Lyon, Université Claude Bernard-Lyon-1, Centre Hospitalier Lyon Sud , Pierre-Bénite , France
| | - Bastian von Tresckow
- d German Hodgkin Study Group (GHSG) , University Hospital of Cologne , Cologne , Germany
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Abstract
Various systemic inflammatory diseases, such as rheumatoid arthritis (RA), Sjögren's syndrome and systemic lupus erythematosus (SLE) are associated with an increased risk for the development of lymphomas. Studies on patients with RA and Sjögren's syndrome have shown that there is a clear association of the incidence of lymphoma with the severity and activity of the disease and lymphomas in particular are diseases which preferentially occur in immunosuppressed patients; therefore, knowledge of the different lymphoma subtypes, their prognosis and treatment options are important for rheumatologists. Currently, there is no evidence for an increased risk of lymphoma with the available conventional basis therapies or biologic disease-modifying antirheumatic drugs (DMARDs). The decision on how to treat a patient with previous lymphoma who requires antirheumatic treatment is more difficult as patients with previous malignancies are not included in clinical studies and in registries a bias with respect to patient selection must be taken into consideration. Decisions on the treatment approach, therefore need to be individualized and interdisciplinary management together with the treating hematologist is warranted.
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Turpin A, Michot JM, Kempf E, Mazeron R, Dartigues P, Terroir M, Boros A, Bonnetier S, Castilla-Llorente C, Coman T, Danu A, Ghez D, Pilorge S, Arfi-Rouche J, Dercle L, Soria JC, Carde P, Ribrag V, Fermé C, Lazarovici J. Le lymphome de Hodgkin : stratégies thérapeutiques actuelles et futures. Bull Cancer 2018; 105:81-98. [DOI: 10.1016/j.bulcan.2017.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 12/22/2022]
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Khan N, Moskowitz AJ. Where Do the New Drugs Fit in for Relapsed/Refractory Hodgkin Lymphoma? Curr Hematol Malig Rep 2017; 12:227-233. [PMID: 28488185 DOI: 10.1007/s11899-017-0384-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The standard approach for relapsed or refractory (rel/ref) Hodgkin lymphoma (HL) following frontline treatment failure is salvage therapy followed by consolidation with high-dose therapy and autologous stem cell transplant (HDT/ASCT). While this overall treatment paradigm has been in place for several decades, recent studies have aimed to improve the efficacy and tolerability of salvage therapies by incorporating newer drugs, such as brentuximab vedotin (BV) and checkpoint inhibitors. Following HDT/ASCT, survival is improved due to the availability of BV and the checkpoint inhibitors, nivolumab and pembrolizumab; however, for patients responding to checkpoint inhibition, the appropriate length of treatment and the role of allogeneic stem cell transplant are unclear. In this review, we discuss our management of rel/ref HL, with particular focus on how BV, nivolumab, and pembrolizumab are currently incorporated into the treatment paradigms for rel/ref HL.
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Affiliation(s)
- Niloufer Khan
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Alison J Moskowitz
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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Nomograms for predicting the overall and cancer-specific survival of patients with classical Hodgkin lymphoma: a SEER-based study. Oncotarget 2017; 8:92978-92988. [PMID: 29190971 PMCID: PMC5696237 DOI: 10.18632/oncotarget.21722] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/27/2017] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to establish nomograms, based on significant clinicopathologic parameters, for predicting the overall survival (OS) and the cancer-specific survival (CSS) of patients with classical Hodgkin lymphoma (CHL). The data of 43,330 CHL patients, diagnosed between 1983 and 2014, were obtainedfrom the database of the Surveillance, Epidemiology, and End Results (SEER) program. These patients were randomly divided into training (n = 30,339) and validation (n = 12,991) cohorts. The Kaplan-Meier method and Cox proportional hazards regression model were used to evaluate the prognostic effects of multiple clinicopathologic parameters on survival. Significant prognostic factors were combined to build nomograms. The predictive performance of nomograms was evaluated using the index of concordance (C-index) and calibration curves. In the training cohort, on univariate and multivariate analyses, age at diagnosis, gender, race, Ann Arbor stage, and histological type significantly correlated with the survival outcomes. These characteristics were used to establish nomograms. The nomograms showed good accuracy in predicting 1-, 5-, and 10-year OS and CSS, with a C-index of 0.794 (95% confidence interval [CI], 0.789-0.799) for OS and 0.760 (95% CI, 0.753-0.767) for CSS. In the validation cohort, the C-index for nomogram-based predictions was 0.787 (95% CI, 0.779-0.795) for OS and 0.769 (95% CI, 0.758-0.780) for CSS. All calibration curves revealed excellent consistency between predicted and actual survival. In summary, novel nomograms were established and validated to predict OS and CSS for patients with CHL. These new prognostic models could aid in improved prediction of survival outcomes leading to reasonable treatment recommendations.
