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Tan D, Chan JY, Wudhikarn K, Wong RSM, Poon L, Norasetthada L, Huang TC, Tse E. Unmet Needs in the First-Line Treatment of Diffuse Large B-cell Lymphoma: Expert Recommendations From the Asia-Pacific Region With a Focus on the Challenging Subtypes. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e320-e328. [PMID: 38853026 DOI: 10.1016/j.clml.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/11/2024]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma, accounting for around 30-60% of all cases. The management of DLBCL in Asia has several unmet needs due to the diversity of the population, the heterogeneity of local clinical guidelines for DLBCL and the wide disparity in resources and healthcare systems across different regions. Rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP) is widely recognized as the standard first-line treatment for DLBCL; however, alternative regimens are required to improve patient outcomes in challenging subtypes, such as patients with high International Prognostic Index scores, old/frail patients, and patients with double-hit and double-expressor DLBCL or concurrent central nervous system disease. This review article draws from the expertise of practicing hematologists/oncologists in the region, with the aim of integrating data from current scientific evidence to address the unmet needs and unique socioeconomic challenges faced by challenging high risk patient groups in the Asia-Pacific region.
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Affiliation(s)
- Daryl Tan
- Clinic for Lymphoma, Myeloma and Blood Disorders, Mount Elizabeth Novena Hospital, Singapore.
| | | | - Kitsada Wudhikarn
- Division of Hematology and Center of Excellence in Translational Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Raymond Siu Ming Wong
- Sir Y.K. Pao Centre for Cancer & Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Limei Poon
- Department of Hematology-Oncology, National University Cancer Institute Singapore, Singapore
| | - Lalita Norasetthada
- Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tai-Chung Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Eric Tse
- Department of Medicine, University of Hong Kong, Hong Kong
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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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de Pádua Covas Lage LA, De Vita RN, de Oliveira Alves LB, Jacomassi MD, Culler HF, Reichert CO, de Freitas FA, Rocha V, Siqueira SAC, de Oliveira Costa R, Pereira J. Predictors of Survival, Treatment Modalities, and Clinical Outcomes of Diffuse Large B-Cell Lymphoma in Patients Older Than 70 Years Still an Unmet Medical Need in 2024 Based on Real-World Evidence. Cancers (Basel) 2024; 16:1459. [PMID: 38672542 PMCID: PMC11048621 DOI: 10.3390/cancers16081459] [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: 02/15/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) especially affects the older population. Old (≥60 years) and very old age (≥80 years) DLBCL patients often present high-risk molecular alterations, lower tolerability to conventional immunochemotherapy, and poor clinical outcomes. In this scenario, attenuated therapeutic strategies, such as the R-MiniCHOP and R-MiniCHOP of the elderly regimens, have emerged for this particularly fragile population. However, the responses, clinical outcomes, and toxicities of these regimens currently remain poorly understood, mainly because these individuals are not usually included in controlled clinical trials. METHODS This retrospective, observational, and single-center real-world study included 185 DLBCL, NOS patients older than 70 years treated at the largest oncology center in Latin America from 2009 to 2020. We aimed to assess the outcomes, determine survival predictors, and compare responses and toxicities between three different primary therapeutic strategies, including the conventional R-CHOP regimen and the attenuated R-MiniCHOP and R-MiniCHOP of the elderly protocols. RESULTS The median age at diagnosis was 75 years (70-97 years), and 58.9% were female. Comorbidities were prevalent, including 19.5% with immobility, 28.1% with malnutrition, and 24.8% with polypharmacy. Advanced clinical stage was observed in 72.4%, 48.6% had bulky disease ≥7 cm, 63.2% had B-symptoms, and 67.0% presented intermediate-high/high-risk IPI. With a median follow-up of 6.3 years, the estimated 5-year OS and PFS were 50.2% and 44.6%, respectively. The R-MiniCHOP of the elderly regimen had a lower ORR (p = 0.040); however, patients in this group had higher rates of unfavorable clinical and laboratory findings, including hypoalbuminemia (p = 0.001), IPI ≥ 3 (p = 0.013), and NCCN-IPI ≥ 3 (p = 0.002). Although associated with higher rates of severe neutropenia (p = 0.003), the R-CHOP regimen promoted increased OS (p = 0.003) and PFS (p = 0.005) in comparison to the attenuated protocols. Additionally, age ≥ 75 years, high levels of LDH, B-symptoms, advanced clinical stage (III/IV), neutrophilia, and low lymphocyte/monocyte ratio were identified as poor prognostic factors in this cohort. CONCLUSIONS In this large and real-life Latin American cohort, we demonstrated that patients with DLBCL, NOS older than 70 years still do not have satisfactory clinical outcomes in 2024, with half of cases not reaching 5 years of life expectancy after diagnosis. Although the conventional R-CHOP offers response and survival advantages over attenuated regimens, its myelotoxicity is not negligible. Therefore, the outcomes reported and the prognostic factors here identified may assist clinicians in the appropriate selection of therapeutic strategies adapted to the risk for old and very old DLBCL patients.
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Affiliation(s)
- Luís Alberto de Pádua Covas Lage
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
| | - Rita Novello De Vita
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
| | - Lucas Bassolli de Oliveira Alves
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
| | - Mayara D’Auria Jacomassi
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
| | - Hebert Fabrício Culler
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
| | - Cadiele Oliana Reichert
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
| | - Fábio Alessandro de Freitas
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
| | - Vanderson Rocha
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
- Fundação Pró-Sangue, Blood Bank of São Paulo, São Paulo 05403000, Brazil
- Department of Hematology & Hemotherapy, Churchill Hospital, Oxford University, Oxford OX3 7LE, UK
| | | | - Renata de Oliveira Costa
- Department of Hematology & Hemotherapy, Faculty of Medicine, Centro Universitário Lusíada (Unilus), Santos 11045101, Brazil;
- Department of Hematology & Oncology, Hospital Alemão Oswaldo Cruz (HAOC), São Paulo 05403000, Brazil
| | - Juliana Pereira
- Department of Hematology, Hemotherapy & Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (J.P.)
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Faculty of Medicine, University of São Paulo (FM-USP), São Paulo 05403000, Brazil (F.A.d.F.)
- Department of Hematology & Oncology, Hospital Alemão Oswaldo Cruz (HAOC), São Paulo 05403000, Brazil
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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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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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Akhtar OS, Huang LW, Tsang M, Torka P, Loh KP, Morrison VA, Cordoba R. Geriatric assessment in older adults with Non-Hodgkin lymphoma: A Young International Society of Geriatric Oncology (YSIOG) review paper. J Geriatr Oncol 2022; 13:572-581. [PMID: 35216939 DOI: 10.1016/j.jgo.2022.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/08/2022] [Indexed: 12/13/2022]
Abstract
Non-Hodgkin lymphoma (NHL) is a disease of older adults, with a median age at diagnosis of 67 years. Treatment in older adults with NHL is challenging. The aging process is associated with a decline in functional reserve that varies among individuals, and results in an increasing risk of treatment-related toxicity and mortality. Chronological age and performance status fail to capture the multidimensional and heterogeneous nature of the aging process. A geriatric assessment (GA) screens multiple geriatric domains and provides a more accurate assessment of functional reserve. Several abbreviated GA tools have been developed for use in oncology clinics and help identify patients at high risk for chemotherapy-related toxicity and mortality. In this review, we explore GA tools validated for use in patients with NHL. We discuss the evidence behind GA-guided treatment in NHL and present a suggested approach to assessing frailty in this patient population.
