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Burton C, Allen P, Herrera AF. Paradigm Shifts in Hodgkin Lymphoma Treatment: From Frontline Therapies to Relapsed Disease. Am Soc Clin Oncol Educ Book 2024; 44:e433502. [PMID: 38728605 DOI: 10.1200/edbk_433502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Combination chemotherapy with or without radiation has served as the primary therapeutic option for classic Hodgkin lymphoma (cHL), leading to durable remission in a majority of patients with early- and advanced-stage cHL. Patients with relapsed/refractory (RR) cHL could still be cured with salvage chemotherapy and autologous stem-cell transplantation. Brentuximab vedotin (BV) and the anti-PD-1-blocking antibodies, nivolumab and pembrolizumab, are highly effective treatments for cHL and have revolutionized the management of the disease. Recent studies incorporating BV and PD-1 blockade into salvage therapy for RR cHL and into frontline treatment regimens have changed the cHL treatment paradigm. The novel agents are also useful in the treatment of older patients who have poor outcomes with traditional therapy. This manuscript will review current strategies for approaching the management of previously untreated, RR, and challenging populations with cHL, including how to incorporate the novel agents.
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Affiliation(s)
- Cathy Burton
- Department of Haematology, St James's University Hospital, Leeds, United Kingdom
| | - Pamela Allen
- Department of Hematology and Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Alex F Herrera
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
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2
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Evens AM. Hodgkin lymphoma treatment for older persons in the modern era. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:483-499. [PMID: 38066840 PMCID: PMC10727079 DOI: 10.1182/hematology.2023000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
There has been a renewed effort globally in the study of older Hodgkin lymphoma (HL) patients, generating a multitude of new data. For prognostication, advancing age, comorbidities, altered functional status, Hispanic ethnicity, and lack of dose intensity (especially without anthracycline) portend inferior survival. Geriatric assessments (GA), including activities of daily living (ADL) and comorbidities, should be objectively measured in all patients. In addition, proactive multidisciplinary medical management is recommended (eg, geriatrics, cardiology, primary care), and pre-phase therapy should be considered for most patients. Treatment for fit older HL patients should be given with curative intent, including anthracyclines, and bleomycin should be minimized (or avoided). Brentuximab vedotin given sequentially before and after doxorubicin, vinblastine, dacarbazine (AVD) chemotherapy for untreated patients is tolerable and effective, and frontline checkpoint inhibitor/AVD platforms are rapidly emerging. Therapy for patients who are unfit or frail, whether due to comorbidities and/or ADL loss, is less clear and should be individualized with consideration of attenuated anthracycline-based therapy versus lower-intensity regimens with inclusion of brentuximab vedotin +/- checkpoint inhibitors. For all patients, there should be clinical vigilance with close monitoring for treatment-related toxicities, including neurotoxicity, cardiopulmonary, and infectious complications. Finally, active surveillance for "postacute" complications 1 to 10 years post therapy, especially cardiac disease, is needed for cured patients. Altogether, therapy for older HL patients should include anthracycline-based therapy in most cases, and novel targeted agents should continue to be integrated into treatment paradigms, with more research needed on how best to utilize GAs for treatment decisions.
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Affiliation(s)
- Andrew M. Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Noll JH, Levine BL, June CH, Fraietta JA. Beyond youth: Understanding CAR T cell fitness in the context of immunological aging. Semin Immunol 2023; 70:101840. [PMID: 37729825 DOI: 10.1016/j.smim.2023.101840] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
Population aging, a pervasive global demographic trend, is anticipated to challenge health and social systems worldwide. This phenomenon is due to medical advancements enabling longer lifespans, with 20% of the US population soon to be over 65 years old. Consequently, there will be a surge in age-related diseases. Senescence, characterized by the loss of biological maintenance and homeostasis at molecular and cellular levels, either correlates with or directly causes age-related phenotypic changes. Decline of the immune system is a critical factor in the senescence process, with cancer being a primary cause of death in elderly populations. Chimeric antigen receptor (CAR) T cell therapy, an innovative approach, has demonstrated success mainly in pediatric and young adult hematological malignancies but remains largely ineffective for diseases affecting older populations, such as late-in-life B cell malignancies and most solid tumor indications. This limitation arises because CAR T cell efficacy heavily relies on the fitness of the patient-derived starting T cell material. Numerous studies suggest that T cell senescence may be a key driver of CAR T cell deficiency. This review examines correlates and underlying factors associated with favorable CAR T cell outcomes and explores potential experimental and clinically actionable strategies for T cell rejuvenation.
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Affiliation(s)
- Julia Han Noll
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Bruce L Levine
- Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Carl H June
- Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph A Fraietta
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Current Treatment Options and the Role of Functional Status Assessment in Classical Hodgkin Lymphoma in Older Adults: A Review. Cancers (Basel) 2023; 15:cancers15051515. [PMID: 36900306 PMCID: PMC10000520 DOI: 10.3390/cancers15051515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Along with the fact that classical Hodgkin lymphoma (cHL) in older adults is frequently considered biologically different from cHL in younger patients, its most distinctive feature is its dismal clinical outcome due to the decreased effectiveness and greater toxicity of therapies. Although strategies to mitigate specific toxicities (e.g., cardiological and pulmonary) have obtained some results, in general, reduced-intensity schemes, proposed as an alternative to ABVD, have proved to be less effective. The addition of brentuximab vedotin (BV) to AVD, especially in a sequential scheme, has demonstrated good efficacy. However, the problem of toxicity persists even with this new therapeutic combination, with comorbidities remaining an important prognostic factor. The adequate stratification of functional status is necessary to distinguish between those patients who will benefit from full treatment and those who will benefit from alternative strategies. A simplified geriatric assessment based on the determination of ADL (activity of daily living), IADL (instrumental ADL), and CIRS-G (Cumulative Illness Rating Scale-Geriatric) scores is an easy-to-use tool that permits adequate patient stratification. Other factors of considerable impact on functional status such as sarcopenia and immunosenescence are currently being studied. A fitness-based treatment choice would also be very useful for relapsed or refractory patients, a more frequent and challenging situation than that is found in young cHL patients.
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Sharma M, Goyal P, Ranjan R, Maheshwari U, Bhurani D, Aggarwal C, Koyyala VPB, Jain P, Agrawal N, Ahmed R. Clinical and Epidemiological Profile of Elderly Hodgkin’s Lymphoma in India. Cureus 2022; 14:e26906. [PMID: 35983400 PMCID: PMC9376209 DOI: 10.7759/cureus.26906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 11/05/2022] Open
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Zilioli VR, Albano D, Arcari A, Merli F, Coppola A, Besutti G, Marcheselli L, Gramegna D, Muzi C, Manicone M, Camalori M, Ciammella P, Colloca G, Tucci A. Clinical and prognostic role of sarcopenia in elderly patients with classical Hodgkin lymphoma: a multicentre experience. J Cachexia Sarcopenia Muscle 2021; 12:1042-1055. [PMID: 34114749 PMCID: PMC8350211 DOI: 10.1002/jcsm.12736] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/31/2021] [Accepted: 05/21/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Elderly classical Hodgkin lymphoma (cHL) (ecHL) is a rare disease with dismal prognosis and no standard treatment. Fitness-based approaches may help design appropriate treatments. Sarcopenia has been associated with an increased risk of treatment-related toxicities and worse survival in various solid tumours, but its impact in ecHL is unknown. The aim of this retrospective multicentre study was to investigate the prognostic role of sarcopenia in ecHL. METHODS We included newly diagnosed >64 years old cHL patients who performed a baseline comprehensive geriatric assessment and high-dose computed tomography (CT) or 18fluorine-fluorodeoxyglucose positron emission tomography/CT before any treatment. Sarcopenia was measured as skeletal muscle index (SMI, cm2 /m2 ) by the analysis of high-dose CT or low-dose positron emission tomography/CT images at the L3 level. The specific cut-offs for the SMI were determined by receiver operator curve analysis and compared with those proposed in literature and studied in diffuse large B-cell lymphoma. Survival functions [progression-free survival [PFS] and overall survival (OS)] were calculated for the whole population and for different subgroups defined as per different sarcopenia cut-off levels. RESULTS We included 154 patients (median age 71 years old, 76 female). The median L3-SMI was 42 cm2 /m2 . The specific cut-off derived in our male population was 45 cm2 /m2 ; using this cut-off, 27 male patients (35%) were defined as sarcopenic. After a median follow-up of 5.9 years, the overall 5-year PFS and OS rates were 53% and 65%, respectively, and were significantly shorter in sarcopenic male patients compared with non-sarcopenic (PFS 31% vs. 61%, P = 0.008; OS 51% vs. 74%, P = 0.042). Applying diffuse large B-cell lymphoma-derived sarcopenic thresholds, there were no significant differences between sarcopenic and non-sarcopenic patients for both PFS and OS, with a sole exception of a significant reduced PFS in sarcopenic male patients using Namakura cut-off. The comprehensive geriatric assessment-determined frail functional status was an independent adverse prognostic factor for both female and male patients. CONCLUSIONS Baseline evaluation of sarcopenia through radiological examinations performed for ecHL staging may help define a proportion of male patients with unfavourable outcome with current treatment strategies. Also the functional status evaluation could allow to identify a frail subgroup of patients with worse outcome.