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Hui L, von Keudell G, Wang R, Zeidan AM, Gore SD, Ma X, Davidoff AJ, Huntington SF. Cost-effectiveness analysis of consolidation with brentuximab vedotin for high-risk Hodgkin lymphoma after autologous stem cell transplantation. Cancer 2017; 123:3763-3771. [PMID: 28640385 PMCID: PMC5610636 DOI: 10.1002/cncr.30818] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND In a recent randomized, placebo-controlled trial, consolidation treatment with brentuximab vedotin (BV) decreased the risk of Hodgkin lymphoma (HL) progression after autologous stem cell transplantation (ASCT). However, the impact of BV consolidation on overall survival, quality of life, and health care costs remain unclear. METHODS A Markov decision-analytic model was constructed to measure the costs and clinical outcomes for BV consolidation therapy compared with active surveillance in a cohort of patients aged 33 years who were at risk for HL relapse after ASCT. Life-time costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each post-ASCT strategy. RESULTS After quality-of-life adjustments and standard discounting, upfront BV consolidation was associated with an improvement of 1.07 QALYs compared with active surveillance plus BV as salvage. However, the strategy of BV consolidation led to significantly higher health care costs ($378,832 vs $219,761), resulting in an ICER for BV consolidation compared with active surveillance of $148,664/QALY. If indication-specific pricing was implemented, then the model-estimated BV price reductions of 18% to 38% for the consolidative setting would translate into ICERs of $100,000 and $50,000 per QALY, respectively. These findings were consistent on 1-way and probabilistic sensitivity analyses. CONCLUSIONS BV as consolidation therapy under current US pricing is unlikely to be cost effective at a willingness-to-pay threshold of $100,000 per QALY. However, indication-specific price reductions for the consolidative setting could reduce ICERs to widely acceptable values. Cancer 2017. © 2017 American Cancer Society. Cancer 2017;123:3763-3771. © 2017 American Cancer Society.
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Affiliation(s)
- Lucy Hui
- Yale School of Medicine, New Haven, CT
| | - Gottfried von Keudell
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
| | - Rong Wang
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Amer M. Zeidan
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - Steven D. Gore
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Amy J. Davidoff
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - Scott F Huntington
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
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Eichenauer DA, Becker I, Monsef I, Chadwick N, de Sanctis V, Federico M, Fortpied C, Gianni AM, Henry-Amar M, Hoskin P, Johnson P, Luminari S, Bellei M, Pulsoni A, Sydes MR, Valagussa P, Viviani S, Engert A, Franklin J. Secondary malignant neoplasms, progression-free survival and overall survival in patients treated for Hodgkin lymphoma: a systematic review and meta-analysis of randomized clinical trials. Haematologica 2017; 102:1748-1757. [PMID: 28912173 PMCID: PMC5622859 DOI: 10.3324/haematol.2017.167478] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/19/2017] [Indexed: 11/29/2022] Open
Abstract
Treatment intensification to maximize disease control and reduced intensity approaches to minimize the risk of late sequelae have been evaluated in newly diagnosed Hodgkin lymphoma. The influence of these interventions on the risk of secondary malignant neoplasms, progression-free survival and overall survival is reported in the meta-analysis herein, based on individual patient data from 9498 patients treated within 16 randomized controlled trials for newly diagnosed Hodgkin lymphoma between 1984 and 2007. Secondary malignant neoplasms were meta-analyzed using Peto’s method as time-to-event outcomes. For progression-free and overall survival, hazard ratios derived from each trial using Cox regression were combined by inverse-variance weighting. Five study questions (combined-modality treatment vs. chemotherapy alone; more extended vs. involved-field radiotherapy; radiation at higher doses vs. radiation at 20 Gy; more vs. fewer cycles of the same chemotherapy protocol; standard-dose chemotherapy vs. intensified chemotherapy) were investigated. After a median follow-up of 7.4 years, dose-intensified chemotherapy resulted in better progression-free survival rates (P=0.007) as compared with standard-dose chemotherapy, but was associated with an increased risk of therapy-related acute myeloid leukemia/myelodysplastic syndromes (P=0.0028). No progression-free or overall survival differences were observed between combined-modality treatment and chemotherapy alone, but more secondary malignant neoplasms were seen after combined-modality treatment (P=0.010). For the remaining three study questions, outcomes and secondary malignancy rates did not differ significantly between treatment strategies. The results of this meta-analysis help to weigh up efficacy and secondary malignancy risk for the choice of first-line treatment for Hodgkin lymphoma patients. However, final conclusions regarding secondary solid tumors require longer follow-up.
