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Cheng PTM, Villa D, Tonseth RP, Scott DW, Gerrie AS, Freeman CL, Pickles T, Lo AC, Farinha P, Craig JW, Slack GW, Gascoyne RD, Bénard F, Wilson D, Skinnider B, Connors JM, Sehn LH, Savage KJ. Outcome of limited-stage nodular lymphocyte-predominant Hodgkin lymphoma and the impact of a PET-adapted approach. Blood Adv 2021; 5:3647-3655. [PMID: 34438445 PMCID: PMC8945586 DOI: 10.1182/bloodadvances.2021004375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/29/2021] [Indexed: 01/05/2023] Open
Abstract
Radiotherapy (RT) is typically incorporated into the treatment of limited-stage nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), although it remains unknown whether chemotherapy alone may be suitable in select patients. We evaluated outcomes of limited-stage NLPHL at BC Cancer on the basis of era-specific guidelines: routine RT era, 1995 to 2005 (n = 36), combined modality with 2 cycles of doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy followed by RT or RT alone; positron emission tomography (PET) era, after 2005 (n = 63), ABVD alone (4 cycles) if the PET scan after the second cycle of ABVD (PET2) is negative, or treatment is changed to RT if PET2 is positive. Median age of patients was 38 years (range, 16-82 years), 73% were male, and 43% had stage II. With a median follow-up of 10.5 years for all patients, 5-year progression-free survival (PFS) was 91% [corrected] and was 97% for overall survival (OS), with no difference by treatment era (PFS, P = .15; [corrected] OS, P = .35). For the 49 patients who had a PET2 scan, 86% were PET negative and 14% were PET positive by Deauville criteria with 5-year PFS rates of 92% and 80% (P = .87) [corrected], respectively. This is the largest study of a PET-adapted approach in NLPHL and supports that ABVD alone may be a viable option in select patients with a negative PET2 scan, with consideration of acute and long-term toxicities.
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Affiliation(s)
| | - Diego Villa
- Centre for Lymphoid Cancer and Department of Medical Oncology
| | | | - David W. Scott
- Centre for Lymphoid Cancer and Department of Medical Oncology
| | - Alina S. Gerrie
- Centre for Lymphoid Cancer and Department of Medical Oncology
| | | | | | | | - Pedro Farinha
- Centre for Lymphoid Cancer and Division of Pathology, BC Cancer, Vancouver, BC, Canada
| | - Jeffrey W. Craig
- Centre for Lymphoid Cancer and Division of Pathology, BC Cancer, Vancouver, BC, Canada
| | - Graham W. Slack
- Centre for Lymphoid Cancer and Division of Pathology, BC Cancer, Vancouver, BC, Canada
| | - Randy D. Gascoyne
- Centre for Lymphoid Cancer and Division of Pathology, BC Cancer, Vancouver, BC, Canada
| | | | | | - Brian Skinnider
- Centre for Lymphoid Cancer and Division of Pathology, BC Cancer, Vancouver, BC, Canada
| | | | - Laurie H. Sehn
- Centre for Lymphoid Cancer and Department of Medical Oncology
| | - Kerry J. Savage
- Centre for Lymphoid Cancer and Department of Medical Oncology
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Lamb MJ, Roman E, Howell DA, Kane E, Bagguley T, Burton C, Patmore R, Smith AG. Hodgkin lymphoma detection and survival: findings from the Haematological Malignancy Research Network. BJGP Open 2019; 3:bjgpopen19X101668. [PMID: 31822492 PMCID: PMC6995857 DOI: 10.3399/bjgpopen19x101668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/08/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Hodgkin lymphoma is usually detected in primary care with early signs and symptoms, and is highly treatable with standardised chemotherapy. However, late presentation is associated with poorer outcomes. AIM To investigate the relationship between markers of advanced disease, emergency admission, and survival following a diagnosis of classical Hodgkin lymphoma (CHL). DESIGN & SETTING The study was set within a sociodemographically representative UK population-based patient cohort of ~4 million, within which all patients were tracked through their care pathways, and linked to national data obtained from Hospital Episode Statistics (HES) and deaths. METHOD All 971 patients with CHL newly diagnosed between 1 September 2004-31 August 2015 were followed until 18th December 2018. RESULTS The median diagnostic age was 41.5 years (range 0-96 years), 55.2% of the patients were male, 31.2% had stage IV disease, 43.0% had a moderate-high or high risk prognostic score, and 18.7% were admitted via the emergency route prior to diagnosis. The relationship between age and emergency admission was U-shaped: more likely in patients aged <25 years and ≥70 years. Compared to patients admitted via other routes, those presenting as an emergency had more advanced disease and poorer 3-year survival (relative survival 68.4% [95% confidence interval {CI} = 60.3 to 75.2] versus 89.8% [95% CI = 87.0 to 92.0], respectively [P<0.01]). However, after adjusting for clinically important prognostic factors, no difference in survival remained. CONCLUSION These findings suggest that CHL survival as a whole could be increased by around 4% if the cancer in patients who presented as an emergency had been detected at the same point as in other patients.