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Affiliation(s)
| | - Domenico Albano
- Division of Nuclear Medicine, ASST Spedali Civili, Brescia, Italy
| | - Annalisa Arcari
- Division of Hematology, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Francesco Merli
- Division of Hematology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Coppola
- Division of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulia Besutti
- Division of Radiology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Marcheselli
- Fondazione Italiana Linfomi Onlus, Trial Office Modena, Modena, Italy
| | | | - Cristina Muzi
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Moana Manicone
- Clinical and Experimental PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Division of Radiotherapy, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Manuela Camalori
- Division of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Patrizia Ciammella
- Division of Radiotherapy, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Colloca
- Division of Geriatrics, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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Evens AM, Carter J, Loh KP, David KA. Management of older Hodgkin lymphoma patients. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:233-242. [PMID: 31808898 PMCID: PMC6913478 DOI: 10.1182/hematology.2019000028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Hodgkin lymphoma (HL) in older patients, commonly defined as ≥60 years of age, is a disease for which survival rates have historically been significantly lower compared with younger patients. Older HL patients appear to have different disease biology compared with younger patients, including increased incidence of mixed cellularity histology, Epstein-Barr virus-related, and advanced-stage disease. For prognostication, several studies have documented the significance of comorbidities and functional status in older HL patients, as well as the importance of achieving initial complete remission. Collectively, selection of therapy for older HL patients should be based in part on functional status, including pretreatment assessment of activities of daily living (ADL), comorbidities, and other geriatric measures (eg, cognition, social support). Treatment of fit older HL patients should be given with curative intent, regardless of disease stage. However, attention should be paid to serious treatment-related toxicities, including risk of treatment-related mortality. Although inclusion of anthracycline therapy is important, bleomycin-containing regimens (eg, doxorubicin, bleomycin, vinblastine, dacarbazine) may lead to prohibitive pulmonary toxicity, and intensive therapies (eg, bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) are too toxic. Brentuximab vedotin given sequentially before and after doxorubicin, vinblastine, and dacarbazine to fit, untreated advanced-stage older HL patients was recently shown to be tolerable and highly effective. Therapy for patients who are unfit or frail because of comorbidities and/or ADL loss is less clear and should be individualized with consideration of lower-intensity therapy, such as brentuximab vedotin with or without dacarbazine. Altogether, therapy for older HL patients should be tailored based upon a geriatric assessment, and novel targeted agents should continue to be integrated into treatment paradigms.
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Affiliation(s)
- Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and
| | - Jordan Carter
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and
| | - Kah Poh Loh
- Division of Hematology and Oncology, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Kevin A David
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and
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8
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O'Brien K, McKoy JM, Penedo F. Cancer Comorbidity: Implications for Drug Safety. Cancer Treat Res 2019; 171:21-35. [PMID: 30552654 DOI: 10.1007/978-3-319-43896-2_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cancer is primarily a disease of aging. This chapter discusses relevant aspect of the physiology of aging, medication use and toxicity, comorbidities, and specific challenges in treating older adults with cancer.
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Affiliation(s)
| | - June M McKoy
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Frank Penedo
- Department of Medicine, Northwestern University, Chicago, IL, USA
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9
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Major A, Jackson MW, Smith DE, Kamdar M, Rabinovitch R. Inferior outcomes and treatment disparities in elderly patients with classical Hodgkin lymphoma: a national cancer data base analysis. Leuk Lymphoma 2018; 60:1234-1243. [PMID: 30501432 DOI: 10.1080/10428194.2018.1522435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Elderly patients with classical Hodgkin lymphoma (cHL) are understudied and poorly defined. The National Cancer Data Base was queried for adults with cHL diagnosed 2004-2013: 22,547 age 18-39, 12,841 age 40-59, and 10,873 age ≥60 were identified. Two-year overall survival (OS) was 97%, 91%, and 65% for the three age cohorts, respectively (p < .0001). Elderly patients age ≥60 had greater advanced comorbidity scores, stage III-IV disease, and lymphocyte-depleted histology. Elderly patients were treated less with chemotherapy, radiotherapy for stage I-II disease, and at academic/research centers (p < .001). There was improved OS in elderly patients who received chemotherapy and/or radiotherapy and were treated at academic/research centers. This largest analysis of elderly cHL demonstrates that patients ≥60 are distinct from those 40-59. Age ≥60 should be a stratification in future trials and merit distinct studies. Improving the poor rate of treatment delivery and directing care to academic centers may improve outcomes.
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Affiliation(s)
- Ajay Major
- a Department of Medicine , Internal Medicine Residency Training Program, University of Colorado School of Medicine , Aurora , CO , USA
| | - Matthew W Jackson
- b Department of Radiation Oncology , University of Colorado School of Medicine , Aurora , CO , USA
| | - Derek E Smith
- c Department of Pediatrics , Cancer Center Biostatistics Core, University of Colorado School of Medicine , Aurora , CO , USA
| | - Manali Kamdar
- d Department of Medicine , Division of Hematology, University of Colorado School of Medicine , Aurora , CO , USA
| | - Rachel Rabinovitch
- b Department of Radiation Oncology , University of Colorado School of Medicine , Aurora , CO , USA
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Mancuso S, Carlisi M, Santoro M, Napolitano M, Raso S, Siragusa S. Immunosenescence and lymphomagenesis. IMMUNITY & AGEING 2018; 15:22. [PMID: 30258468 PMCID: PMC6151062 DOI: 10.1186/s12979-018-0130-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/07/2018] [Indexed: 12/13/2022]
Abstract
One of the most important determinants of aging-related changes is a complex biological process emerged recently and called “immunosenescence”. Immunosenescence refers to the inability of an aging immune system to produce an appropriate and effective response to challenge. This immune dysregulation may manifest as increased susceptibility to infection, cancer, autoimmune disease, and vaccine failure. At present, the relationship between immunosenescence and lymphoma in elderly patients is not defined in a satisfactory way. This review presents a brief overview of the interplay between aging, cancer and lymphoma, and the key topic of immunosenescence is addressed in the context of two main lymphoma groups, namely Non Hodgkin Lymphoma (NHL) and Hodgkin Lymphoma (HL). Epstein Barr Virus (EBV) plays a central role in the onset of neoplastic lymphoproliferation associated with immunological changes in aging, although the pathophysiology varies vastly among different disease entities. The interaction between immune dysfunction, immunosenescence and Epstein Barr Virus (EBV) infection appears to differ between NHL and HL, as well as between NHL subtypes.
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Affiliation(s)
- Salvatrice Mancuso
- 1Haematology, Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Melania Carlisi
- 2Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Marco Santoro
- 2Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Mariasanta Napolitano
- 1Haematology, Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Simona Raso
- 2Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Sergio Siragusa
- 1Haematology, Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
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Wróbel T, Biecek P, Rybka J, Szulgo A, Sorbotten N, Giza A, Tyczyńska A, Nowara E, Badora-Rybicka A, Adamowicz K, Kulikowski W, Kroll-Balcerzak R, Balcerzak A, Spychałowicz W, Kalinka-Warzocha E, Kumiega B, Drozd-Sokołowska J, Subocz E, Sałek A, Machaczka M, Hołojda J, Pogrzeba J, Dobrzyńska O, Chmielowska E, Jurczak W, Knopińska-Posłuszny W, Leśniewski-Kmak K, Maciej Zaucha J. Hodgkin lymphoma of the elderly patients: a retrospective multicenter analysis from the Polish Lymphoma Research Group. Leuk Lymphoma 2018; 60:341-348. [DOI: 10.1080/10428194.2018.1482539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Tomasz Wróbel
- Department of Hematology, Wroclaw Medical University, Wrocław, Poland
| | - Przemysław Biecek
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Justyna Rybka
- Department of Hematology, Wroclaw Medical University, Wrocław, Poland
| | - Anna Szulgo
- Department of Oncology, Center of Oncology of Professor Franciszek Łukaszczyk, Bydgoszcz, Poland
| | - Natalia Sorbotten
- Department of Oncology, Center of Oncology of Professor Franciszek Łukaszczyk, Bydgoszcz, Poland
| | - Agnieszka Giza
- Department of Hematology, Collegium Medicum of the Jagiellonian University, Kraków, Poland
| | - Agata Tyczyńska
- Department of Oncology and Radiotherapy, Gdynia Oncology Center, Gdynia, Poland
| | - Elżbieta Nowara
- Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | | | | | | | | | - Andrzej Balcerzak
- Department of Hematology, University of Medical Sciences, Poznan, Poland
| | - Wojciech Spychałowicz
- Internal Medicine and Oncology Clinic, Silesian Medical University, Katowice, Poland
| | | | - Beata Kumiega
- Department of Hematology, Brzozow Oncology Center, Brzozów, Poland
| | - Joanna Drozd-Sokołowska
- Department of Haematology, Oncology and Internal Medicine, The Medical University of Warsaw, Warsaw, Poland
| | - Edyta Subocz
- Department of Haematology, Military Institute of Medicine in Warsaw, Warsaw, Poland
| | - Agata Sałek
- Department of Hematology KSW No.1 and Medical Faculty, University of Rzeszow, Rzeszow, Poland
| | - Maciej Machaczka
- Department of Hematology KSW No.1 and Medical Faculty, University of Rzeszow, Rzeszow, Poland
| | - Jadwiga Hołojda
- Department of Hematology, Provincial Specialist Hospital, Legnica, Poland
| | - Joanna Pogrzeba
- Department of Hematology, Provincial Specialist Hospital, Opole, Poland
| | - Olga Dobrzyńska
- Department of Hematology, Wroclaw Medical University, Wrocław, Poland