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Affiliation(s)
| | - Li-Wen Huang
- San Francisco VA Medical Center, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Mazie Tsang
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kah Poh Loh
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Vicki A Morrison
- Hennepin Healthcare/University of Minnesota, Minneapolis, MN, USA
| | - Raul Cordoba
- Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
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Rodday AM, Hahn T, Kumar AJ, Lindenauer PK, Friedberg JW, Evens AM, Parsons SK. Association of Treatment Intensity With Survival in Older Patients With Hodgkin Lymphoma. JAMA Netw Open 2021; 4:e2128373. [PMID: 34673965 PMCID: PMC8531990 DOI: 10.1001/jamanetworkopen.2021.28373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Hodgkin lymphoma is an aggressive blood cancer that is highly curable in younger patients who receive multiagent chemotherapy. Worse survival in older patients may reflect less-aggressive treatment, competing risks of death, or different disease biological factors. OBJECTIVE To examine the association between treatment intensity and cause-specific mortality among older adults with Hodgkin lymphoma. DESIGN, SETTING, AND PARTICIPANTS This was a population-based cohort study of patients aged 65 years or older with Medicare Part A and B fee-for-service coverage who received a diagnosis of Hodgkin lymphoma from 2000 to 2013. The association between treatment intensity and cause-specific mortality was estimated separately for early-stage and advanced-stage disease with Cox proportional hazards models. Multivariable adjustment and propensity score weighting helped control for confounding. Data are from the 1999 to 2016 Surveillance, Epidemiology, and End Results Medicare database. Data analysis was performed from April 2020 to June 2021. EXPOSURES First-line treatment categorized as (1) full chemotherapy regimen, (2) partial chemotherapy regimen, (3) single chemotherapy agent or radiotherapy, or (4) no treatment. MAIN OUTCOMES AND MEASURES The main outcome was 3-year Hodgkin lymphoma-specific and other-cause mortality. RESULTS Among 2686 patients (mean [SD] age, 75.7 [6.9] years; 1333 men [50%]), 1307 had early-stage disease and 1379 had advanced-stage disease. For Hodgkin lymphoma-specific mortality in patients with early-stage disease, hazard ratios (HRs) were higher for partial regimens (HR, 1.77; 95% CI, 1.22-2.57) or no treatment (HR, 1.91; 95% CI, 1.31-2.79) than for full regimens; there was no difference between single-agent chemotherapy or radiotherapy and full regimens. For other-cause mortality in patients with early-stage disease, HRs were higher for partial regimens (HR, 1.69; 95% CI, 1.18-2.44), single-agent chemotherapy or radiotherapy (HR, 1.62; 95% CI, 1.13-2.33), or no treatment (HR, 2.71; 95% CI, 1.95-3.78) than for full regimens. For Hodgkin lymphoma-specific mortality in patients with advanced-stage disease, HRs were higher for partial regimens (HR, 3.26; 95% CI, 2.44-4.35), single-agent chemotherapy or radiotherapy (HR, 2.85; 95% CI, 1.98-4.11), or no treatment (HR, 4.06; 95% CI, 3.06-5.37) than for full regimens. For other-cause mortality in patients with advanced-stage disease, HRs were higher for partial regimens (HR, 1.76; 95% CI, 1.32-2.33), single-agent chemotherapy or radiotherapy (HR, 1.65; 95% CI, 1.15-2.37), or no treatment (HR, 2.24; 95% CI, 1.71-2.94) than for full regimens. CONCLUSIONS AND RELEVANCE This cohort study found variability in the magnitude of the association between treatment intensity and mortality by stage and cause-specific mortality, possibly reflecting competing risks of death. However, full chemotherapy regimens were associated with lower mortality and could be considered for older adults who can tolerate them.
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Affiliation(s)
- Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Theresa Hahn
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Anita J. Kumar
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Peter K. Lindenauer
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School Baystate, Springfield
| | | | | | - Susan K. Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
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Kumar AJ, Nelson J, Rodday AM, Evens AM, Friedberg JW, Wildes TM, Parsons SK. Development and validation of a prediction model for 1-year mortality among older adults with Hodgkin Lymphoma who receive dose-intense chemotherapy. J Geriatr Oncol 2021; 12:1233-1239. [PMID: 34330667 DOI: 10.1016/j.jgo.2021.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/12/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Older adults with Hodgkin Lymphoma (HL) have poorer outcomes than younger patients. There are little data about which baseline patient and disease factors inform prognosis among older patients. We sought to create a prediction model for 1-year mortality among older patients with new HL who received dose-intense chemotherapy. METHODS We included adults ≥65 years old with a new diagnosis of classical HL between 2000-2013 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset who received full-regimen chemotherapy. Through a non-random 2:1 split, we created development and validation cohorts. Multiple imputation was used for missing data. Using stepwise selection and logistic regression, we identified predictive variables for 1-year mortality. The model was applied to the validation cohort. A final model was then fit in the full cohort. RESULTS We included 1315 patients. In the development cohort (n = 813), we identified significant predictors of 1-year mortality including age, Charlson comorbidity index (CCI), B symptoms at diagnosis, and advanced stage at diagnosis. The c-statistic was 0.70. When this model was applied to the validation cohort (n = 502), the c-statistic was 0.65. Predictors of 1-year mortality in the final model were CCI (OR = 1.41), B symptoms (OR = 1.54), advanced stage (OR = 1.44), and older age at diagnosis (OR = 1.33). CONCLUSION We present a prediction model for use among older adults with HL who receive intensive chemotherapy. We identify risk factors for death within 1 year of diagnosis. Future work will build upon prognostication and shared decision-making after diagnosis for this population.
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Affiliation(s)
- Anita J Kumar
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America; Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, United States of America.
| | - Jason Nelson
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America
| | - Angie Mae Rodday
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Jonathan W Friedberg
- Wilmot Cancer Institute, University of Rochester, Rochester, NY, United States of America
| | - Tanya M Wildes
- Cancer and Aging Research Group, United States of America
| | - Susan K Parsons
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America; Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, United States of America; Department of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA, United States of America
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Makiyama J, Imaizumi Y, Watanabe H, Fujioka M, Chiwata M, Kitanosono H, Nakashima J, Miyazaki Y, Yoshida S. Outcomes in Patients with Classic Hodgkin Lymphoma Treated with ABVD: A Single-center Retrospective Study. Intern Med 2021; 60:709-718. [PMID: 33087662 PMCID: PMC7990646 DOI: 10.2169/internalmedicine.5004-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Classic Hodgkin lymphoma (CHL) has been regarded as a curable disease when treated appropriately, especially in younger patients, and ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) has been regarded as the standard regimen. However, a relatively poor prognosis has been reported in older patients with CHL, and the efficacy and tolerability of the ABVD regimen has not been fully elucidated. We retrospectively investigated the outcomes in patients with CHL treated with ABVD at our institute. Methods Twenty-five patients were evaluated; 14 were ≤60 years of age, and 11 were >60 years of age (older group). Results The ABVD doses were reduced in all patients in the older group; the median average relative dose intensity was 0.58. In the older group, the 5-year overall survival (OS) and median OS were 100% and not reached, respectively, for patients with early-stage CHL and 66.7% and not reached, respectively, for those with advanced-stage CHL. No patients died of CHL, and only one treatment-related death was observed in the older group. Conclusion ABVD with dose attenuation may represent a feasible and effective strategy for the treatment of older patients with CHL in clinical practice, particularly in those with early-stage disease, although the optimal degree of attenuation remains unclear.