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Affiliation(s)
- Maxine Je Lamb
- Research Fellow, Epidemiology & Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, York, UK
| | - Eve Roman
- Professor, Epidemiology & Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, York, UK
| | - Debra A Howell
- Senior Research Fellow, Epidemiology & Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, York, UK
| | - Eleanor Kane
- Research Fellow, Epidemiology & Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, York, UK
| | - Timothy Bagguley
- Data Analyst, Epidemiology & Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, York, UK
| | - Cathy Burton
- Consultant Haematologist, Haematological Malignancy Diagnostic Service, St James's University Hospital, Leeds, UK
| | - Russell Patmore
- Consultant Haematologist, Queen's Centre for Oncology and Haematology, Hull and East Yorkshire Hospitals, Cottingham, UK
| | - Alexandra G Smith
- Reader, Epidemiology & Cancer Statistics Group (ECSG), Department of Health Sciences, University of York, York, UK
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Shankar AG, Roques G, Kirkwood AA, Lambilliotte A, Freund K, Leblanc T, Hayward J, Abbou S, Ramsay AD, Schmitt C, Gorde-Grosjean S, Pacquement H, Haouy S, Boudjemaa S, Aladjidi N, Hall GW, Landman-Parker J. Advanced stage nodular lymphocyte predominant Hodgkin lymphoma in children and adolescents: clinical characteristics and treatment outcome - a report from the SFCE & CCLG groups. Br J Haematol 2017; 177:106-115. [PMID: 28220934 DOI: 10.1111/bjh.14518] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/07/2016] [Indexed: 12/21/2022]
Abstract
Advanced stage nodular lymphocyte predominant Hodgkin lymphoma (nLPHL) is extremely rare in children and as a consequence, optimal treatment for this group of patients has not been established. Here we retrospectively evaluated the treatments and treatment outcomes of 41 of our patients from the UK and France with advanced stage nLPHL. Most patients received chemotherapy, some with the addition of the anti CD20 antibody rituximab or radiotherapy. Chemotherapy regimens were diverse and followed either classical Hodgkin lymphoma or B non-Hodgkin lymphoma protocols. All 41 patients achieved a complete remission with first line treatment and 40 patients are alive and well in remission. Eight patients subsequently relapsed and 1 patient died of secondary cancer (9 progression-free survival events). The median time to progression for those who progressed was 21 months (5·9-73·8). The median time since last diagnosis is 87·3 months (8·44-179·20). Thirty-six (90%), 30 (75%) and 27 (68%) patients have been in remission for more than 12, 24 and 36 months, respectively. Overall, the use of rituximab combined with multi-agent chemotherapy as first line treatment seems to be a reasonable therapeutic option.