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Affiliation(s)
- Dennis A Eichenauer
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), University Hospital Cologne, Germany
| | - Ingrid Becker
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany
| | - Ina Monsef
- Cochrane Haematological Malignancies Group, First Department of Internal Medicine, University Hospital Cologne, Germany
| | | | | | | | - Catherine Fortpied
- European Organisation of Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | | | - Michel Henry-Amar
- Centre de Traitement des Données du Cancéropôle Nord-Ouest, Centre François Baclesse, Caen, France
| | | | - Peter Johnson
- Cancer Research UK Centre, University of Southampton, UK
| | | | - Monica Bellei
- University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Pulsoni
- Cellular Biotechnology and Hematology Department, University "La Sapienza", Rome, Italy
| | - Matthew R Sydes
- Medical Research Council (MRC), Clinical Trials Unit at University College London (UCL), UK
| | | | | | - Andreas Engert
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), University Hospital Cologne, Germany
| | - Jeremy Franklin
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany
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Franklin J, Eichenauer DA, Becker I, Monsef I, Engert A. Optimisation of chemotherapy and radiotherapy for untreated Hodgkin lymphoma patients with respect to second malignant neoplasms, overall and progression-free survival: individual participant data analysis. Cochrane Database Syst Rev 2017; 9:CD008814. [PMID: 28901021 PMCID: PMC6483617 DOI: 10.1002/14651858.cd008814.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Efficacy and the risk of severe late effects have to be well-balanced in treatment of Hodgkin lymphoma (HL). Late adverse effects include secondary malignancies which often have a poor prognosis. To synthesise evidence on the risk of secondary malignancies after current treatment approaches comprising chemotherapy and/or radiotherapy, we performed a meta-analysis based on individual patient data (IPD) from patients treated for newly diagnosed HL. OBJECTIVES We investigated several questions concerning possible changes in the risk of secondary malignancies when modifying chemotherapy or radiotherapy (omission of radiotherapy, reduction of the radiation field, reduction of the radiation dose, use of fewer chemotherapy cycles, intensification of chemotherapy). We also analysed whether these modifications affect progression-free survival (PFS) and overall survival (OS). SEARCH METHODS We searched MEDLINE and Cochrane CENTRAL trials databases comprehensively in June 2010 for all randomised trials in HL since 1984. Key international trials registries were also searched. The search was updated in March 2015 without collecting further IPD (one further eligible study found) and again in July 2017 (no further eligible studies). SELECTION CRITERIA We included randomised controlled trials (RCTs) for untreated HL patients which enrolled at least 50 patients per arm, completed recruitment by 2007 and performed a treatment comparison relevant to our objectives. DATA COLLECTION AND ANALYSIS Study groups submitted IPD, including age, sex, stage and the outcomes secondary malignant neoplasm (SMN), OS and PFS as time-to-event data. We meta-analysed these data using Petos method (SMN) and Cox regression with inverse-variance pooling (OS, PFS) for each of the five study questions, and performed subgroup and sensitivity analyses to assess the applicability and robustness of the results. MAIN RESULTS We identified 21 eligible trials and obtained IPD for 16. For four studies no data were supplied despite repeated efforts, while one study was only identified in 2015 and IPD were not sought. For each study question, between three and six trials with between 1101 and 2996 participants in total and median follow-up between 6.7 and 10.8 years were analysed. All participants were adults and mainly under 60 years. Risk of bias was assessed as low for the majority of studies and outcomes. Chemotherapy alone versus same chemotherapy plus radiotherapy. Omitting additional radiotherapy probably reduces secondary malignancy incidence (Peto odds ratio (OR) 0.43, 95% confidence interval (CI) 0.23 to 0.82, low quality of evidence), corresponding to an estimated reduction of eight-year SMN risk from 8% to 4%. This decrease was particularly true for secondary acute leukemias. However, we had insufficient evidence to determine whether OS rates differ between patients treated with chemotherapy alone versus combined-modality (hazard ratio (HR) 0.71, 95% CI 0.46 to 1.11, moderate quality of evidence). There was a slightly higher rate of PFS with combined modality, but our confidence in the results was limited by high levels of statistical heterogeneity between studies (HR 1.31, 95% CI 0.99 to 1.73, moderate quality of evidence). Chemotherapy plus involved-field radiation versus same chemotherapy plus extended-field radiation (early stages) . There is insufficient evidence to determine whether smaller radiation field reduces SMN risk (Peto OR 0.86, 95% CI 0.64 to 1.16, low quality of evidence), OS (HR 0.89, 95% C: 0.70 to 1.12, high quality of evidence) or PFS (HR 0.99, 95% CI 0.81 to 1.21, high quality of evidence). Chemotherapy plus lower-dose radiation versus same chemotherapy plus higher-dose radiation (early stages). There is insufficient evidence to determine the effect of lower-radiation dose on SMN risk (Peto OR 1.03, 95% CI 0.71 to 1.50, low quality of evidence), OS (HR 0.91, 95% CI 0.65 to 1.28, high quality of evidence) or PFS (HR 1.20, 95% CI 0.97 to 1.48, high quality of evidence). Fewer versus more courses of chemotherapy (each with or without radiotherapy; early stages). Fewer chemotherapy courses probably has little or no