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Affiliation(s)
- Junya Makiyama
- Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Japan
- Department of Hematology, National Hospital Organization Nagasaki Medical Center, Japan
| | | | - Haruka Watanabe
- Department of Hematology, National Hospital Organization Nagasaki Medical Center, Japan
| | - Machiko Fujioka
- Department of Hematology, National Hospital Organization Nagasaki Medical Center, Japan
- Department of Hematology, Nagasaki University Hospital, Japan
| | - Masahiko Chiwata
- Department of Hematology, National Hospital Organization Nagasaki Medical Center, Japan
- Department of Hematology, Nagasaki University Hospital, Japan
| | - Hideaki Kitanosono
- Department of Hematology, National Hospital Organization Nagasaki Medical Center, Japan
| | - Jun Nakashima
- Department of Hematology, National Hospital Organization Nagasaki Medical Center, Japan
| | - Yasushi Miyazaki
- Department of Hematology, Nagasaki University Hospital, Japan
- Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Japan
| | - Shinichiro Yoshida
- Department of Hematology, National Hospital Organization Nagasaki Medical Center, Japan
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Kobayashi H, Seki R, Ujita M, Hirayama K, Yamada S, Ohashi R, Otsuki Y, Watanabe T, Yoshino T. An Autopsy Case of an Elderly Patient with Classic Hodgkin Lymphoma Presenting with a Plethora of Clinical Symptoms and Signs. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926177. [PMID: 33087692 PMCID: PMC7588351 DOI: 10.12659/ajcr.926177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/14/2020] [Accepted: 07/25/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Hodgkin lymphoma (HL) is a potentially curable disease with favorable outcomes. However, elderly patients with HL usually have more adverse prognostic factors and hence a much worse prognosis than younger patients. CASE REPORT The patient was a woman in her 80s. She reported high fever, anorexia, and a weight loss of 8 kg within 5 months. She had been on treatment for diabetes mellitus and hypertension. She had undergone percutaneous coronary intervention and pacemaker implantation to treat acute coronary syndrome and sinus arrhythmia, respectively. Blood tests showed elevation of alkaline phosphatase, C-reactive protein, leukocyte count, CA 19-9, and carcinoembryonic antigen. Computed tomography did not show tumors in the liver, and cholangitis and sepsis were suspected. Aspartate transaminase, alanine aminotransferase, and total bilirubin gradually increased through the course of the patient's hospital stay. Despite treatment, her condition deteriorated and she died 22 days after hospital admission. At autopsy, we found stage IV HL with lymph node swelling on both sides of the diaphragm, as well as diffusely disseminated nodules in the liver and spleen. CONCLUSIONS Our patient had several poor prognostic factors including B symptoms, comorbidity, advanced stage, Epstein-Barr virus infection, and expression of programmed death-ligand 1 and interleukin-6, all of which were closely connected with her advanced age. Her age and comorbidities may have been the most adverse prognostic factors for her illness. An effective HL screening method for elderly individuals should be developed to ameliorate poor prognosis and adverse outcomes.
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Affiliation(s)
- Hiroshi Kobayashi
- Department of Pathology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Ryouya Seki
- Department of of Gastroenterology, Tachikawa General Hopspital, Nagaoka, Niigata, Japan
| | - Masuo Ujita
- Department of Radiology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Kana Hirayama
- Department of Dermatology, Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan
| | - Satoshi Yamada
- Health Examination Center, Nagaoka Central General Hospital, Nagaoka, Niigata, Japan
| | - Riuko Ohashi
- Histopathology Core Facility, Niigata University School of Medicine, Niigata City, Niigata, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Takuya Watanabe
- Department of General Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University, Okayama City, Okayama, Japan
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Stefoni V, Marangon M, Re A, Lleshi A, Bonfichi M, Pinto A, Bianchetti N, Pellegrini C, Argnani L, Zinzani PL. Brentuximab vedotin in the treatment of elderly Hodgkin lymphoma patients at first relapse or with primary refractory disease: a phase II study of FIL ONLUS. Haematologica 2020; 105:e512. [PMID: 33054094 PMCID: PMC7556670 DOI: 10.3324/haematol.2019.243170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Vittorio Stefoni
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna
| | - Miriam Marangon
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna
| | - Alessandro Re
- Department of Hematology, ASST Spedali Civili di Brescia, Brescia
| | | | | | - Antonello Pinto
- Hematology-Oncology and Stem Cell Transplantation Unit, National Cancer Institute, Fondazione Pascale, IRCCS, Napoli, Italy
| | | | - Cinzia Pellegrini
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna
| | - Lisa Argnani
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna
| | - Pier Luigi Zinzani
- Institute of Hematology “L. e A. Seràgnoli”, University of Bologna, Bologna
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12
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Older adults in hematologic malignancy trials: Representation, barriers to participation and strategies for addressing underrepresentation. Blood Rev 2020; 43:100670. [PMID: 32241586 DOI: 10.1016/j.blre.2020.100670] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/22/2020] [Accepted: 01/30/2020] [Indexed: 12/15/2022]
Abstract
Despite a high incidence of hematologic malignancies in older adults, available data indicate that there is disproportionately low representation of adults ≥65 years with hematologic malignancies (greater in patients ≥75 years) in clinical trials. Biological and clinical differences between older and younger adults and diversity within older patients necessitate adequate representation of the older subpopulation in hematologic malignancy trials. This would allow trial results to be generalizable and inform treatment decisions in the older patient population. Restrictive eligibility criteria may be barriers to adequate representation, as older adults do not typically meet these criteria. Efforts to broaden eligibility criteria in clinical trials have been proposed and may promote enrollment of a representative older population with hematologic malignancies. Collaboration among a diverse group of stakeholders will be needed to implement current proposals and evaluate their impact on increasing representation of older adults in trials evaluating therapies for hematologic malignancies.