| | - Ewa Chmielowska
- Department of Oncology, Center of Oncology of Professor Franciszek Łukaszczyk, Bydgoszcz, Poland
| | - Wojciech Jurczak
- Department of Hematology, Collegium Medicum of the Jagiellonian University, Kraków, Poland
| | | | - Krzysztof Leśniewski-Kmak
- Department of Oncology and Radiotherapy, Gdynia Oncology Center, Gdynia, Poland
- Department of Oncological Propaedeutics, Medical University of Gdańsk, Gdańsk, Poland
| | - Jan Maciej Zaucha
- Department of Oncology and Radiotherapy, Gdynia Oncology Center, Gdynia, Poland
- Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk, Poland
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12
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Levis A, Pietrasanta D, Anselmo AP, Ambrosetti A, Bertini M. Treatment of Elderly Hodgkin's Lymphoma Patients. The Experience of the Italian Lymphoma Intergroup. TUMORI JOURNAL 2018; 88:S29-31. [PMID: 11989917 DOI: 10.1177/030089160208800109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alessandro Levis
- Haematology Department, Ospedale SS Antonio e Biagio, Alessandria
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13
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The absolute lymphocyte to monocyte ratio is associated with poor prognosis in classical Hodgkin lymphoma patients younger than 60 years of age. Hematol Oncol 2014; 33:133-40. [DOI: 10.1002/hon.2155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 05/28/2014] [Accepted: 06/25/2014] [Indexed: 11/07/2022]
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14
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Böll B, Görgen H, Fuchs M, Pluetschow A, Eich HT, Bargetzi MJ, Weidmann E, Junghanß C, Greil R, Scherpe A, Schmalz O, Eichenauer DA, von Tresckow B, Rothe A, Diehl V, Engert A, Borchmann P. ABVD in Older Patients With Early-Stage Hodgkin Lymphoma Treated Within the German Hodgkin Study Group HD10 and HD11 Trials. J Clin Oncol 2013; 31:1522-9. [DOI: 10.1200/jco.2012.45.4181] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Older patients with Hodgkin lymphoma (HL) account for approximately 20% of all HL patients. ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy is regarded as standard of care in these patients. However, little is known on feasibility and efficacy of ABVD in this age group. Patients and Methods We analyzed the feasibility and efficacy of four cycles of ABVD in older patients age 60 to 75 years with early-stage HL who were treated within the German Hodgkin Study Group (GHSG) HD10 and HD11 trials; results were compared with those of younger patients treated within these trials. Results In total, 1,299 patients received four cycles of ABVD, and 117 of those patients were older than age 60 years (median, 65 years). In 14% of older patients, treatment was not administered according to protocol, mainly because of excessive toxicity. The mean delay of treatment was twice as high in the older patients (2.2 v 1.2 weeks). Fifty-nine percent of older patients achieved a relative dose-intensity of at least 80% compared with 85% of younger patients. Major toxicity (WHO grade 3 and 4), including leucopenia, nausea, infection, and others, was documented in 68% of older patients with a treatment-related mortality of 5%. Complete response was achieved in 89% of older patients, 3% had progressive disease, and 11% relapsed. At a median observation time of 92 months, 28% of the patients had died, and the 5-year progression-free survival estimate was 75% (95% CI, 66% to 82%). Conclusion In patients age ≥ 60 years with HL, four cycles of ABVD is associated with substantial dose reduction, treatment delay, toxicity, and treatment-related mortality.
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Affiliation(s)
- Boris Böll
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Helen Görgen
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Michael Fuchs
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Annette Pluetschow
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Hans Theodor Eich
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Mario J. Bargetzi
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Eckhart Weidmann
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Christian Junghanß
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Richard Greil
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Alexander Scherpe
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Oliver Schmalz
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Dennis A. Eichenauer
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Bastian von Tresckow
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Achim Rothe
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Volker Diehl
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Andreas Engert
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Peter Borchmann
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
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15
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Evens AM, Hong F. How Can Outcomes Be Improved for Older Patients With Hodgkin Lymphoma? J Clin Oncol 2013; 31:1502-5. [DOI: 10.1200/jco.2012.47.3058] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andrew M. Evens
- The University of Massachusetts Medical School and University of Massachusetts Memorial Cancer Center, Worcester, MA
| | - Fangxin Hong
- Dana-Farber Cancer Institute and Harvard School of Public Health, Boston, MA
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16
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Evens AM, Hong F, Gordon LI, Fisher RI, Bartlett NL, Connors JM, Gascoyne RD, Wagner H, Gospodarowicz M, Cheson BD, Stiff PJ, Advani R, Miller TP, Hoppe RT, Kahl BS, Horning SJ. The efficacy and tolerability of adriamycin, bleomycin, vinblastine, dacarbazine and Stanford V in older Hodgkin lymphoma patients: a comprehensive analysis from the North American intergroup trial E2496. Br J Haematol 2013; 161:76-86. [PMID: 23356491 DOI: 10.1111/bjh.12222] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 12/17/2012] [Indexed: 11/29/2022]
Abstract
There is a lack of contemporary prospective data examining the adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) and Stanford V (SV; doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, prednisone) regimens in older Hodgkin lymphoma (HL) patients. Forty-four advanced-stage, older HL patients (aged ≥60 years) were treated on the randomized study, E2496. Toxicities were mostly similar between chemotherapy regimens, although 24% of older patients developed bleomycin lung toxicity (BLT), which occurred mainly with ABVD (91%). Further, the BLT-related mortality rate was 18%. The overall treatment-related mortality for older HL patients was 9% vs. 0·3% for patients aged <60 years (P < 0·001). Among older patients, there were no survival differences between ABVD and SV. According to age, outcomes were significantly inferior for older versus younger patients (5-year failure-free survival: 48% vs. 74%, respectively, P = 0·002; 5-year overall survival: 58% and 90%, respectively, P < 0·0001), although time-to-progression (TTP) was not significantly different (5-year TTP: 68% vs. 78%, respectively, P = 0·37). Furthermore, considering progression and death without progression as competing risks, the risk of progression was not different between older and younger HL patients (5 years: 30% and 23%, respectively, P = 0·30); however, the incidence of death without progression was significantly increased for older HL patients (22% vs. 9%, respectively, P < 0·0001). Altogether, the marked HL age-dependent survival differences appeared attributable primarily to non-HL events.
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Affiliation(s)
- Andrew M Evens
- The University of Massachusetts Medical School, Worcester, MA 01655, USA.
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17
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A retrospective multicenter analysis of elderly Hodgkin lymphoma: outcomes and prognostic factors in the modern era. Blood 2012; 119:692-5. [DOI: 10.1182/blood-2011-09-378414] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractWe investigated a recent (January 1999 to December 2009) cohort of 95 elderly Hodgkin lymphoma subjects. At diagnosis, median age was 67 years (range, 60-89 years), whereas 61% had significant comorbidity, 26% were unfit, 17% had a geriatric syndrome, and 13% had loss of activities of daily living. Overall response rate to therapy was 85%, whereas incidence of bleomycin lung toxicity was 32% (with associated mortality rate, 25%). With 66-month median follow-up, 2-year and 5-year overall survival were 73% and 58%, respectively (advanced-stage, 63% and 46%, respectively). Most International Prognostic Score factors were not prognostic on univariate analyses, whereas Cox multivariate regression identified 2 risk factors associated with inferior overall survival: (1) age more than 70 years (2.24; 95% CI, 1.16-4.33, P = .02) and (2) loss of activities of daily living (2.71; 95% CI, 1.07-6.84, P = .04). Furthermore, a novel survival model based on number of these risk factors (0, 1, or 2) showed differential 2-year OS of 83%, 70%, and 13%, respectively (P < .0001) and 5-year OS of 73%, 51%, and 0%, respectively (P < .0001).
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18
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ABVD as the Treatment Option in Advanced Hodgkin’s Lymphoma Patients Older than 45 Years. Pathol Oncol Res 2012; 18:675-80. [DOI: 10.1007/s12253-011-9494-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 09/06/2011] [Indexed: 10/14/2022]
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19
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Halbsguth TV, Böll B, Borchmann P, Diehl V. The unique characteristics and management of patients over 60 years of age with classic Hodgkin lymphoma. Curr Hematol Malig Rep 2011; 6:164-71. [PMID: 21553348 DOI: 10.1007/s11899-011-0089-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In recent decades, the prognosis of Hodgkin lymphoma has been substantially improved, but these successes have been restricted to younger patients and could not be translated into a major benefit for older patients, especially those with advanced-stage disease. Major problems in treating older patients include a different biology, frailty, comorbidities, and poorer tolerance of therapy. Additionally, these patients are often excluded from randomized trials, so an evidence-based standard of care is lacking. Importantly, the proportion of older patients with HL will increase over the next 50 years. Currently, ABVD (Adriamycin [doxorubicin], bleomycin, vinblastine, and dacarbazine) is considered to be the gold standard, even though it has some toxicity in older patients and prospective data are not available. Thus, further studies are required, including the assessment of comorbidities and the incorporation of new drugs such as immunomodulatory agents, antibody-drug conjugates, mTOR inhibitors, or histone deacetylase (HDAC) inhibitors.
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Affiliation(s)
- Teresa V Halbsguth
- First Department of Internal Medicine, German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany.