effect on SMN risk (Peto OR 1.10, 95% CI 0.74 to 1.62), OS (HR 0.99, 95% CI 0.73 to1.34) or PFS (HR 1.15, 95% CI 0.91 to 1.45).Outcomes had a moderate (SMN) or high (OS, PFS) quality of evidence. Dose-intensified versus ABVD-like chemotherapy (with or without radiotherapy in each case). In the mainly advanced-stage patients who were treated with intensified chemotherapy, the rate of secondary malignancies was low. There was insufficient evidence to determine the effect of chemotherapy intensification (Peto OR 1.37, CI 0.89 to 2.10, low quality of evidence). The rate of secondary acute leukemias (and for younger patients, all secondary malignancies) was probably higher than among those who had treatment with standard-dose ABVD-like protocols. In contrast, the intensified chemotherapy protocols probably improved PFS (eight-year PFS 75% versus 69% for ABVD-like treatment, HR 0.82, 95% CI 0.7 to 0.95, moderate quality of evidence). Evidence suggesting improved survival with intensified chemotherapy was not conclusive (HR: 0.85, CI 0.70 to 1.04), although escalated-dose BEACOPP appeared to lengthen survival compared to ABVD-like chemotherapy (HR 0.58, 95% CI 0.43 to 0.79, moderate quality of evidence).Generally, we could draw valid conclusions only in terms of secondary haematological malignancies, which usually occur less than 10 years after initial treatment, while follow-up within the present analysis was too short to record all solid tumours. AUTHORS' CONCLUSIONS The risk of secondary acute myeloid leukaemia and myelodysplastic syndrome (AML/MDS) is increased but efficacy is improved among patients treated with intensified chemotherapy protocols. Treatment decisions must be tailored for individual patients. Consolidating radiotherapy is associated with an increased rate of secondary malignancies; therefore it appears important to define which patients can safely be treated without radiotherapy after chemotherapy, both for early and advanced stages. For early stages, treatment optimisation methods such as use of fewer chemotherapy cycles and reduced field or reduced-dose radiotherapy did not appear to markedly affect efficacy or secondary malignancy risk. Due to the limited amount of long-term follow-up in this meta-analysis, further long-term investigations of late events are needed, particularly with respect to secondary solid tumours. Since many older studies have been included, possible improvement of radiotherapy techniques must be considered when interpreting these results.
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Affiliation(s)
- Jeremy Franklin
- University Hospital of CologneInstitute of Medical Statistics, Informatics and EpidemiologyKerpener Str. 62CologneGermany50937
| | - Dennis A. Eichenauer
- University Hospital of CologneDepartment I of Internal Medicine, Center of Integrated Oncology Köln BonnCologneGermany50924
| | - Ingrid Becker
- University Hospital of CologneInstitute of Medical Statistics, Informatics and EpidemiologyKerpener Str. 62CologneGermany50937
| | - Ina Monsef
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Andreas Engert
- University Hospital of CologneDepartment I of Internal MedicineKerpener Str. 62CologneGermany50924
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Biasoli I, Castro N, Delamain M, Silveira T, Farley J, Simões BP, Solza C, Praxedes M, Baiocchi O, Gaiolla R, Franceschi F, Sola CB, Boquimpani C, Clementino N, Perini G, Pagnano K, Steffenello G, Tabacof J, de Freitas Colli G, Soares A, de Souza C, Chiattone CS, Milito C, Morais JC, Spector N. Treatment outcomes for Hodgkin lymphoma: First report from the Brazilian Prospective Registry. Hematol Oncol 2017. [PMID: 28643458 DOI: 10.1002/hon.2450] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Data about Hodgkin lymphoma (HL) in developing countries are scarce and suggest the existence of substantial disparities in healthcare and outcomes in large areas of the world. In 2009, a prospective registry of HL was implemented in Brazil. Web-based data were contributed by 20 institutions across the country participating in the Brazilian Prospective Hodgkin's Lymphoma Registry. The aim of this study was to present the clinical features and outcomes of newly diagnosed patients with HL aged 13 to 90 years. Multivariate Cox regression models were used to estimate progression-free (PFS) and overall survival (OS) by clinical factors. A total of 674 patients with classical HL were analysed, with a median follow-up of 37 months. Median age was 30 years (13-90). The median time from the onset of symptoms to diagnosis was 6 months (0-60). Only 6% of patients had early favourable disease, while 65% had advanced disease. Stage IVB was present in 26% and a high-risk International Prognostic Score in 38%. Doxorubicin, bleomycin, vinblastine, and dacarbazine was used in 93%. The median dose of radiotherapy was 36 Gy for localized disease and 32 Gy for advanced disease. The 3 year PFS in early favourable, early unfavourable, and advanced disease were 95%, 88%, and 66%, respectively. High-risk International Prognostic Score, advanced disease, and age greater than or equal to 60 were independently associated with poorer PFS and OS; performance status greater than or equal to 2 was also associated with a poorer OS. Poor-risk patients predominated. Radiation doses for localized disease appear higher than current recommendations. Outcomes appear inferior in developing countries than in developed countries. Delayed diagnosis is probably a major factor underlying these findings. Scattered reports from developing nations suggest that many aspects of standard care in developed countries remain unmet needs for populations living in developing countries. The present report contributes to this body of data, with a proper description of what is currently achieved in urban areas in Brazil.