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13
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Galli E, Cuccaro A, Maiolo E, Bellesi S, D'Alò F, Fusco D, Colloca G, De Stefano V, Hohaus S. Comorbidity assessment to determine prognosis in older adult patients with classical Hodgkin lymphoma. Hematol Oncol 2020; 38:153-161. [PMID: 31953864 DOI: 10.1002/hon.2715] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/11/2020] [Accepted: 01/14/2020] [Indexed: 12/14/2022]
Abstract
The clinical management of older adult patients with Hodgkin lymphoma (HL) remains a major challenge. The aim of this study was to evaluate the impact of comorbidity assessment according to a standardized approach, the Cumulative Illness Rating Scale (CIRS), on prognosis in patients with classical HL aged 60 years and older. We studied 76 consecutive older adult patients with HL (median age 69 y, range 60-84) who had been treated in our institution between 1999 and 2018. Comorbidity was assessed at diagnosis according to CIRS. Anthracycline-containing chemotherapy with curative intent was administered in 59 (78%) patients. We identified 41 (54%) patients with at least one severe comorbidity rated on CIRS grade ≥ 3. Patients with severe comorbidity were more likely to have advanced-stage disease (P = .003), to have an International Prognostic Score (IPS) > 3 (P = .03), and to not receive anthracycline-containing chemotherapy (P = .008). The probability of overall survival (OS) at 3 years was 88% (95% CI, 71%-95%) in patients without severe comorbidities, while it was only 46% (95% CI, 29%-62%) in patients with a comorbidity CIRS grade ≥ 3 (P = .0001). The impact of comorbidity on prognosis was also evident when restricting the analysis to patients treated with anthracycline-containing therapy. The 3-year OS was 93% (95% CI, 76%-98%) (P = .004) in patients without severe comorbidity and 72% (95% CI, 47%-87%) in patients with severe comorbidity (P = .004). In a multivariate analysis, presence of comorbidity, but not age, was a significant factor for OS. Therefore, we conclude that a significant proportion of older adult patients with HL has severe comorbidity on the CIRS scale, which impacts more importantly than age on prognosis.
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Affiliation(s)
- Eugenio Galli
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annarosa Cuccaro
- Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Elena Maiolo
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Silvia Bellesi
- Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco D'Alò
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Domenico Fusco
- Area Invecchiamento, Ortopedia e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giuseppe Colloca
- Istituto di Geriatria, Università Cattolica del Sacro Cuore, Rome, Italy.,Area Invecchiamento, Ortopedia e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Valerio De Stefano
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Stefan Hohaus
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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14
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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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15
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Wästerlid T, Mohammadi M, Smedby KE, Glimelius I, Jerkeman M, Bottai M, Eloranta S. Impact of comorbidity on disease characteristics, treatment intent and outcome in diffuse large B-cell lymphoma: a Swedish lymphoma register study. J Intern Med 2019; 285:455-468. [PMID: 30368947 DOI: 10.1111/joim.12849] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Comorbidity impacts overall survival amongst patients with diffuse large B-cell lymphoma (DLBCL). However, associations of comorbidity with lymphoma characteristics, treatment selection and lymphoma-specific mortality are less well known. OBJECTIVE To examine the impact of comorbidity on DLBCL characteristics, treatment intent and cause of death. METHODS We identified 3905 adult patients diagnosed with DLBCL 2007-2013 through the Swedish Lymphoma Register. We assessed comorbid disease history according to the Charlson comorbidity index (CCI). Comorbidity data and causes of death were collected through register linkage. Associations were estimated using multinomial regression and flexible parametric survival models. RESULTS Overall, 45% of the patients (n = 1737) had a history of at least one comorbidity at DLBCL diagnosis (cardiovascular disease, diabetes and solid cancer were most frequent), and 997 (26%) had a CCI score of ≥2. The relative probability of presenting with poor performance status (PS > 2) was higher amongst comorbid patients [Relative Risk Ratio (RRR)PS>2 : 2.02, 95% CI: 1.63-2.51]. Comorbid patients had a substantially lower relative probability of receiving curative treatment (RRR: 0.48, 95% CI: 0.38-0.61). Amongst all patients, CCI ≥ 1 was associated with a significantly increased risk of all-cause and lymphoma-specific death after adjustments. Amongst patients selected for curative treatment, comorbidity was associated with an increased risk of all-cause death (HRCCI>1 : 1.54, 95% CI: 1.32-1.80), but not with lymphoma-specific death (HRCCI>1 : 1.05, 95% CI: 0.86-1.28). CONCLUSION Comorbidity is associated with inferior DLBCL outcome, mainly due to a lower likelihood of receiving treatment with curative intent. Possibly, more comorbid DLBCL patients could be treated with curative intent if comorbid conditions were optimized in parallel.
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Affiliation(s)
- T Wästerlid
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - M Mohammadi
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - K E Smedby
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - I Glimelius
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University, Uppsala, Sweden
| | - M Jerkeman
- Department of Oncology, Lund University Hospital, Lund, Sweden
| | - M Bottai
- Institute of Environmental Medicine, Division of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - S Eloranta
- Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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16
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Lugtenburg PJ, Lyon AR, Marks R, Luminari S. Treatment of aggressive non-Hodgkin's lymphoma in frail patients: cardiac comorbidities and advanced age. Future Oncol 2019; 15:1197-1205. [PMID: 30730219 DOI: 10.2217/fon-2019-0019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The decisive factor in selecting a treatment regimen for a frail patient with aggressive non-Hodgkin's lymphoma is identifying whether a patient is fit enough to tolerate curative-intent anthracycline-containing regimens or too frail and therefore at risk of being undertreated. As cardiac comorbidities are an important contributor to both the health status and the selection of treatment, cardiovascular profiling and baseline risk stratification prior to treatment should be considered. Comprehensive geriatric assessment is an efficient means of identifying elderly patients with non-Hodgkin's lymphoma who may benefit from a curative treatment approach. If anthracycline-based therapy is not suitable, alternative treatment options are available in frail patients with cardiac comorbidities, but these must be adjusted to the patient's health status to achieve a maximal benefit-risk ratio.
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Affiliation(s)
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton & Harefield NHS Trust, London, UK.,Imperial College London, National Heart & Lung Institute, London, UK
| | - Reinhard Marks
- Department of Hematology, Oncology & Stem Cell Transplantation, Faculty of Medicine & Medical Centre, University of Freiburg, Freiburg, Germany
| | - Stefano Luminari
- Hematology, Azienda USL IRCCS Reggio Emilia, Italy.,CHIMOMO Department University of Modena & Reggio Emilia, Reggio Emilia, Italy
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17
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Evens AM, Advani RH, Helenowski IB, Fanale M, Smith SM, Jovanovic BD, Bociek GR, Klein AK, Winter JN, Gordon LI, Hamlin PA. Multicenter Phase II Study of Sequential Brentuximab Vedotin and Doxorubicin, Vinblastine, and Dacarbazine Chemotherapy for Older Patients With Untreated Classical Hodgkin Lymphoma. J Clin Oncol 2018; 36:3015-3022. [PMID: 30179569 DOI: 10.1200/jco.2018.79.0139] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To improve the curability of older patients with newly diagnosed Hodgkin lymphoma. PATIENTS AND METHODS We conducted a multicenter phase II study that administered brentuximab vedotin (Bv) sequentially before and after standard doxorubicin, vinblastine, and dacarbazine (AVD) for untreated patients with Hodgkin lymphoma age 60 years or older. After two lead-in doses of single-agent Bv (1.8 mg/kg once every 3 weeks), patients received six cycles of AVD chemotherapy followed by four consolidative doses of Bv in responding patients. RESULTS Patient characteristics included median age of 69 years (range, 60 to 88 years), 63% male, median Eastern Cooperative Oncology Group performance status 1, 81% stage III to IV disease, 60% International Prognostic Score 3 to 7, median Cumulative Illness Rating Scale-Geriatric comorbidity score of 7 (52% grade 3 to 4); and 12% had loss of instrumental activities of daily living at diagnosis. Thirty-seven (77%) of 48 patients completed six cycles of AVD, and 35 patients (73%) received at least one Bv consolidation. Overall response and complete remission rates after initial Bv lead-in dose were 18 (82%) of 22 and 8 (36%) of 22, respectively, and 40 (95%) of 42 and 34 (90%) of 42, respectively, after six cycles of AVD among 42 response-evaluable patients. Twenty (42%) of 48 patients experienced a grade 3 to 4 adverse event, most commonly neutropenia (44%), febrile neutropenia and pneumonia (8%), or diarrhea (6%); 33% had grade 2 peripheral neuropathy, which was reversible in a majority of patients. By intent-to-treat, the 2-year event-free survival, progression-free survival, and overall survival rates were 80%, 84%, and 93%, respectively. Furthermore, 2-year progression-free survival rates for patients with a Cumulative Illness Rating Scale-Geriatric comorbidity score of ≥ 10 versus < 10 were 45% versus 100%, respectively (P < .001), and with baseline loss versus no loss of instrumental activities of daily living were 25% versus 94% (P < .001), respectively, the latter persisting on multivariable analyses. CONCLUSION Altogether, sequential Bv-AVD was well tolerated and was associated with robust outcomes. Furthermore, geriatric-based measures were strongly associated with patient survival.