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20
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Borchmann P, Haverkamp H, Diehl V, Cerny T, Markova J, Ho AD, Eich HT, Mueller-Hermelink HK, Kanz L, Greil R, Rank A, Paulus U, Smardova L, Huber C, Dörken B, Nerl C, Krause SW, Mueller RP, Fuchs M, Engert A. Eight Cycles of Escalated-Dose BEACOPP Compared With Four Cycles of Escalated-Dose BEACOPP Followed by Four Cycles of Baseline-Dose BEACOPP With or Without Radiotherapy in Patients With Advanced-Stage Hodgkin's Lymphoma: Final Analysis of the HD12 Trial of the German Hodgkin Study Group. J Clin Oncol 2011; 29:4234-42. [DOI: 10.1200/jco.2010.33.9549] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Eight cycles of BEACOPPescalated (escalated dose of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) followed by radiotherapy (RT) to initial bulk or residual tumor mass is the German Hodgkin Study Group standard of care for advanced-stage Hodgkin's lymphoma (HL). However, treatment-related toxicity is a concern, and the role of RT in this setting is unclear. The HD12 study thus aimed to reduce toxicity while maintaining efficacy. Patients and Methods In this prospectively randomized multicenter trial, eight cycles of BEACOPPescalated was compared with four cycles of BEACOPPescalated followed by four cycles of the baseline dose of BEACOPP (BEACOPPbaseline; 4 + 4), and RT with no RT in the case of initial bulk or residual disease. The study was designed to exclude a difference in 5-year freedom from treatment failure (FFTF) rate of 6%. Results Between January 1999 and January 2003, 1,670 patients age 16 to 65 years were enrolled onto the HD12 study. At 5 years, FFTF was 86.4% in the BEACOPPescalated arm and 84.8% in the 4 + 4 arm (difference, −1.6%; 95% CI, −5.2% to 1.9%), and overall survival was 92% versus 90.3% (difference, −1.7%; 95% CI, −4.6% to 1.1%). Deaths related to acute toxicity of chemotherapy were observed in 2.9% of patients (BEACOPPescalated, n = 19; 4 + 4, n = 27). FFTF was inferior without RT (90.4% v 87%; difference, −3.4%; 95% CI, −6.6% to −0.1%), particularly in patients who had residual disease after chemotherapy (difference, −5.8%; 95% CI, −10.7% to −1.0%), but not in patients with bulk in complete response after chemotherapy (difference, −1.1%; 95% CI, −6.2% to 4%). Conclusion The reduction of BEACOPP to the 4 + 4 regimen did not substantially reduce severe toxicity but might decrease efficacy. Our results do not support the omission of consolidation RT for patients with residual disease. Alternative strategies for improving the risk-to-benefit ratio for patients with advanced HL are needed.
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Affiliation(s)
- Peter Borchmann
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Heinz Haverkamp
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Volker Diehl
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Thomas Cerny
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Jana Markova
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Anthony D. Ho
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Hans-Theodor Eich
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Hans Konrad Mueller-Hermelink
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Lothar Kanz
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Richard Greil
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Andreas Rank
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Ursula Paulus
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Lenka Smardova
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Christoph Huber
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Bernd Dörken
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Christoph Nerl
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Stefan W. Krause
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Rolf-Peter Mueller
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Michael Fuchs
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Andreas Engert
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
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Carbone A, Spina M, Gloghini A, Tirelli U. Classical Hodgkin's lymphoma arising in different host's conditions: pathobiology parameters, therapeutic options, and outcome. Am J Hematol 2011; 86:170-9. [PMID: 21264899 DOI: 10.1002/ajh.21910] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Epidemiologic and molecular findings suggest that classical Hodgkin's lymphoma (CHL) is not a single disease but consists of more than one entity and may occur in different clinical settings. This review analyzes similarities and disparities among CHL entities arising in different host's conditions with respect to pathobiology parameters, therapeutic options, and outcome. For the purpose of this analysis, CHL entities have been subdivided according to the immune status of the host. In nonimmunosuppressed hosts, according to the age, CHL include pediatric, adult, and elderly forms, whereas, in immunosuppressed hosts, according to the type of immunosuppression, CHL include human immunodeficiency virus (HIV)-associated, iatrogenic, and post-transplant types. CHL entities in different settings are similar in morphology of neoplastic cells, expression of activation markers, and aberrations/activation of NFKB, JAK/STAT, and P13K/AKT pathways, but differ in the association with Epstein-Barr virus (EBV) infection, persistent B-cell phenotype, and cellular background composition. Large B-cell lymphomas resembling CHL may also be observed in the same clinical settings. These lesions, however, do not fulfill the diagnostic criteria of CHL and clinically display a very aggressive behavior. In this article, current treatment options for the CHL entities, especially for elderly CHL and HIV-associated CHL, are specifically reviewed. ABVD remains the gold standard both in nonimmunosuppressed or immunosuppressed hosts even if there are several data suggesting a possible improvement in outcome using the aggressive BEACOPP regimen in advanced stages. Refractory CHL, a clinical condition that may occur throughout the entire spectrum of CHL, is discussed separately.
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Affiliation(s)
- Antonino Carbone
- Division of Pathology, Centro di Riferimento Oncologico Aviano, Istituto Nazionale Tumori, Aviano, Italy
| | - Michele Spina
- Department of Medical Oncology, Centro di Riferimento Oncologico Aviano, Istituto Nazionale Tumori, Aviano, Italy
| | - Annunziata Gloghini
- Department of Diagnostic Pathology and Laboratory Medicine, Istituto Nazionale Tumori, Milano, Italy
| | - Umberto Tirelli
- Department of Medical Oncology, Centro di Riferimento Oncologico Aviano, Istituto Nazionale Tumori, Aviano, Italy
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Phase 2 study of BACOPP (bleomycin, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone) in older patients with Hodgkin lymphoma: a report from the German Hodgkin Study Group (GHSG). Blood 2010; 116:2026-32. [DOI: 10.1182/blood-2009-11-253211] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractFor older patients with early unfavorable or advanced stage Hodgkin lymphoma (HL) the prognosis is much worse than for younger HL patients. We thus developed a new regimen, BACOPP (bleomycin, adriamycin, cyclophosphamide, vincristine, procarbazine, and prednisone), to improve both tolerability and efficacy of treatment for older HL patients. Between 2004 and 2005, 65 patients with early unfavorable or advanced stage HL aged between 60 and 75 years were enrolled in this phase 2 trial. Treatment consisted of 6 to 8 cycles of BACOPP. Residual tumor masses were irradiated. Primary endpoints were feasibility as determined by adherence to protocol and overall response rate. Secondary endpoints included toxicity, freedom from treatment failure, and progression free and overall survival. For the final analysis 60 patients (92%) were eligible; 75% of treatment courses were administered according to protocol. World Health Organization grade 3/4 toxicities occurred in 52 patients. Fifty-one patients (85%) achieved complete remission, 2 (3%) partial remission, and 4 (7%) developed progressive disease. With a median observation time of 33 months, 18 patients died (30%), including 7 treatment-associated deaths. Three patients died before response assessment. Thus, the BACOPP regimen is active in older HL patients but is compromised by a high rate of toxic deaths. This trial was registered at www.clinicaltrials.gov as #NCT00284271.
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Jayasekara H, Karahalios A, Juneja S, Thursfield V, Farrugia H, English DR, Giles GG. Incidence and survival of lymphohematopoietic neoplasms according to the World Health Organization classification: a population-based study from the Victorian Cancer Registry in Australia. Leuk Lymphoma 2010; 51:456-68. [PMID: 20141433 DOI: 10.3109/10428190903552104] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hodgkin lymphoma in the elderly: a clinical review of treatment and outcome, past, present and future. Crit Rev Oncol Hematol 2009; 71:222-32. [PMID: 19179093 DOI: 10.1016/j.critrevonc.2008.12.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 11/28/2008] [Accepted: 12/10/2008] [Indexed: 12/27/2022] Open
Abstract
Hodgkin lymphoma (HL) is a curable cancer in the vast majority of patients under the age of 60 years. Because of the rarity of the disease in older people, and age related factors such as co-morbidity, inability to tolerate aggressive chemotherapy, poor ECOG status at presentation and issues relating to frailty, the literature is sparse and no prospective randomised studies exist. The incidence of HL in the over 60s range between 10% and 20% of the disease overall and, as a potentially curable cancer, new specific treatment approaches designed for the elderly are necessary. This review discusses the available data in relation to treatments and outcome to date, and proposes how future studies and evaluations might be constructed for this disease. The SHIELD study (Study of Hodgkin lymphoma in the Elderly/Lymphoma Database) is a current example of an approach aimed at objectively defining some of the difficulties of this patient population.
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Abstract
Hodgkin's lymphoma (HL) has a unique and distinct history, epidemiology, treatment, and biology. A viral agent or infectious agent has long been considered as the etiologic agent and Epstein-Barr virus is the main candidate for the infectious agent causing HL; however, Epstein-Barr virus genome is found within the tumor in only about 20% to 40% of HL cases with a prior diagnosis of infectious mononucleosis. Recently, autoimmune and related conditions have drawn attention to a potential role for immune-related and inflammatory conditions in the etiology and pathogenesis of the malignancy. Evidence from multiply-affected families, a twin study, a case-control study, and population-based registry studies implicate genetic factors. Data from Eastern Asia and among Chinese immigrants in North America indicate increasing incidence trends for HL being associated with westernization. These results emphasize an interaction between environmental and genetic risk factors in HL.
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Kolstad A, Nome O, Delabie J, Lauritzsen GF, Fossa A, Holte H. Standard CHOP-21 as first line therapy for elderly patients with Hodgkin's lymphoma. Leuk Lymphoma 2009; 48:570-6. [PMID: 17454601 DOI: 10.1080/10428190601126610] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is no consensus on the optimal chemotherapy regimen for Hodgkin's lymphoma patients > or = 60 years. We present our institution's results of 5 years, using CHOP-21 as standard for this patient group. Twenty-nine patients with a median age of 71 years (range, 60 - 91) were included in this cohort. Fifty-five percent had known co-morbidities. Stage I/IIA patients (38%) were treated with 2 - 4 cycles of CHOP followed by radiotherapy. Stage IIB - IV patients (62%) received 6 - 8 cycles of CHOP and for the majority (13/18 pts) no radiotherapy. Two treatment-related deaths occurred. Febrile neutropenia was the most common toxicity (31%). The complete response rate after CHOP +/- radiotherapy was 93%. With a median follow-up of 41 months, five patients have relapsed and four have died from Hodgkin's lymphoma. So far, no relapses have occurred after 2 years from the end of therapy. Overall survival and progression-free survival at 3 years were 79% and 76%, respectively. We conclude that CHOP-21 is a well-tolerated and effective treatment for elderly patients with Hodgkin's lymphoma.