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Affiliation(s)
- Irene Biasoli
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Marcia Delamain
- Hematology and Hemotherapy Center, University of Campinas, Campinas, Brazil
| | | | - James Farley
- Liga Norte Rio Grandense Contra o Cancer, Natal, Brazil
| | | | - Cristiana Solza
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | | | - Kátia Pagnano
- Hematology and Hemotherapy Center, University of Campinas, Campinas, Brazil
| | | | | | | | - Andrea Soares
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carmino de Souza
- Hematology and Hemotherapy Center, University of Campinas, Campinas, Brazil
| | | | - Cristiane Milito
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Carlos Morais
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nelson Spector
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Dann EJ, Bairey O, Bar-Shalom R, Mashiach T, Barzilai E, Kornberg A, Akria L, Tadmor T, Filanovsky K, Abadi U, Kagna O, Ruchlemer R, Abdah-Bortnyak R, Goldschmidt N, Epelbaum R, Horowitz NA, Lavie D, Ben-Yehuda D, Shpilberg O, Paltiel O. Modification of initial therapy in early and advanced Hodgkin lymphoma, based on interim PET/CT is beneficial: a prospective multicentre trial of 355 patients. Br J Haematol 2017; 178:709-718. [PMID: 28589704 DOI: 10.1111/bjh.14734] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/20/2017] [Indexed: 11/28/2022]
Abstract
This multicentre study evaluated 5-year progression-free (PFS) and overall survival (OS) in early and advanced Hodgkin lymphoma (HL), where therapy was individualized based on initial prognostic factors and positron emission tomography-computed tomography performed after two cycles (PET-2). Between September 2006 and August 2013, 359 patients aged 18-60 years, were recruited in nine Israeli centres. Early-HL patients initially received ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) ×2. Depending on initial unfavourable prognostic features, PET-2-positive patients received additional ABVD followed by involved-site radiotherapy (ISRT). Patients with negative PET-2 and favourable disease received ISRT or ABVD ×2; those with unfavourable disease received ABVD ×2 with ISRT or, alternatively, ABVD ×4. Advanced-HL patients initially received ABVD ×2 or escalated BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone; EB) ×2 based on their international prognostic score (≤2 or ≥3). PET-2-negative patients further received ABVD ×4; PET-2-positive patients received EB ×4 and ISRT to residual masses. With a median follow-up of 55 (13-119) months, 5-year PFS was 91% and 69% for PET-2-negative and positive early-HL, respectively; 5-year OS was 100% and 95%, respectively. For advanced-HL, the PFS was 81% and 68%, respectively (P = 0·08); 5-year OS was 98% and 91%, respectively. PET-2 positivity is associated with inferior prognosis in early-HL, even with additional ABVD and ISRT. Advanced-HL patients benefit from therapy escalation following positive PET-2. EB can be safely de-escalated to ABVD in PET-2-negative patients.
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Affiliation(s)
- Eldad J Dann
- Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Osnat Bairey
- Rabin Medical Centre, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Abraham Kornberg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Assaf Harofeh Medical Centre, Zerifin, Israel
| | | | - Tamar Tadmor
- Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Bnai Zion Medical Centre, Haifa, Israel
| | | | - Uri Abadi
- Meir Medical Centre, Kfar Saba, Israel
| | - Olga Kagna
- Rambam Health Care Campus, Haifa, Israel
| | | | | | | | - Ron Epelbaum
- Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Netanel A Horowitz
- Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - David Lavie
- Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Dina Ben-Yehuda
- Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | | | - Ora Paltiel
- Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
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Biasoli I, Spector N. New agents in relapsed/refractory Hodgkin's lymphoma. Rev Bras Hematol Hemoter 2017; 39:193-196. [PMID: 28830595 PMCID: PMC5568577 DOI: 10.1016/j.bjhh.2017.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Irene Biasoli
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
| | - Nelson Spector
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Skoetz N, Will A, Monsef I, Brillant C, Engert A, von Tresckow B. Comparison of first-line chemotherapy including escalated BEACOPP versus chemotherapy including ABVD for people with early unfavourable or advanced stage Hodgkin lymphoma. Cochrane Database Syst Rev 2017; 5:CD007941. [PMID: 28541603 PMCID: PMC6481581 DOI: 10.1002/14651858.cd007941.pub3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There are two different international standards for the treatment of early unfavourable and advanced stage Hodgkin lymphoma (HL): chemotherapy with escalated BEACOPP (bleomycin/etoposide/doxorubicin/cyclophosphamide/vincristine/procarbazine/prednisone) regimen and chemotherapy with ABVD (doxorubicin/bleomycin/vinblastine/dacarbazine) regimen. OBJECTIVES To determine the advantages and disadvantages of chemotherapy including escalated BEACOPP compared to chemotherapy including ABVD in the treatment of early unfavourable or advanced stage HL as