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Affiliation(s)
- Andrew M Evens
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ranjana H Advani
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Irene B Helenowski
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michelle Fanale
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sonali M Smith
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Borko D Jovanovic
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gregory R Bociek
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andreas K Klein
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jane N Winter
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leo I Gordon
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul A Hamlin
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
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18
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Ellin F, Jerkeman M, Törnqvist J, Brudin L, Relander T. Impact of comorbidity on survival in peripheral T-cell lymphomas: A Swedish Lymphoma Registry study. Hematol Oncol 2017; 36:159-165. [PMID: 28474339 DOI: 10.1002/hon.2428] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/07/2017] [Accepted: 04/09/2017] [Indexed: 11/07/2022]
Abstract
Comorbidity impacts survival in B-cell lymphoma patients, but the influence in peripheral T-cell lymphomas (PTCLs) has been little studied. To investigate the impact of comorbidity on outcome in PTCL, we identified adult patients with newly diagnosed PTCL from 2000 to 2009 in the Swedish Lymphoma Registry. Data on comorbidity at diagnosis were retrospectively collected according to the Charlson Comorbidity Index (CCI). Comorbid conditions were present in 263 out of 694 (38%) patients. A CCI score of ≥2 was associated with inferior overall survival (OS) (hazard ratio [HR] 1.63, P < .001) and progression-free survival (HR 1.54, P < .001) in multivariate analysis. In patients undergoing front-line autologous stem cell transplantation (auto SCT), CCI >0 was associated with inferior OS (HR 2.40, P = .013). Chemotherapy regimens were classified as curative or low-intensity treatments. Among patients aged ≥75 years (n = 214), low-intensity and curative treatment groups had similar OS (HR 0.8, P = .6), also when adjusted for CCI. In summary, our results demonstrate CCI to be independently associated with survival in PTCLs. Even limited comorbidity impacted survival after front-line auto SCT, which needs to be considered in treatment decisions. Intensive anthracycline-based chemotherapy in elderly PTCL patients might be of limited benefit.
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Affiliation(s)
- Fredrik Ellin
- Department of Internal Medicine, Kalmar County Hospital, Kalmar, Sweden.,Department of Clinical Sciences Lund, Section for oncology and pathology, Lund University, Lund, Sweden
| | - Mats Jerkeman
- Department of Clinical Sciences Lund, Section for oncology and pathology, Lund University, Lund, Sweden.,Department of Oncology, Skane University Hospital, Lund, Sweden
| | - Jenny Törnqvist
- Department of Clinical Sciences Lund, Section for oncology and pathology, Lund University, Lund, Sweden
| | - Lars Brudin
- Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden
| | - Thomas Relander
- Department of Clinical Sciences Lund, Section for oncology and pathology, Lund University, Lund, Sweden.,Department of Oncology, Skane University Hospital, Lund, Sweden
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19
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Comorbidities, not age, are predictive of survival after autologous hematopoietic cell transplantation for relapsed/refractory Hodgkin’s lymphoma in patients older than 50 years. Ann Hematol 2016; 96:9-16. [DOI: 10.1007/s00277-016-2832-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022]
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20
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Hitz F, Zucca E, Pabst T, Fischer N, Cairoli A, Samaras P, Caspar CB, Mach N, Krasniqi F, Schmidt A, Rothermundt C, Enoiu M, Eckhardt K, Berardi Vilei S, Rondeau S, Mey U. Rituximab, bendamustine and lenalidomide in patients with aggressive B-cell lymphoma not eligible for anthracycline-based therapy or intensive salvage chemotherapy - SAKK 38/08. Br J Haematol 2016; 174:255-63. [DOI: 10.1111/bjh.14049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/22/2016] [Indexed: 12/19/2022]
Affiliation(s)
| | - Emanuele Zucca
- IOSI (Istituto Oncologico della Svizzera Italiana); Bellinzona Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ulrich Mey
- Kantonsspital Graubünden; Chur Switzerland
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21
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Iioka F, Izumi K, Kamoda Y, Akasaka T, Ohno H. Outcomes of very elderly patients with aggressive B-cell non-Hodgkin lymphoma treated with reduced-dose chemotherapy. Int J Clin Oncol 2015; 21:498-505. [DOI: 10.1007/s10147-015-0912-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/30/2015] [Indexed: 01/17/2023]
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22
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Gafter-Gvili A, Ribakovsky E, Mizrahi N, Avigdor A, Aviv A, Vidal L, Ram R, Perry C, Avivi I, Kedmi M, Nagler A, Raanani P, Gurion R. Infections associated with bendamustine containing regimens in hematological patients: a retrospective multi-center study. Leuk Lymphoma 2015; 57:63-9. [PMID: 25944378 DOI: 10.3109/10428194.2015.1046862] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A multi-center retrospective analysis of a cohort of patients in Israel treated with any bendamustine containing regimen between 2010-2014 was performed in order to determine the incidence and predictors for infection. The Kaplan Meier Model, employing log rank analysis, was used to assess time-to-infection. The Cox Proportional Hazards model was used to analyze multivariate effects of risk and 234 patients were included in the analysis. One hundred and nine (46.6%) developed at least one infection and 33.76% had severe infections. Seventy-six (41.5%) developed bacterial infection, nine (3.8%) fungal infection and 26 (11.5%) had viral infections. Factors significantly associated with time to infection on multivariable analysis were: bendamustine-combinations [hazard ratio (HR) = 0.589 (95% CI = 0.374-0.926), p = 0.022], Hb level [HR = 0.791 (95% CI = 0.716-0.875), p < 0.0001] and ischemic heart disease [HR = 1.828 (95% CI = 1.165-2.868), p = 0.009]. Infections were associated with a higher mortality and hospitalization rate.