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Affiliation(s)
- A Kolstad
- Department of Medical Oncology and Radiotherapy, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway.
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Feltl D, Vítek P, Zámecník J. Hodgkin's lymphoma in the elderly: The results of 10 years of follow-up. Leuk Lymphoma 2009; 47:1518-22. [PMID: 16966262 DOI: 10.1080/10428190500518602] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Elderly patients with Hodgkin's lymphoma carry a worse prognosis than younger patients because of a higher incidence of advanced stages, a worse performance status and the intolerance of full-dose curative treatment. A retrospective analysis of patients treated at our institution was performed. Our retrospective study summarizes the treatment results for 52 Hodgkin's lymphoma patients aged older than 60 years between 1973 and 1993. These patients were treated with combination of less toxic chemotherapy schedule (cyclophosphamide, vincristine, procarbazine and prednisone) and/or involved-field radiotherapy. The aim was to maintain an acceptable quality of life in spite of lower remission rate. The 5- and 10-year overall survival rates were 48% and 33%, respectively. We found two independent prognostic factors for overall survival: (i) stage of the disease and (ii) accomplishment of the treatment. Combined modality treatment yielded better results than chemotherapy. Tolerance of the treatment was acceptable. The present study demonstrates that a combination of mild chemotherapy with limited radiotherapy is a feasible way of treating elderly patients with Hodgkin's lymphoma.
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Affiliation(s)
- David Feltl
- Department of Radiotherapy and Oncology, Third Faculty of Medicine, University Hospital Královské, Vinohrady, Czech Republic.
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Seegmiller AC, Karandikar NJ, Kroft SH, McKenna RW, Xu Y. Overexpression of CD7 in classical Hodgkin lymphoma-infiltrating T lymphocytes. CYTOMETRY PART B-CLINICAL CYTOMETRY 2009; 76:169-74. [DOI: 10.1002/cyto.b.20459] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ongoing improvement in long-term survival of patients with Hodgkin disease at all ages and recent catch-up of older patients. Blood 2008; 111:2977-83. [DOI: 10.1182/blood-2007-10-115493] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Since the breakthroughs in combination chemotherapy of patients with Hodgkin disease (HD) starting in the 1960s, prognosis of patients has been rising steadily. Trends in long-term survival of patients with HD on the population level should therefore be monitored in an as timely as possible manner. We assessed trends in age specific 5- and 10-year relative survival of patients with HD in the United States from 1980-1984 to 2000-2004 from the 1973-2004 database of the Surveillance, Epidemiology, and End Results (SEER) Program. Period analysis was used to disclose recent developments with minimum delay. Overall, 5-year relative survival steadily increased from 73.5% to 85.2% (+11.7 percentage units), and 10-year relative survival increased from 62.1% to 80.1% (+18.0 percentage units) between 1980-1984 and 2000-2004, according to period analysis. The increase was particularly pronounced for patients aged 45 to 59 years and 60 years and older (increases in 10-year relative survival by 24.8 and 23.3 percentage points, respectively). Nevertheless, a strong age gradient persisted, with 10-year relative survival of 92.7%, 88.7%, 84.9%, 76.2%, and 44.9% in patients aged 15 to 24 years, 25 to 34 years, 35 to 44 years, 45 to 54 years, and 60 years and older, respectively, in 2000-2004. Our period analysis discloses ongoing, major improvement in long-term survival of patients with HD in recent years, particularly among older patients.
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Abstract
AbstractWith the application of modern chemotherapy and radiation techniques, most patients with Hodgkin lymphoma can be cured, regardless of initial extent of disease. However, the lymphoma sometimes presents coincident with certain other major conditions, including pregnancy, infection with human immunodeficiency virus (HIV) or older age, which complicate treatment and make management considerably more challenging. Specially crafted approaches to staging and treatment, including the addition of specific supportive care measures, are required in these situations. Pregnant patients with coincident Hodgkin lymphoma should be staged without the use of imaging requiring radiation and treated with an approach that includes initial treatment deferral when appropriate, single agent vinblastine and reservation of multi-agent chemotherapy for the small minority with very aggressive lymphoma. Patients with Hodgkin lymphoma and HIV infection can be given standard anti-lymphoma treatment but require intensive supportive care with highly active anti-retroviral treatment (HAART) and prophylactic anti-fungal and anti-Pneumocystis antibiotics plus neutrophil growth factors. Standard staging and full dose multi-agent chemotherapy are necessary if older patients with Hodgkin lymphoma are to be afforded the best chance of cure but the final choice of the individual elements of treatment must respect co-morbid conditions and age- or other disease-related organ compromise. If appropriately chosen, these special measures permit delivery of safe, effective treatment and frequent cure of the Hodgkin lymphoma despite complicating pregnancy, HIV infection or older age.
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Landgren O, Caporaso NE. New aspects in descriptive, etiologic, and molecular epidemiology of Hodgkin's lymphoma. Hematol Oncol Clin North Am 2007; 21:825-40. [PMID: 17908622 DOI: 10.1016/j.hoc.2007.07.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Epstein-Barr virus (EBV) has remained the main candidate suggested as the infection causing Hodgkin's lymphoma for several years. However, EBV genome has been found only within the tumor in about 20%-40% of Hodgkin's lymphoma cases with a prior diagnosis of infectious mononucleosis. Recently, autoimmune and related conditions have drawn attention to a potential role for immune-related and inflammatory conditions in the etiology and pathogenesis of the malignancy. Evidence from multiple affected families from case series, a twin study, a case-control study, and population-based registry studies implicate a role for genetic factors. Simultaneously, data from Eastern Asia and among Chinese immigrants in North America indicate increasing incidence trends for Hodgkin's lymphoma being associated with westernization. These results emphasize an interaction between environmental and genetic risk factors in Hodgkin's lymphoma.
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Affiliation(s)
- Ola Landgren
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, National Institutes of Health, 6120 Executive Boulevard, Building EPS/Room 7110, Bethesda, MD 20892-7236, USA.
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Klimm B, Eich HT, Haverkamp H, Lohri A, Koch P, Boissevain F, Trenn G, Worst P, Dühmke E, Müller RP, Müller-Hermelink K, Pfistner B, Diehl V, Engert A. Poorer outcome of elderly patients treated with extended-field radiotherapy compared with involved-field radiotherapy after chemotherapy for Hodgkin's lymphoma: an analysis from the German Hodgkin Study Group. Ann Oncol 2007; 18:357-63. [PMID: 17071932 DOI: 10.1093/annonc/mdl379] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The optimal treatment of elderly patients with Hodgkin's lymphoma (HL) is still a matter of debate. Since many of these patients receive combined modality treatment, we evaluated the impact of different radiation field sizes, that is extended-field (EF) or involved-field (IF) technique when given after four cycles of chemotherapy. PATIENTS AND METHODS In the multicenter HD8 study of the German Hodgkin Study Group, 1204 patients with early-stage unfavorable HL were randomized to receive four cycles of chemotherapy followed by either radiotherapy (RT) of 30 Gy EF + 10 Gy to bulky disease (arm A) or 30 Gy IF + 10 Gy to bulky disease (arm B). A total of 1064 patients were assessable for the analysis. Of these, 89 patients (8.4%) were 60 years or older. RESULTS Elderly patients had a poorer risk profile. Acute toxicity from RT was more pronounced in elderly patients receiving EF-RT compared with IF-RT [World Health Organization (WHO) grade 3/4: 26.5% versus 8.6%)]. Freedom from treatment failure (FFTF, 64% versus 87%) and overall survival (OS, 70% versus 94%) after 5 years was lower in elderly patients compared with younger patients. Importantly, elderly patients had poorer outcome when treated with EF-RT compared with IF-RT in terms of FFTF (58% versus 70%; P = 0.034) and OS (59% versus 81%; P = 0.008). CONCLUSION Elderly patients with early-stage unfavorable HL generally have a poorer risk profile and outcome when compared with younger patients. Treatment with EF-RT instead of IF-RT after chemotherapy has a negative impact on survival of elderly patients and should be avoided.
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Affiliation(s)
- B Klimm
- Department I of Internal Medicine, University Hospital Cologne, Germany.