first-line treatment. SEARCH METHODS We searched for randomised controlled trials in MEDLINE, CENTRAL and conference proceedings (January 1985 to July 2013 and for the update to March 2017) and Embase (1985 to November 2008). Moreover we searched trial registries (March 2017; www.controlled-trials.com, www.clinicaltrialsregister.eu/ctr-search/search, clinicaltrials.gov, www.eortc.be, www.ghsg.org, www.ctc.usyd.edu.au, www.trialscentral.org/index.html) SELECTION CRITERIA: We included randomised controlled trials examining chemotherapy including at least two cycles of escalated BEACOPP regimens compared with chemotherapy including at least four cycles of ABVD regimens as first-line treatment for patients with early unfavourable stage or advanced stage HL. DATA COLLECTION AND ANALYSIS The effect measures we used were hazard ratios (HRs) for overall survival (OS), progression-free survival (PFS) and freedom from first progression.We used risk ratios (RRs) relative risks to analyse harms: treatment-related mortality, secondary malignancies (including myeloid dysplastic syndrome (MDS) or acute myeloid leukaemia (AML)), infertility and adverse events.Quality of life was not reported in any trial, therefore not analysed. Two review authors independently extracted data and assessed quality of trials. MAIN RESULTS We screened 1796 records and identified five eligible trials in total i.e. one trial could be added on the previous review. These trials included only adults (16 to 65 years of age). We included all five trials with 3427 people in the meta-analyses: the HD9 and HD14 trials were co-ordinated in Germany, the HD2000 and GSM-HD trials were performed in Italy and the EORTC 20012 was conducted in Belgium. The overall risk of performance and detection bias was low for overall survival (OS), but was high for other outcomes, as therapy blinding was not feasible. The remaining 'Risk of bias' domains were low and unclear.All trials reported results for OS and progression-free survival (PFS). In contrast to the our first published review (2011) the addition of results from the EORTC 20012 BEACOPP escalated increases OS (3142 participants; HR 0.74 (95% confidence interval (CI) 0.57 to 0.97; high-quality evidence). This means that only 90 (70 to 117) patients will die after five years in the BEACOPP escalated arm compared to 120 in the ABVD arm. This survival advantage is also reflected in an increased PFS with BEACOPP escalated (3142 participants; HR 0.54 (95% CI 0.45 to 0.64); moderate-quality evidence), meaning that after five years only 144 (121 to 168) patients will experience a progress, relapse or death in the BEACOPP escalated arm compared to 250 in the ABVD arm.There is no evidence for a difference for treatment-related mortality (2700 participants, RR 2.15 (95% CI = 0.93 to 4.95), low-quality evidence).Although the occurrence of MDS or AML may increase with BEACOPP escalated (3332 participants, RR 3.90 (95% CI 1.36 to 11.21); low-quality evidence)), there is no evidence for a difference between both regimens for overall secondary malignancies (3332 participants, RR 1.00 (95% CI 0.68 to 1.48), low-quality evidence). However, the observation time of the studies included in the review is too short to be expected to demonstrate differences with respect to second solid tumours which would not be expected to show significance until around 15 years after treatment.We are very uncertain how many female patients will be infertile due to chemotherapy and which arm might be favoured (106 participants, RR 1.37 (95% CI 0.83 to 2.26), very low-quality evidence). This is a very small sample, and the age of the patients was not detailed. No analysis of male fertility was provided.Five trials reported adverse events and the analysis shows that the escalated BEACOPP regimens probably causes more haematological toxicities WHO grade III or IV ((anaemia: 2425 participants, RR 10.67 (95% CI 7.14 to 15.93); neutropenia: 519 participants, RR 1.80 (95% CI 1.52 to 2.13); thrombocytopenia: 2425 participants, RR 18.12 (95% CI 11.77 to 27.92); infections: 2425 participants, RR 3.73 (95% CI 2.58 to 5.38), all low-quality evidence).Only one trial (EORTC 20012) planned to assess quality of life, however, no results were reported. AUTHORS' CONCLUSIONS This meta-analysis provides moderate- to high-quality evidence that adult patients between 16 and 60 years of age with early unfavourable and advanced stage HL benefit regarding OS and PFS from first-line chemotherapy including escalated BEACOPP. The proven benefit in OS for patients with advanced HL is a new finding of this updated review due to the inclusion of the results from the EORTC 20012 trial. Furthermore, there is only low-quality evidence of a difference in the total number of secondary malignancies, as the follow-up period might be too short to detect meaningful differences. Low-quality evidence also suggests that people treated with escalated BEACOPP may have a higher risk to develop secondary AML or MDS. Due to the availability of only very low-quality evidence available, we are unable to come to a conclusion in terms of infertility. This review does for the first time suggest a survival benefit. However, it is clear from this review that BEACOPP escalated may be more toxic that ABVD, and very important long-term side effects of second malignancies and infertility have not been sufficiently analysed yet.