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Affiliation(s)
- Anat Gafter-Gvili
- a Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center , Petah-Tikva , Israel.,b Sackler School of Medicine , Tel-Aviv , Israel
| | - Elena Ribakovsky
- b Sackler School of Medicine , Tel-Aviv , Israel.,c Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center , Tel Hashomer , Israel
| | | | - Abraham Avigdor
- b Sackler School of Medicine , Tel-Aviv , Israel.,c Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Ariel Aviv
- d Department of Hematology , HaEmek Medical Center , Afula , Israel
| | - Liat Vidal
- a Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center , Petah-Tikva , Israel.,b Sackler School of Medicine , Tel-Aviv , Israel
| | - Ron Ram
- b Sackler School of Medicine , Tel-Aviv , Israel.,e Institute of Hematology, Sourasky Medical Center , Tel Aviv , Israel
| | - Chava Perry
- e Institute of Hematology, Sourasky Medical Center , Tel Aviv , Israel
| | - Irit Avivi
- b Sackler School of Medicine , Tel-Aviv , Israel.,e Institute of Hematology, Sourasky Medical Center , Tel Aviv , Israel
| | - Meirav Kedmi
- b Sackler School of Medicine , Tel-Aviv , Israel.,c Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Arnon Nagler
- b Sackler School of Medicine , Tel-Aviv , Israel.,c Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Pia Raanani
- a Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center , Petah-Tikva , Israel.,b Sackler School of Medicine , Tel-Aviv , Israel
| | - Ronit Gurion
- a Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center , Petah-Tikva , Israel.,b Sackler School of Medicine , Tel-Aviv , Israel
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Factors that influence treatment decision-making in elderly DLBCL patients: a case vignette study. Ann Hematol 2015; 94:1373-9. [PMID: 25869027 PMCID: PMC4488461 DOI: 10.1007/s00277-015-2358-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 03/18/2015] [Indexed: 10/26/2022]
Abstract
Elderly patients with diffuse large B-cell lymphoma (DLBCL) are frequently not treated with standard immunochemotherapy, and this influences survival negatively. The purpose of this study was to gain more insight into treatment decision-making by hematologists. Case vignettes concerning patients with DLBCL were presented to hematologists in the Netherlands. Patient characteristics (age, comorbidity) differed per case. Respondents were asked in each case if they would treat the patient with curative intent by means of full-dose chemotherapy or chemotherapy with dose reduction or if they would not treat the patient with curative intent. The vast majority of respondents would treat an elderly patient diagnosed with DLBCL without a relevant medical history with full-dose chemotherapy irrespective of age. In the presence of comorbidity, lack of social support, cognitive disorders, and untreated depression dose reductions in advance are frequently applied or patients are not treated with curative intent. This is most pronounced for patients aged older than 80 years. Respondents working in a university hospital more frequently refrain form full-dose chemotherapy with curative intent compared to respondents working in tertiary medical teaching hospitals or general hospitals. Patients without a relevant medical history are generally treated with curative intent irrespective of age. Cognitive disorders, comorbidity, and depression reduce the change of being treated with curative intent. This is most prominent in the eldest patient category.
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24
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Issa DE, van de Schans SAM, Chamuleau MED, Karim-Kos HE, Wondergem M, Huijgens PC, Coebergh JWW, Zweegman S, Visser O. Trends in incidence, treatment and survival of aggressive B-cell lymphoma in the Netherlands 1989-2010. Haematologica 2014; 100:525-33. [PMID: 25512643 DOI: 10.3324/haematol.2014.107300] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Only a small number of patients with aggressive B-cell lymphoma take part in clinical trials, and elderly patients in particular are under-represented. Therefore, we studied data of the population-based nationwide Netherlands Cancer Registry to determine trends in incidence, treatment and survival in an unselected patient population. We included all patients aged 15 years and older with newly diagnosed diffuse large B-cell lymphoma or Burkitt lymphoma in the period 1989-2010 and mantle cell lymphoma in the period 2001-2010, with follow up until February 2013. We examined incidence, first-line treatment and survival. We calculated annual percentage of change in incidence and carried out relative survival analyses. Incidence remained stable for diffuse large B-cell lymphoma (n=23,527), while for mantle cell lymphoma (n=1,634) and Burkitt lymphoma (n=724) incidence increased for men and remained stable for women. No increase in survival for patients with aggressive B-cell lymphoma was observed during the period 1989-1993 and the period 1994-1998 [5-year relative survival 42% (95%CI: 39%-45%) and 41% (38%-44%), respectively], but increased to 46% (43%-48%) in the period 1999-2004 and to 58% (56%-61%) in the period 2005-2010. The increase in survival was most prominent in patients under 65 years of age, while there was a smaller increase in patients over 75 years of age. However, when untreated patients were excluded, patients over 75 years of age had a similar increase in survival to younger patients. In the Netherlands, survival for patients with aggressive B-cell lymphoma increased over time, particularly in younger patients, but also in elderly patients when treatment had been initiated. The improvement in survival coincided with the introduction of rituximab therapy and stem cell transplantation into clinical practice.
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Affiliation(s)
- Djamila E Issa
- Department of Haematology, VU University Medical Centre, Amsterdam
| | | | | | - Henrike E Karim-Kos
- Department of Public Health, Erasmus University Medical Centre Rotterdam, The Netherlands
| | | | - Peter C Huijgens
- Department of Haematology, VU University Medical Centre, Amsterdam Comprehensive Cancer Centre the Netherlands, Utrecht
| | - Jan Willem W Coebergh
- Department of Public Health, Erasmus University Medical Centre Rotterdam, The Netherlands
| | - Sonja Zweegman
- Department of Haematology, VU University Medical Centre, Amsterdam
| | - Otto Visser
- Comprehensive Cancer Centre the Netherlands, Utrecht
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25
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Abramson JS, Feldman T, Kroll-Desrosiers AR, Muffly LS, Winer E, Flowers CR, Lansigan F, Nabhan C, Nastoupil LJ, Nath R, Goy A, Castillo JJ, Jagadeesh D, Woda B, Rosen ST, Smith SM, Evens AM. Peripheral T-cell lymphomas in a large US multicenter cohort: prognostication in the modern era including impact of frontline therapy. Ann Oncol 2014; 25:2211-2217. [PMID: 25193992 DOI: 10.1093/annonc/mdu443] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Optimal frontline therapy for peripheral T-cell lymphoma (PTCL) in the modern era remains unclear. PATIENTS AND METHODS We examined patient characteristics, treatment, and outcomes among 341 newly diagnosed PTCL patients from 2000 to 2011. Outcome was compared with a matched cohort of diffuse large B-cell lymphoma (DLBCL) patients, and prognostic factors were assessed using univariate and multivariate analyses. RESULTS PTCL subtypes included PTCL, not otherwise specified (PTCL-NOS) (31%), anaplastic large T-cell lymphoma (ALCL) (26%), angioimmunoblastic T-cell lymphoma (23%), NK/T-cell lymphoma (7%), acute T-cell leukemia/lymphoma (6%), and other (7%). Median age was 62 years (range 18-95 years), and 74% had stage III-IV disease. Twenty-three (7%) patients received only palliative care whereas 318 received chemotherapy: CHOP-like regimens (70%), hyperCVAD/MA (6%), or other (18%). Thirty-three patients (10%) underwent stem-cell transplantation (SCT) in first remission. The overall response rate was 73% (61% complete); 24% had primary refractory disease. With 39-month median follow-up, 3-year progression-free survival (PFS) and overall survival (OS) were 32% and 52%. PFS and OS for PTCL patients were significantly inferior to matched patients with DLBCL. On multivariate analysis, stage I-II disease was the only significant pretreatment prognostic factor [PFS: hazard ratio (HR) 0.54, 95% confidence interval (CI) 0.34-0.85, P = 0.007; OS: HR 0.42, 95% CI 0.22-0.78, P = 0.006]. ALK positivity in ALCL was prognostic on univariate analysis, but lost significance on multivariate analysis. The most dominant prognostic factor was response to initial therapy (complete response versus other), including adjustment for stage and SCT [PFS: HR 0.19, 95% CI 0.14-0.28, P < 0.0001; OS: HR 0.26, 95% CI 0.17-0.40, P < 0.0001]. No overall survival difference was observed based on choice of upfront regimen or SCT in first remission. CONCLUSIONS This analysis identifies early-stage disease and initial treatment response as dominant prognostic factors in PTCL. No clear benefit was observed for patients undergoing consolidative SCT. Novel therapeutic approaches for PTCL are critically needed.