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Allemani C, Sant M, De Angelis R, Marcos-Gragera R, Coebergh JW. Hodgkin disease survival in Europe and the U.S. Cancer 2006; 107:352-60. [PMID: 16770772 DOI: 10.1002/cncr.21995] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The survival of patients with Hodgkin disease (HD) varies markedly across Europe and generally is shorter than the survival of patients in the U.S. To investigate these differences, the authors compared population-based HD survival in relation to morphologic type among populations in Europe and the U.S. METHODS The authors analyzed 6726 patients from 37 cancer registries that participated in EUROCARE-3 and 3442 patients from 9 U.S. Surveillance, Epidemiology, and End Results (SEER) registries. Patients were diagnosed during 1990 to 1994 and were followed for at least 5 years. The European registries were grouped into EUROCARE West, EUROCARE UK, and EUROCARE East. Morphologic groups were nodular sclerosis, mixed cellularity, lymphocyte depletion, lymphocyte predominance, and not otherwise specified (NOS). The influence of morphology on geographic differences in 5-year relative survival was explored by using multiple regression analysis. RESULTS In the model that was adjusted by age, gender, and years since diagnosis, the relative excess risk (RER) of death was 0.93 (95% confidence interval [95% CI], 0.81-1.05) in EUROCARE West, 1.15 (95% CI, 1.04-1.28) in EUROCARE UK, and 1.39 (95% CI, 1.21-1.60) in EUROCARE East (compared with the SEER data). When morphology was included, EUROCARE UK and SEER no longer differed (RER, 1.06; 95% CI, 0.95-1.18). Morphology distribution varied markedly across Europe and much less in the U.S., with nodular sclerosis less common in Europe (45.9%) than the U.S. (61.7%). The RER data showed that patients who had lymphocyte depletion, NOS, and mixed cellularity had a significantly worse prognoses compared with patients who had nodular sclerosis, whereas patients who had lymphocyte predominance had the best prognosis. CONCLUSIONS The current results provide population-based evidence that morphology strongly influences the prognosis of patients with HD. However differences in the morphologic case mix explains only some of the geographic variations observed in survival.
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Affiliation(s)
- Claudia Allemani
- Epidemiology Unit, Department of Preventive and Predictive Medicine, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy.
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Jarrett RF, Stark GL, White J, Angus B, Alexander FE, Krajewski AS, Freeland J, Taylor GM, Taylor PRA. Impact of tumor Epstein-Barr virus status on presenting features and outcome in age-defined subgroups of patients with classic Hodgkin lymphoma: a population-based study. Blood 2005; 106:2444-51. [PMID: 15941916 DOI: 10.1182/blood-2004-09-3759] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractThe association between tumor Epstein-Barr virus (EBV) status and clinical outcome in Hodgkin lymphoma (HL) is controversial. This population-based study assessed the impact of EBV status on survival in age-stratified cohorts of adults with classic HL (cHL). Data from 437 cases were analyzed with a median follow-up of 93 months. Overall survival (OS) was significantly better for EBV-negative compared with EBV-positive patients (P < .001), with 5-year survival rates of 81% and 66%, respectively; disease-specific survival (DSS) was also greater for EBV-negative patients (P = .03). The impact of EBV status varied with age at diagnosis. In patients aged 16 to 34 years, EBV-associated cases had a survival advantage compared with EBV-negative cases, but differences were not statistically significant (P = .21). Among patients 50 years or older, EBV positivity was associated with a significantly poorer outcome (P = .003). Excess deaths occurred in EBV-positive patients with both early- and advanced-stage disease. In multivariate analysis of OS in the older patients, EBV status retained statistical significance after adjusting for the effects of sex, stage, and B symptoms (P = .01). Impaired immune status may contribute to the development of EBV-positive cHL in older patients, and strategies aimed at boosting the immune response should be investigated in the treatment of these patients. (Blood. 2005;106:2444-2451)
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Affiliation(s)
- Ruth F Jarrett
- Leukaemia Research Fund (LRF) Virus Centre, Institute of Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
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Engert A, Ballova V, Haverkamp H, Pfistner B, Josting A, Dühmke E, Müller-Hermelink K, Diehl V. Hodgkin's lymphoma in elderly patients: a comprehensive retrospective analysis from the German Hodgkin's Study Group. J Clin Oncol 2005; 23:5052-60. [PMID: 15955904 DOI: 10.1200/jco.2005.11.080] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE With improved prognosis for patients with Hodgkin's lymphoma (HL), interest increasingly focuses on high-risk groups such as elderly patients. We thus performed a retrospective analysis using the German Hodgkin's Study Group (GHSG) database to determine clinical risk factors, course of treatment, and outcome in elderly HL patients in comparison with younger adults. PATIENTS AND METHODS A total of 4,251 patients included in the GHSG studies HD5 to HD9 were analyzed, of whom 372 (8.8%) were 60 years or older and 3,879 (91.2%) were younger than 60 years. Patient characteristics, treatment results, toxicity, freedom from treatment failure (FFTF), and overall survival (OS) were compared. RESULTS Elderly patients more often had mixed cellularity subtype, "B" symptoms, elevated erythrocyte sedimentation rate, and poorer performance status. Less frequently observed were nodular sclerosis subtype, large mediastinal mass, and bulky disease. Acute toxicity during chemotherapy was generally higher in elderly patients. This was most obvious for severe infections (grade 3 or 4; 15% v 6%) correlating with more severe leukopenia in elderly patients (grade 4; 38% v 23%). As a result, significantly fewer elderly patients received the intended full chemotherapy dose (75% v 91%). The survival analysis showed a significantly poorer treatment outcome for elderly patients in terms of 5-year OS (65% v 90%), FFTF (60% v 80%), and HL-specific FFTF (73% v 82%). CONCLUSION Elderly patients have a poorer risk profile compared with younger HL patients and experience more severe treatment-associated toxicity. Higher mortality during treatment as well as lower dose-intensity are the major factors explaining the poorer overall outcome of elderly HL patients.
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Affiliation(s)
- Andreas Engert
- Department of Internal Medicine, University of Cologne, Kerpener Str 62, 50924 Cologne, Germany.
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Proctor SJ, White J, Jones GL. An international approach to the treatment of Hodgkin's disease in the elderly: launch of the SHIELD study programme. Eur J Haematol 2005:63-7. [PMID: 16007871 DOI: 10.1111/j.1600-0609.2005.00457.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Utilising the Scotland and Newcastle Lymphoma Group population data for Hodgkin's disease (HD), collected over a 20-year period, it is evident that 20% of patients are over the age of 60 yr at diagnosis. Data from 674 patients are available. This group comprised 346 men and 328 women. Median follow-up was 9.5 yr. In total 361 patients had stage I/II disease. In this cohort overall response and complete response (CR) rates were 88% and 79%, respectively, for treated patients. Overall 308 patients had stage III/IV disease. Among treated patients in this cohort, overall and CR rates were 78% and 59%, respectively. Response data were missing for 26 patients with stage I/II disease and 43 patients with stage III/IV disease. The chlorambucil, vinblastine, procarbazine and prednisolone, mechlorethamine, vincristine, probarbazine and prednisolone and doxorubicin, bleomycin, vinblastine and decarbazine were the commonest chemotherapy regimens, in descending order of frequency, used to treat this cohort of patients. Outcome did not vary with these regimens. Thirty-four other chemotherapy combinations were used, some curative others palliative. These data and all other published studies confirm the need for a prospective, age-defined approach to HD in the elderly. Such an approach needs to be closely linked to issues of comorbidity, an assessment of frailness and the tailoring of specific protocols for the elderly to allow full dose delivery. The Study of Hodgkin Lymphoma In the Elderly/Lymphoma Database programme has now been launched and attempts to address these issues (http://www.shieldstudy.co.uk).
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Affiliation(s)
- Stephen J Proctor
- Department of Academic Haematology, Medical School, University of Newcastle, Newcastle upon Tyne, UK.
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Ballova V, Rüffer JU, Haverkamp H, Pfistner B, Müller-Hermelink HK, Dühmke E, Worst P, Wilhelmy M, Naumann R, Hentrich M, Eich HT, Josting A, Löffler M, Diehl V, Engert A. A prospectively randomized trial carried out by the German Hodgkin Study Group (GHSG) for elderly patients with advanced Hodgkin's disease comparing BEACOPP baseline and COPP-ABVD (study HD9elderly). Ann Oncol 2004; 16:124-31. [PMID: 15598949 DOI: 10.1093/annonc/mdi023] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In contrast to younger patients, the prognosis of elderly patients with advanced Hodgkin's disease (HD) has not improved substantially over the last 20 years. We thus carried out a prospectively randomized study (HD9(elderly)) to compare the BEACOPP regimen in this setting against standard COPP-ABVD. Between February 1993 and 1998, 75 patients aged 66-75 years with newly diagnosed HD in advanced stages were recruited into the HD9 trial as a separate stratum (HD9(elderly)). Patients were assigned to eight alternating cycles of COPP and ABVD or eight cycles of BEACOPP in baseline doses. Radiotherapy was given to initial bulky or residual disease. In total, 68 of 75 registered patients were assessable: 26 were treated with COPP-ABVD and 42 with BEACOPP baseline. There were no significant differences between COPP-ABVD and BEACOPP in terms of complete remission (76%), overall survival (50%) and freedom from treatment failure (FFTF) (46%) at 5 years. At a median follow-up of 80 months, a total of 37 patients died: 14/26 patients (54%) treated with COPP-ABVD and 23/42 patients (55%) with BEACOPP. Two patients (8%) treated with COPP-ABVD and nine patients (21%) treated with BEACOPP died of acute toxicity. Hodgkin-specific FFTF at 5 years was 55% after COPP-ABVD and 74% after BEACOPP (P=0.13). Thus, there are no differences in survival between these regimens in elderly patients.