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Affiliation(s)
- Nicole Skoetz
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50937
| | - Andrea Will
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50937
| | - Ina Monsef
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50937
| | - Corinne Brillant
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50937
| | - Andreas Engert
- University Hospital of CologneDepartment I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Bastian von Tresckow
- University Hospital of CologneDepartment I of Internal MedicineKerpener Str. 62CologneGermany50924
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146
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Bond DA, Alinari L. Emerging treatment options for the management of Hodgkin's lymphoma: clinical utility of nivolumab. J Blood Med 2017; 8:41-54. [PMID: 28546779 PMCID: PMC5436782 DOI: 10.2147/jbm.s117452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Classical Hodgkin's lymphoma (cHL) is a B-cell malignancy comprised of pathologic Reed Sternberg cells with a surrounding immune-tolerant inflammatory milieu. RS cells evade immune recognition in part through programmed death ligand 1 (PD-L1) overexpression, which is genetically programmed through copy number alterations, polysomy, and amplification of the 9p24.1 locus encoding PD-L1. By engaging with PD-1+ T-cells, PD-L1 delivers a potent immune suppressive signal promoting immunologic escape of the tumor cell. Enhancing antitumor immune response by targeting PD-1 with the monoclonal antibody nivolumab has proved to be effective in multiple solid tumors, but the highest response rates to date have been reported in patients with cHL, with over 65% of treated patients achieving an objective clinical response. In this review, we will summarize the published evidence regarding the activity of nivolumab in cHL as well as its current place in therapy. We will review the pharmacology, mechanism of action, and side effects of nivolumab as well as the emerging data indicating possible increased risk of graft versus host disease in patients treated with PD-1 inhibitors either pre- or post-allogeneic stem cell transplant. Given the remarkable single-agent activity and safety profile of PD-1 inhibitors in heavily pretreated patients with cHL, the possibility of employing nivolumab in combination with other active agents and earlier in therapy is a promising area of active investigation, and we will briefly summarize current clinical trials.
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Affiliation(s)
- David A Bond
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lapo Alinari
- Department of Internal Medicine, Division of Hematology, Arthur G James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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147
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Marr KC, Connors JM, Savage KJ, Goddard KJ, Deyell RJ. ABVD chemotherapy with reduced radiation therapy rates in children, adolescents and young adults with all stages of Hodgkin lymphoma. Ann Oncol 2017; 28:849-854. [PMID: 28327925 DOI: 10.1093/annonc/mdx005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Indexed: 11/13/2022] Open
Abstract
Background We adopted ABVD chemotherapy with risk-adapted radiation therapy (RT) as first-line therapy for children, adolescents and young adults with Hodgkin lymphoma (HL) in British Columbia in 2004. Patients and methods Patients ≤ 25 years diagnosed from 2004 to 2013 with all stages of HL who received ABVD as initial therapy were included. Results Among 55 children (age < 18 year) and 154 young adults (18-25 year), there were no significant differences among age groups for sex, histologic subtype, tumour bulk, B symptoms, prognostic risk groups or treatment received. The rates of complete response, partial response and progressive disease were 84%, 7% and 10% for children and 95%, 4% and 1% for young adults (P=0.01), respectively. Treatment failures in children all occurred within one year of completion, while 8/21 (38%) relapses in young adults occurred later (P=0.04). With a median follow-up of 66 months the 5-year progression-free (PFS) and overall survival (OS) were 85 ± 3% and 97 ± 1%, respectively. For limited stage disease, PFS was 90 ± 7% for children and 93 ± 3% for young adults (P=0.65); OS was 100% for both. For advanced stage patients, PFS and OS were also similar for the children and young adults (77 ± 7% versus 81 ± 4%; P=0.38 and OS 90 ± 6% versus 97 ± 2%; P=0.17). The rate of consolidative RT was low (21%) and did not differ between age groups. Conclusion ABVD is an effective treatment in children, adolescents and young adults with HL. Children were less likely to achieve complete response and demonstrated earlier relapses compared to young adults. RT may be omitted for the majority of patients while maintaining excellent 5-year OS.
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Affiliation(s)
- K C Marr
- Division of Paediatric Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children's Hospital
| | - J M Connors
- British Columbia Cancer Agency, Centre for Lymphoid Cancer
| | - K J Savage
- British Columbia Cancer Agency, Centre for Lymphoid Cancer
| | - K J Goddard
- British Columbia Cancer Agency, Department of Radiation Oncology, University of British Columbia, Vancouver, Canada
| | - R J Deyell
- Division of Paediatric Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children's Hospital
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148
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Yu WY, Geng M, Hao J, Chen M, Zhang SJ, Wang J, Mi JQ. Clinical Features and Prognosis Analysis of Hodgkin Lymphoma: A Multicenter Retrospective Study Over a Decade of Patients in China. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:274-282. [PMID: 28292586 DOI: 10.1016/j.clml.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/22/2016] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE There is little information available regarding Chinese patients with Hodgkin lymphoma (HL). We analyzed the clinical features, outcome, and prognostic factors of Chinese patients with HL, aiming to establish a new risk model for better risk-adapted therapeutic strategy. PATIENTS AND METHODS Patients with newly diagnosed HL at 4 medical centers from January 2000 to August 2014 were recruited. RESULTS A total of 150 patients were reviewed. The median age was 30 years (range, 15-91 years). At completion of initial therapy, 73.65% of patients achieved complete remission. The 5-year event-free survival (EFS) of the entire cohort was 61.1%, the overall survival was 84.7%, and the disease-free survival was 78.8%. B symptoms, extranodal involvement, and International Prognostic Score ≥ 3 remained as independent prognostic factors of EFS. Patients who failed to reach complete remission on interim positron emission tomography/computed tomography or computed tomography had a significantly worse outcome than those who did. A new risk model incorporating traditional risk factors and interim response stratified patients into 3 classes, with a 5-year EFS of 100%, 83.1%, and 33.1%, respectively (P < .0001). CONCLUSIONS General clinical features were comparable with those of Western patients, whereas therapeutic outcomes were slightly inferior. The novel risk assessment model showed potential as a more powerful prognostic tool by identifying 3 subsets of patients with significantly distinct outcomes, which warrants further validations.