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Affiliation(s)
- J S Abramson
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston
| | - T Feldman
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack
| | - A R Kroll-Desrosiers
- Department of Hematology/Oncology, University of Massachusetts Medical School, Worcester
| | - L S Muffly
- Department of Hematology/Oncology, University of Chicago, Chicago
| | - E Winer
- Department of Hematology/Oncology, Rhode Island Hospital, Providence
| | - C R Flowers
- Department of Hematology/Oncology, Emory University School of Medicine, Atlanta
| | - F Lansigan
- Department of Hematology/Oncology, Dartmouth-Hitchcock Medical Center, Lebanon
| | - C Nabhan
- Department of Hematology/Oncology, University of Chicago, Chicago
| | - L J Nastoupil
- Department of Hematology/Oncology, Emory University School of Medicine, Atlanta
| | - R Nath
- Department of Hematology/Oncology, University of Massachusetts Medical School, Worcester
| | - A Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack
| | - J J Castillo
- Department of Hematology/Oncology, Miriam Hospital, Providence
| | - D Jagadeesh
- Department of Hematology/Oncology, University of Massachusetts Medical School, Worcester
| | - B Woda
- Department of Hematology/Oncology, University of Massachusetts Medical School, Worcester
| | - S T Rosen
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago
| | - S M Smith
- Department of Hematology/Oncology, University of Chicago, Chicago
| | - A M Evens
- Department of Hematology/Oncology, Tufts Medical Center, Boston, USA.
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Hodgkin's Lymphoma in Older Patients: an Orphan Disease? Mediterr J Hematol Infect Dis 2014; 6:e2014050. [PMID: 25045458 PMCID: PMC4103506 DOI: 10.4084/mjhid.2014.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/20/2014] [Indexed: 01/04/2023] Open
Abstract
Hodgkin Lymphoma HL can be cured in the large majority of younger patients, but prognosis for older patients, especially those with advanced-stage disease, has not improved substantially. The percentage of HL patients aged over 60 ranges between 15% and 35%. A minority of them is enrolled into clinical trials. HL in the elderly have some specificities: more frequent male sex, B-symptoms, advanced stage, sub diaphragmatic presentation, higher percentage of mixed cellularity, up to 50% of advanced cases associated to EBV. Very old age (>70) and comorbidities are factor of further worsening prognosis. Like in younger patients, ABVD is the most used protocol, but treatment outcome remains much inferior with more frequent, severe and sometimes specific toxicities. Few prospective studies with specific protocols are available. The main data have been published by the Italian Lymphoma Group with the VEPEMB schedule and the German Hodgkin Study Group with the PVAG regimen. Recently, the Scotland and Newcastle Lymphoma Study Group published the SHIELD program associating a prospective phase 2 trial with VEPEMB and a prospective registration of others patients. Patients over 60y with early-stage disease received three cycles plus radiotherapy and had 81% of 3-year overall survival (OS). Those with advanced-stage disease received six cycles, with 3-year OS of 66%. The role of geriatric and comorbidity assessment in the treatment’s choice for HL in the elderly is a major challenge. The combination of loss of activities of daily living combined with the age stratification more or less 70y has been shown as a simple and effective survival model. Hopes come from promising new agents like brentuximab-vedotin (BV) a novel antibody-drug conjugate. The use of TEP to adapt the combination of chemotherapy and radiotherapy according to the metabolic response could also be way for prospective studies.
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27
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Wieringa A, Boslooper K, Hoogendoorn M, Joosten P, Beerden T, Storm H, Kibbelaar RE, Veldhuis GJ, van Kamp H, van Rees B, Kluin-Nelemans HC, Veeger NJGM, van Roon EN. Comorbidity is an independent prognostic factor in patients with advanced-stage diffuse large B-cell lymphoma treated with R-CHOP: a population-based cohort study. Br J Haematol 2014; 165:489-96. [PMID: 24754632 DOI: 10.1111/bjh.12765] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 12/15/2013] [Indexed: 11/27/2022]
Abstract
An observational population-based cohort study was performed to investigate the role of comorbidity on outcome and treatment-related toxicity in patients with newly diagnosed advanced-stage diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone). Data for the clinical characteristics of 154 patients (median age 69 years), including Charlson Comorbidity Index (CCI), treatment, toxicity and outcome were evaluated. Forty-five percent of the patients had an International Prognistic index ≥3 and 16% had a CCI ≥2. The planned R-CHOP schedule was completed by 84% and 75% reached complete remission (CR). In those with CCI ≥2, 67% completed treatment with 46% CR. In patients with a CCI <2, overall survival (OS) after 1, 2 and 5 years was 84%, 79% and 65% respectively and it was 64%, 48% and 48% for those with CCI ≥2. Grade III/IV toxicity was documented in 53%, most frequently febrile neutropenia (27%) and infections (23%). In multivariate analysis CCI ≥2 and IPI ≥3 were independent risk indicators for OS and grade III/IV toxicity. In conclusion, comorbidity is an independent risk indicator for worse OS in patients with advanced DLBCL treated with R-CHOP by interference with intensive treatment schedules and more grade III/IV toxicity. Future studies are warranted to determine the optimal treatment approach in patients with significant comorbidities.