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Affiliation(s)
- V Ballova
- Department of Internal Medicine I, University Hospital of Cologne, Cologne and the German Hodgkin Lymphoma Study Group, Germany
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Levis A, Anselmo AP, Ambrosetti A, Adamo F, Bertini M, Cavalieri E, Gavarotti P, Genua A, Liberati M, Pavone V, Pietrasanta D, Ricetti MM, Scalabrini DR, Salvi F, Vitolo U, Angelucci E, Boccadoro M, Gallo E, Mandelli F. VEPEMB in elderly Hodgkin’s lymphoma patients. Results from an Intergruppo Italiano Linfomi (IIL) study. Ann Oncol 2004; 15:123-8. [PMID: 14679131 DOI: 10.1093/annonc/mdh012] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In advanced age the prognosis of Hodgkin's lymphoma (HL) is poor, but, as a consequence of the low incidence of HL in the elderly, prospective studies are lacking and the best treatment strategy is difficult to define. PATIENTS AND METHODS One-hundred and five HL patients over 65 years of age were treated homogeneously with an original reduced-intensity regimen designed for HL in the elderly containing vinblastine, cyclophosphamide, procarbazine, etoposide, mitoxantrone and bleomycin (VEPEMB). Forty-eight early stage (IA-IIA) patients received three courses of VEPEMB followed by involved field irradiation. Fifty-seven advanced stage (IIB-IV) patients received six courses followed by radiotherapy limited to the areas of bulky disease. RESULTS Mean age was 71 years (range 66-83). Co-morbidities were present in 39 patients (37%). A treatment plan modification for poor tolerance or toxicity was needed in 18 patients. Results were satisfactory, even if they were better in early rather than in advanced stage disease: complete response rate 98% versus 58% (P <0.01); 5-year failure-free survival 79% versus 34% (P <0.01). The results were affected by advanced stage, systemic symptoms and co-morbidity but they were not influenced by age itself. CONCLUSIONS VEPEMB is an effective and low toxic regimen for HL in the elderly. Co-morbidity is a prognostic factor more important than age itself.
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Affiliation(s)
- A Levis
- Haematology Division of the Ospedale SS Antonio e Biagio, Alessandria, Italy.
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Kim HK, Silver B, Li S, Neuberg D, Mauch P. Hodgkin's disease in elderly patients (> or =60): clinical outcome and treatment strategies. Int J Radiat Oncol Biol Phys 2003; 56:556-60. [PMID: 12738333 DOI: 10.1016/s0360-3016(02)04596-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Older age is an adverse prognostic factor for survival for patients with Hodgkin's disease. This study assessed the outcome of elderly patients (>or=60 years) with Hodgkin's disease treated with curative intent in an attempt to identify the optimal treatment strategies for this group of patients. METHODS AND MATERIALS Eighty-six patients, 60-93 years old at the time of diagnosis, were treated for Hodgkin's disease with radical intent between 1969 and 1995. All patients underwent radiographic staging of the chest, abdomen, and pelvis, and 17 patients underwent staging laparotomy. Fifty-two patients had early-stage disease (Stage IA-IIA) and 34 had Stage IIB-IV Hodgkin's disease. The median follow-up time was 75 months (range 24-267) for surviving patients. RESULTS The 10-year actuarial freedom from treatment failure (FFTF) rate for all patients was 62%. The 10-year FFTF rate for patients with Stage IA-IIA and Stage IIB-IV disease was 71% and 49%, respectively (p = 0.03). Patients with early-stage disease treated with chemoradiotherapy had a lower crude rate of treatment failure (20%) than patients treated with either chemotherapy alone (33%) or radiotherapy alone (46%). However, no statistically significant difference was found between the treatment groups in terms of actuarial FFTF or overall survival. The 5- and 10-year overall survival rate (all causes) for all patients was 48% and 30%, respectively. The 10-year survival rate for patients with Stage IA-IIA and Stage IIB-IV disease was 31% and 26%, respectively (p = 0.07). On multiple regression analysis, including age, treatment, and stage in the Cox regression model with respect to overall survival, age was a marginally significant factor (p = 0.08). For FFTF, age was not a significant factor in the model (p = 0.11). We analyzed the subsequent outcome of patients who developed a first recurrence after initial treatment; the 5-year survival rate was only 20% after recurrence of Hodgkin's disease. Initial treatment was reasonably well tolerated. CONCLUSION Although more patients died of other causes than Hodgkin's disease, the recurrence of Hodgkin's disease had a significant impact on survival. Thus, we favor the use of chemoradiotherapy in early-stage patients >60 years to minimize the risk of relapse.
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Affiliation(s)
- H Katherine Kim
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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40
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Stark GL, Wood KM, Jack F, Angus B, Proctor SJ, Taylor PR. Hodgkin's disease in the elderly: a population-based study. Br J Haematol 2002; 119:432-40. [PMID: 12406082 DOI: 10.1046/j.1365-2141.2002.03815.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study evaluated the incidence and outcome of Hodgkin's disease (HD) in older patients using a population-based approach. In total, 102 patients (52 men, 50 women) aged >or= 60 years presented in the Northern Health Region of England (population of 3.09 million) between 1 January 1991 and 31 December 1998 and were studied prospectively. The age-specific incidence was 1.97/100,000 for those aged 60-69 years, and 2.18/100,000 for those aged 70 years or over. The median age of the cohort was 70 years (range 60-91) and the median follow up was 63 months (range 20-113). Out of 95 treated patients, 70 (74%) obtained complete or good partial (> 90% response) remissions. In the 60 to 69-year-old group, the disease-specific survival at 5 years was 100% for those presenting with early stage disease and 52% for those with advanced stage disease. In patients aged >70 years the 5 year disease-specific survival was 36% in patients with early stage and 14% for patients with advanced stage disease. The survival of patients with Epstein-Barr virus (EBV)-positive tumours was significantly poorer than that of patients with EBV-negative tumours (P = 0.007); median survival in the former group was 20 months versus undefined in the latter group. In total, 43 deaths were due to progressive HD and five were treatment-related. This study defined the incidence of HD in our population and demonstrated that the prognosis of elderly patients, particularly those with advanced stage disease, has not improved concurrently with that of patients aged < 60 years old. Novel approaches to assessment and treatment are necessary.
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Affiliation(s)
- Gail L Stark
- University Department of Haematology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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Macpherson N, Klasa RJ, Gascoyne R, O'Reilly SE, Voss N, Connors JM. Treatment of elderly Hodgkin's lymphoma patients with a novel 5-drug regimen (ODBEP): a phase II study. Leuk Lymphoma 2002; 43:1395-402. [PMID: 12389619 DOI: 10.1080/10428190290033332] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Elderly patients with Hodgkin's lymphoma (HL) have a worse outcome than young patients. In an effort to improve the outcome in elderly HL patients, we used a 5-drug chemotherapy regimen called ODBEP (vincristine, doxorubicin, bleomycin, etoposide, prednisone) from 1986-1995. We hoped that by increasing dose intensity through delivery of treatment without delays, and increasing the number of non-cross-resistant chemotherapeutic drugs that were selected for minimal cumulative myelotoxicity, we might improve the cure rate in elderly patients with Hodgkin's lymphoma. Comparison was made with a similar group of patients treated from 1981-1986 with MOPP/ABV-variant chemotherapy. Ninety-nine patients who were 65 years or older, were diagnosed with HL from 1981-1995. Seventy-one patients had advanced disease and 55 of this group were treated with curative intent using multi-agent chemotherapy (ODBEP = 38; MOPP/ABV-variant = 17). ODBEP and MOPP/ABV-type treatment gave a median survival of 43 and 39 months, with 5-year overall survival (OS) of 42 and 32%, respectively. There was no statistically significant difference in OS or disease specific survival between the treatments. Both treatments were well tolerated, but ODBEP was less myelotoxic. ODBEP patients had a relative risk of 0.47 of developing febrile neutropenia compared to the MOPP/ABV-variant patients. In conclusion, treatment of elderly Hodgkin's lymphoma patients with ODBEP resulted in a similar OS and disease-specific survival compared to those treated with MOPP/ABV type chemotherapy, but appeared to be less toxic.
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Affiliation(s)
- Nicol Macpherson
- Division of Medical Oncology, British Columbia Cancer Agency and the University of British Columbia, Vancouver Island Centre, Victoria, Canada
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42
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Weekes CD, Vose JM, Lynch JC, Weisenburger DD, Bierman PJ, Greiner T, Bociek G, Enke C, Bast M, Chan WC, Armitage JO. Hodgkin's disease in the elderly: improved treatment outcome with a doxorubicin-containing regimen. J Clin Oncol 2002; 20:1087-93. [PMID: 11844834 DOI: 10.1200/jco.2002.20.4.1087] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Hodgkin's disease (HD) is a malignancy that displays a bimodal age distribution. Previous reports of treatment in patients greater-than-or-equal 60 years have found a poor outcome, particularly in patients with advanced disease. Because of an improved side-effect profile, the regimen of chlorambucil, vinblastine, procarbazine, and prednisone (ChlVPP) has been proposed for use in elderly patients. PATIENTS AND METHODS From September 1982 to May 1998, 262 patients with previously untreated HD received either ChlVPP (n = 176) or ChlVPP plus doxorubicin/bleomycin/vincristine (ChlVPP/ABV hybrid; n = 86). Fifty-six patients were greater-than-or-equal 60 years old, and 206 were younger than 60 years. RESULTS The 5-year overall survival (OS; 87% v 39%) and the 5-year event-free survival (EFS; 75% v 31%) favored patients younger than 60 years of age. Prognostic factors analyzed in patients greater-than-or-equal 60 years of age, other than type of therapy, included sex, stage, Karnofsky performance score, lactic dehydrogenase, number of extranodal sites, B symptoms, size of largest mass, and histologic subtype. In patients older than 60 years, none of the clinical features was a statistically significant predictor of EFS; however, ChlVPP/ABV hybrid was associated with a decreased risk of an event (relative risk, 0.40; 95% confidence interval, 0.19 to 0.83; P =.014) compared with ChlVPP. The 5-year OS for patients greater-than-or-equal 60 years who received ChlVPP was 30%, compared with 67% for those patients receiving the ChlVPP/ABV regimen (P =.0086) CONCLUSION Patients greater-than-or-equal 60 years with HD who require chemotherapy are better treated with ChlVPP/ABV hybrid than with ChlVPP alone.