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Affiliation(s)
- Ananth G Shankar
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Amy A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | | | - Katja Freund
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Janis Hayward
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | | | - Alan D Ramsay
- Department of Cellular Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | | | - Sabah Boudjemaa
- Service d'hématologie et d'oncologie pédiatrique, Hopital A, Trousseau, 75571 APHP/UPMC Univ Paris 06, Paris, France
| | | | - Georgina W Hall
- Paediatric Haematology/Oncology Unit, Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Judith Landman-Parker
- Service d'hématologie et d'oncologie pédiatrique, Hopital A, Trousseau, 75571 APHP/UPMC Univ Paris 06, Paris, France
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4
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Cencini E, Fabbri A, Bocchia M. Rituximab plus ABVD in newly diagnosed nodular lymphocyte-predominant Hodgkin lymphoma. Br J Haematol 2016; 176:831-833. [PMID: 26913966 DOI: 10.1111/bjh.14001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Emanuele Cencini
- Haematology Unit, Azienda Ospedaliera Universitaria Senese & University of Siena, Siena, Italy
| | - Alberto Fabbri
- Haematology Unit, Azienda Ospedaliera Universitaria Senese & University of Siena, Siena, Italy
| | - Monica Bocchia
- Haematology Unit, Azienda Ospedaliera Universitaria Senese & University of Siena, Siena, Italy
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Rueda Domínguez A, Alfaro Lizaso J, de la Cruz Merino L, Gumá I Padró J, Quero Blanco C, Gómez Codina J, Llanos Muñoz M, Martinez Banaclocha N, Rodriguez Abreu D, Provencio Pulla M. SEOM clinical guidelines for the treatment of Hodgkin's lymphoma. Clin Transl Oncol 2015; 17:1005-13. [PMID: 26497354 PMCID: PMC4689754 DOI: 10.1007/s12094-015-1429-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 10/09/2015] [Indexed: 11/27/2022]
Abstract
Hodgkin lymphoma (HL) is an uncommon B cell lymphoid malignancy representing approximately 10-15 % of all lymphomas. HL is composed of two distinct disease entities; the more commonly diagnosed classical HL and the rare nodular lymphocyte-predominant HL. An accurate assessment of the stage of disease and prognostic factors that identify patients at low or high risk for recurrence are used to optimize therapy. Patients with early stage disease are treated with combined modality strategies using abbreviated courses of combination chemotherapy followed by involved-field radiation therapy, while those with advanced stage disease receive a longer course of chemotherapy often without radiation therapy. High-dose chemotherapy (HDCT) followed by an autologous stem cell transplant (ASCT) is the standard of care for most patients who relapse following initial therapy. Brentuximab vedotin should be considered for patients who fail HDCT with ASCT.
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Affiliation(s)
- A Rueda Domínguez
- Área de Oncología y Hematología, Hospital Costa del Sol, Autovía A-7, km 187, 29603, Marbella, Málaga, Spain.
| | - J Alfaro Lizaso
- Servicio de Oncología Médica, Instituto Oncológico de Guipúzcoa, San Sebastian, Spain
| | - L de la Cruz Merino
- Servicio de Oncología Médica, Complejo Hospitalario Regional Virgen Macarena, Seville, Spain
| | - J Gumá I Padró
- Servicio de Oncología Médica, Hospital Universitari de Sant Joan de Reus, Reus, Spain
| | - C Quero Blanco
- Servicio de Oncología Médica, Complejo Hospitalario Regional y Virgen de la Victoria, Málaga, Spain
| | - J Gómez Codina
- Servicio de Oncología Médica, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - M Llanos Muñoz
- Servicio de Oncología Médica, Hospital Universitario de Canarias (H.U.C), San Cristóbal De La Laguna, Tenerife, Spain
| | - N Martinez Banaclocha
- Servicio de Oncología Médica, Hospital General Universitario de Elche y Vega Baja, Elche, Spain
| | - D Rodriguez Abreu
- Servicio de Oncología Médica, Hospital Universitario Insular de Gran Canaria, Las Palmas De Gran Canarias, Spain
| | - M Provencio Pulla
- Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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