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Affiliation(s)
- Wen-Yan Yu
- Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mei Geng
- Department of Oncology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Hao
- Department of Hematology, Shanghai North Station Hospital, Shanghai, China
| | - Mei Chen
- Department of Hematology, Shanghai Yang Pu Central Hospital Affiliated to Shanghai Tong Ji University, Shanghai, China
| | - Su-Jiang Zhang
- Department of Hematology, Rui Jin North Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jin Wang
- Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-Qing Mi
- Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Does interim 18F-FDG-PET response-adapted therapy really benefit advanced-stage Hodgkin lymphoma patients? Nucl Med Commun 2017; 37:1333-1334. [PMID: 27501435 DOI: 10.1097/mnm.0000000000000584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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150
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Progression-free survival of early interim PET-positive patients with advanced stage Hodgkin's lymphoma treated with BEACOPP escalated alone or in combination with rituximab (HD18): an open-label, international, randomised phase 3 study by the German Hodgkin Study Group. Lancet Oncol 2017; 18:454-463. [PMID: 28236583 DOI: 10.1016/s1470-2045(17)30103-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/01/2016] [Accepted: 12/05/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Advanced stage Hodgkin's lymphoma represents a heterogeneous group of patients with different risk profiles. Data suggests that interim PET assessment during chemotherapy is superior to baseline international prognostic scoring in terms of predicting long-term treatment outcome in patients with Hodgkin's lymphoma. We therefore hypothesised that early interim PET-imaging after two courses of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) might be suitable for guiding treatment in patients with advanced stage Hodgkin's lymphoma. We aimed to assess whether intensifying standard chemotherapy (BEACOPPescalated) by adding rituximab would improve progression-free survival in patients with positive PET after two courses of chemotherapy. METHODS In this open-label, international, randomised, phase 3 study, we recruited patients aged 18-60 years with newly diagnosed, advanced stage Hodgkin's lymphoma from 160 hospitals and 77 private practices in Germany, Switzerland, Austria, the Netherlands, and the Czech Republic. Interim PET-imaging was done after two cycles of BEACOPPescalated and centrally assessed by an expert panel. Patients with a positive PET after 2 cycles of BEACOPPescalated chemotherapy (PET-2) were randomly assigned (1:1) to receive six additional courses of either BEACOPPescalated (BEACOPPescalated group) or BEACOPPescalated plus rituximab (R-BEACOPPescalated group). PET-2 was assessed using a 5-point scale with 18FDG uptake higher than the mediastinal blood pool (corresponding to Deauville scale 3) defined as positive. BEACOPPescalated was given as previously described; rituximab was given intravenously at a dose of 375 mg/m2 (maximum total dose 700 mg), the first administration starting 24 h before starting the fourth cycle of BEACOPPescalated (day 0 and day 3 in cycle 4, day 1 in cycles 5-8). Randomisation was done centrally and used the minimisation method including a random component, stratified according to centre, age, stage, international prognostic score, and sex. The primary efficacy endpoint was 5 year progression-free survival, analysed in the intention-to-treat population. We are reporting this second planned interim analysis as the final report of the trial. The trial is registered with ClinicalTrials.gov, number NCT00515554. FINDINGS Between May 14, 2008, and May 31, 2011, we enrolled 1100 patients. 440 patients had a positive PET-2 and were randomly assigned to either the BEACOPPescalated group (n=220) or the R-BEACOPPescalated group (n=220). With a median follow-up of 33 months (IQR 25-42) for progression-free survival, estimated 3 year progression-free survival was 91·4% (95% CI 87·0-95·7) for patients in the BEACOPPescalated group and 93·0% (89·4-96·6) for those in the R-BEACOPPescalated group (difference 1·6%, 95% CI -4·0 to 7·3; log rank p=0·99). Common grade 3-4 adverse events were leucopenia (207 [95%] of 218 patients in the BEACOPPescalated group vs 211 [96%] of 220 patients in the R-BEACOPPescalated group), and severe infections (51 [23%] vs 43 [20%] patients). Based on a futility analysis, the independent data monitoring committee recommended publication of this second planned interim analysis as the final result. Six (3%) of 219 patients in the BEACOPPescalated group and ten (5%) of 220 in the R-BEACOPPescalated group died; fatal treatment-related toxic effects occurred in one (<1%) patient in the BEACOPPescalated group and three (1%) in the R-BEACOPPescalated group, all of them due to infection. INTERPRETATION The addition of rituximab to BEACOPPescalated did not improve the progression-free survival of PET-2 positive patients with advanced stage Hodgkin's lymphoma. However, progression-free survival for PET-2 positive patients was much better than expected, exceeding even the outcome of PET-2-unselected patients in the previous HD15 trial. Thus, PET-2 cannot identify patients at high-risk for treatment failure in the context of the very effective German Hodgkin Study Group standard treatment for advanced stage Hodgkin's lymphoma. FUNDING Deutsche Krebshilfe; Swiss State Secretariat for Education, Research and Innovation (SERI); and Roche Pharma.
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