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Affiliation(s)
- Colin D Weekes
- University of Nebraska Medical Center, Omaha, NE 68198-7680, USA.
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Abstract
OBJECTIVE Prior reports on Hodgkin's disease have suggested a biologic behavior difference between young and old patients. A study of 35,033 patients could confirm that older patients do not do as well as young patients regardless of age. METHODS The National Cancer Data Base provided data from U.S. tumor registries on 35,033 patients newly diagnosed with Hodgkin's disease from 1985 through 1994. For analysis the patients were divided into two time periods, 1985-1989 and 1990-1994. The earlier period provided survival data to assess the impact of age and stage. RESULTS The overall disease-specific, 5-year survival rate for the 1985-1989 period was 84.9%. For stages I and II, it reached almost 90%. For both observed survival based on all deaths and disease-specific survival, the duration of survival decreased with increasing age. This decrease with age occurred for all stages of the disease. CONCLUSIONS The data reflect the actual status of management of Hodgkin's disease in the United States rather than the best attainable results. The decreasing survival with increasing age and in all stages further supports the concept of a difference in biologic behavior of Hodgkin's disease associated with age.
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Affiliation(s)
- B J Kennedy
- Commission on Cancer of the American College of Surgeons and the National Cancer Data Base, USA
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Greil R, Holzner B, Kemmler G, Kopp M, Buchowski A, Oberaigner W, Fritsch E, Dirnhofer S, Rueffer U, Diehl V, Sperner-Unterweger B. Retrospective assessment of quality of life and treatment outcome in patients with Hodgkin's disease from 1969 to 1994. Eur J Cancer 1999; 35:698-706. [PMID: 10505027 DOI: 10.1016/s0959-8049(99)00025-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We determined the current quality of life (QoL) of patients with Hodgkin's disease treated at the Innsbruck University Hospital between 1969 and 1994 at a mean time of 9.1 +/- 7.0 years after their initial treatment. Further aims of our study were to assess potential differences in objective treatment outcome and QoL between patients treated with chemo-, radio- or combined modality therapy and those enrolled in randomised clinical trials or treated according to standard procedures. The QLQ-C30, a health-related and validated self-report questionnaire developed by the Study Group on Quality of Life of the European Organization for Research and Treatment of Cancer (EORTC) was mailed to a cohort of 194 survivors out of a total of 225 patients with Hodgkin's disease; 126 of them (64.9%) returned the completed questionnaire. The 5- and 10-year overall survival rates for the total group of 225 patients were 94.3% and 84.9%, respectively. Irrespective of stage, higher relapse-free survival rates were observed in patients receiving combined modality treatment (P = 0.025). Five-year relapse-free survival rates were 96.6% for patients enrolled in clinical trials and 82.8% for patients treated outside of randomised studies (P = 0.037 in univariate and P = 0.064 in multivariate analysis). Patients treated with combined modality regimens had reduced QoL scores in comparison with those treated with either radiation or chemotherapy alone, but QoL parameters did not differ between patients enrolled in clinical trials and those treated according to standard procedures. Patients with Hodgkin's disease had an excellent long-term prognosis and very high QoL scores a mean of 9.1 years after treatment of their disease. The improved relapse-free survival rates achieved by combined modality regimens must be carefully weighed against the accompanying reduced QoL, since lower relapse rates did not translate into a survival advantage.
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Affiliation(s)
- R Greil
- Department of Internal Medicine, University of Innsbruck, Austria.
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Quaglino D, Di Leonardo G, Furia N, Recchia F, Pasqualoni E, Ciarrocchi G. Therapeutic management of hematological malignancies in elderly patients. Biological and clinical considerations. Part II: Non-Hodgkin lymphomas and Hodgkin's disease. AGING (MILAN, ITALY) 1997; 9:310-9. [PMID: 9458991 DOI: 10.1007/bf03339609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Increased knowledge of the nature and biology of lymphoid cells has provided more rational classification schemes, and has improved therapeutic strategies. However, non-Hodgkin lymphomas (NHL) as well as Hodgkin's disease (HD) show a less favorable outcome in elderly compared to young patients. The poorer outcome in elderly patients with NHL is largely due to chemotherapy-related issues, although other age-related factors may contribute to determine a poor prognosis, such as the presence of more aggressive pathological subtypes and an increase in extranodal vs nodal presentations. Similarly, HD patients older than 50 years have higher rates of advanced disease, B symptoms, and histological types associated with poor prognosis at presentation. The poor prognosis in lymphoid malignancies also appears to be attributable to inadequate treatment. However, the inability to administer full therapy may be real, due to the high percentages of deaths caused by severe infections and intercurrent disease (cardiac, renal, lung) related to diminished organ function. The availability of growth factors may help to reduce the incidence of severe neutropenia and other related septic conditions.
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Affiliation(s)
- D Quaglino
- Department of Internal Medicine, University of L'Aquila, Italy
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Forsyth PD, Bessell EM, Moloney AJ, Leach IH, Davies JM, Fletcher J. Hodgkin's disease in patients older than 70 years of age: a registry-based analysis. Eur J Cancer 1997; 33:1638-42. [PMID: 9389927 DOI: 10.1016/s0959-8049(97)00119-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Between 1973 and 1993, 529 patients aged 15 years and over with Hodgkin's disease (HD) were entered into a lymphoma registry. Twenty-eight cases (1 only diagnosed at autopsy) of histologically proven HD in patients aged 70 years or older were identified. The distribution of sex, 'B' symptoms, histology and stage was not significantly different from that of younger patients, except for the fact that there were no patients aged 70 years or older with lymphocyte predominant HD. Nineteen patients were treated radically, 5 patients palliatively and 4 patients received no radiotherapy or chemotherapy. Three of the 14 patients treated with chemotherapy achieved the planned dose intensity. The cause-specific 5-year survival was 75% for patients aged 15-69 years and 28% for patients aged 70 years and over (logrank chi(2) = 43.7, P < 0.00001). The younger and older groups treated with radical intent had complete response rates of 97% and 74%, respectively (logrank chi(2) = 17.91, P < 0.00001) and relapse rates at 5 years of 27% and 56%, respectively (logrank chi(2) = 4.86, P = 0.0275). The main reason for the poorer prognosis of patients aged 70 years and over was the increasing difficulty of chemotherapy delivery associated with advancing age.
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Affiliation(s)
- P D Forsyth
- Department of Clinical Haematology, Nottingham City Hospital NHS Trust, U.K
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Abstract
To evaluate the role of pregnancy in the pathogenesis and clinical course of Hodgkin's disease (HD), we studied a series of 192 female patients aged 17-50 years at the time of diagnosis, and 496 healthy controls matched by residence and year of birth. Cases showed a marginally significant excess for the father having a high level of education, and more families were classified as white-collar workers than as industrial workers. No significant differences between cases and controls were found in other parameters describing the family and living conditions in childhood. Before the age when cases were diagnosed, 35.4% of cases and 34.7% of their controls were nulliparous. Among the cases, the mean age at first delivery was 22.4 years, with a total of 201 children (average: 1.05 per case) born before diagnosis; for the controls, the corresponding figures were 22.2 years and 573 children (average: 1.15). Within the first 6 months after the last delivery, HD was diagnosed in 12 of 124 parous cases (9.7%); for controls, the corresponding number is 18 out of 324 (5.6%). A marginally significant negative trend (P = 0.07) in odds ratios is seen with increasing duration of this interval. We conclude that our study could not confirm previous reports of a protective effect of pregnancy for the risk of HD. On the other hand, marked physiological changes in the period of puerperium may accelerate the expression of HD.
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Affiliation(s)
- M Zwitter
- Institute of Oncology, Ljubljana, Slovenia
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Holte H, Mella O, Wist E, Telhaug R, Hannisdal E, Abrahamsen AF. ChlVPP is as effective as alternating ChlVPP/ABOD in advanced stage Hodgkin's disease. Acta Oncol 1996; 35 Suppl 8:73-80. [PMID: 9073051 DOI: 10.3109/02841869609098523] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The purpose of the study was to evaluate and compare the efficacy and tolerability of two cytostatic regimens-chlorambucil, vinblastine, procarbazine and prednisone (ChlVPP) vs. ChlVPP alternating with doxorubicin, bleomycin, vincristine and dacarbazine (ABOD). One hundred eligible patients with stage IIIA-IVB Hodgkin's disease were randomized to either ChlVPP or ChlVPP alternating with ABOD. The complete response rate (CR) was 80% in both treatment groups. After a median follow-up time of 59 months, 42 (84%) of the patients in the ChlVPP-treated group were in CR compared with 39 (78%) treated with ChlVPP/ABOD. The estimated five-year overall and relapse-free survival rates were 87% and 74%, respectively, for the ChlVPP-treated patients and 76% and 73% for the ChlVPP/ABOD-treated patients. The ChlVPP regimen showed a slightly better subjective tolerance than the ChlVPP/ABOD regimen. The given dose intensity was very close to optimal, and equal for the two regimens.
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Affiliation(s)
- H Holte
- Department of Oncology, The Norwegian Radium Hospital, Oslo
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49
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Busby-Whitehead J, Johnson TM, Hanson LC, Dent G. CAROLINA CLINICAL PATHOLOGY CONFERENCE. J Am Geriatr Soc 1995. [DOI: 10.1111/j.1532-5415.1995.tb07019.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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50
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Enblad G. Hodgkin's disease in young and elderly patients. Clinical and pathological studies. Minireview based on a doctoral thesis. Ups J Med Sci 1994; 99:1-38. [PMID: 7810027 DOI: 10.3109/03009739409179348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- G Enblad
- Department of Oncology, University Hospital, Uppsala, Sweden
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