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Affiliation(s)
- Andre Wieringa
- Department of Pharmacotherapy & Pharmaceutical Care, University Centre for Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Clinical Pharmacy, Isala Klinieken, Zwolle, The Netherlands
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28
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van de Schans SAM, van Steenbergen LN, Coebergh JWW, Janssen-Heijnen MLG, van Spronsen DJ. Actual prognosis during follow-up of survivors of B-cell non-Hodgkin lymphoma in the Netherlands. Haematologica 2013; 99:339-45. [PMID: 24038025 DOI: 10.3324/haematol.2012.081885] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Survival rates determined at diagnosis are often too negative for cancer survivors. Conditional relative survival reflects actual prognosis during follow-up better. Data from all 54,015 patients newly diagnosed in the Netherlands with B-cell non-Hodgkin lymphoma during 1989-2008, aged 15-89 years (Netherlands Cancer Registry), were used. Five-year conditional relative survival was computed for every additional year of survival up to 16 years after diagnosis, according to entity, grade, gender, age, and Ann Arbor stage. The prognosis for survivors of indolent B-cell non-Hodgkin lymphoma improved slightly with each additional year survived up to 91%. For patients with aggressive non-Hodgkin lymphoma conditional relative survival improved strongly during the first year after diagnosis (from 48% to 68%) and gradually thereafter to 93% after 16 years. There were differences between morphological entities. Initial differences in conditional relative survival at diagnosis between groups with different disease stages became smaller with increasing number of years survived. Age remained a prognostic indicator, also after prolonged follow-up. These results help caregivers to plan optimal surveillance and inform patients about their actual prognosis during follow-up. Long-lasting excess mortality among patients with B-cell non-Hodgkin lymphoma indicates the need for additional care long after their diagnosis.
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29
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Jagadeesh D, Diefenbach C, Evens AM. XII. Hodgkin lymphoma in older patients: challenges and opportunities to improve outcomes. Hematol Oncol 2013; 31 Suppl 1:69-75. [DOI: 10.1002/hon.2070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Catherine Diefenbach
- New York University School of Medicine; NYU Cancer Institute; New York City; NY; USA
| | - Andrew M. Evens
- Division of Hematology/Oncology; The University of Massachusetts Medical School; Worcester; MA; USA
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30
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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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Cai X, Wu H, Peng J, Zhu J, Cai S, Cai G, Zhang Z. Tolerability and outcomes of radiotherapy or chemoradiotherapy for rectal cancer in elderly patients aged 70 years and older. Radiat Oncol 2013; 8:86. [PMID: 23574985 PMCID: PMC3641029 DOI: 10.1186/1748-717x-8-86] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 04/07/2013] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To assess the safety and outcomes of radiotherapy (RT) or chemoradiotherapy (CRT) in elderly patients (≥70) with rectal cancer. METHODS Elderly patients aged 70 and older with rectal cancer, who were treated with RT or CRT at a single institution, were retrospectively analyzed. Performance status (KPS and ECOG score) and comorbidity (Charlson comorbidity index) were calculated, and their correlation with treatment toxicity and overall survival were studied. Risk factors for overall survival were investigated using univariate and multivariate survival analysis. RESULTS A total of 126 patients with locally advanced disease, local recurrence or synchronous metastasis were included, with a 3-year OS rate of 48.1%. Scheduled dosage of radiation was delivered to 69% of patients. Grade 3 toxicities occurred more often in patients treated with CRT versus RT. The occurrence of grade 3 toxicities was not related to KPS score, ECOG score, number of comorbidities, and Charlson score. Multivariate analysis found that only age and Charlson score were independent prognostic factors for predicting patients' 3-year OS. The 3-year OS rate was significantly higher in patients with Charlson score <4 vs Charlson score ≥4 (71.1% vs. 26.4%, P=0.0003). CONCLUSIONS Although toxicities may be significant, elderly patients with rectal cancer of varied stages can be safely treated with RT or CRT with careful monitoring and frequent modification of treatment. Except for patients' age, Charlson comorbidity index may be helpful in assessing patients' outcomes in elderly patients with rectal cancer.
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Affiliation(s)
- Xin Cai
- Department of Radiological Oncology, Fudan University Shanghai Cancer Center, 270 Dong'An Road, Shanghai 200032, People's Republic of China
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Eloranta S, Lambert PC, Sjöberg J, Andersson TM, Björkholm M, Dickman PW. Temporal Trends in Mortality From Diseases of the Circulatory System After Treatment for Hodgkin Lymphoma: A Population-Based Cohort Study in Sweden (1973 to 2006). J Clin Oncol 2013; 31:1435-41. [DOI: 10.1200/jco.2012.45.2714] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeHodgkin lymphoma (HL) survival in Sweden has improved dramatically over the last 40 years, but little is known about the extent to which efforts aimed at reducing long-term treatment-related mortality have contributed to the improved prognosis.MethodsWe used population-based data from Sweden to estimate the contribution of treatment-related mortality caused by diseases of the circulatory system (DCS) to temporal trends in excess HL mortality among 5,462 patients diagnosed at ages 19 to 80 between 1973 and 2006. Flexible parametric survival models were used to estimate excess mortality. In addition, we used recent advances in statistical methodology to estimate excess mortality in the presence of competing causes of death.ResultsExcess DCS mortality within 20 years after diagnosis has decreased continually since the mid-1980s and is expected to further decrease among patients diagnosed in the modern era. Age at diagnosis and sex were important predictors for excess DCS mortality, with advanced age and male sex being associated with higher excess DCS mortality. However, when accounting for competing causes of death, we found that excess DCS mortality constitutes a relatively small proportion of the overall mortality among patients with HL in Sweden.ConclusionExcess DCS mortality is no longer a common source of mortality among Swedish patients with HL. The main causes of death among long-term survivors today are causes other than HL, although other (non-DCS) excess mortality also persists for as long as 20 years after diagnosis, particularly among older patients.
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Affiliation(s)
- Sandra Eloranta
- All authors: Karolinska Institutet; Jan Sjöberg and Magnus Björkholm, Karolinska University Hospital Solna, Stockholm, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom
| | - Paul C. Lambert
- All authors: Karolinska Institutet; Jan Sjöberg and Magnus Björkholm, Karolinska University Hospital Solna, Stockholm, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom
| | - Jan Sjöberg
- All authors: Karolinska Institutet; Jan Sjöberg and Magnus Björkholm, Karolinska University Hospital Solna, Stockholm, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom
| | - Therese M.L. Andersson
- All authors: Karolinska Institutet; Jan Sjöberg and Magnus Björkholm, Karolinska University Hospital Solna, Stockholm, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom
| | - Magnus Björkholm
- All authors: Karolinska Institutet; Jan Sjöberg and Magnus Björkholm, Karolinska University Hospital Solna, Stockholm, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom
| | - Paul W. Dickman
- All authors: Karolinska Institutet; Jan Sjöberg and Magnus Björkholm, Karolinska University Hospital Solna, Stockholm, Sweden; Paul C. Lambert, University of Leicester, Leicester, United Kingdom
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33
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Kuper-Hommel MJJ, van de Schans SAM, Vreugdenhil G, van Krieken JHJM, Coebergh JWW. Trends in incidence, therapy and outcome of localized nodal and extranodal marginal zone lymphomas: declining incidence and inferior outcome for gastrointestinal sites. Leuk Lymphoma 2013; 54:1891-7. [DOI: 10.3109/10428194.2013.764421] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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34
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Kuper-Hommel MJJ, van de Schans SAM, Vreugdenhil G, van Krieken JH, Coebergh JWW. Undertreatment of patients with localized extranodal compared with nodal diffuse large B-cell lymphoma. Leuk Lymphoma 2012. [PMID: 23190406 DOI: 10.3109/10428194.2012.753447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Population-based studies analyzing clinical implications of nodal versus extranodal (EN) presentation of diffuse large B-cell lymphoma (DLBCL) are scarce. We studied clinical differences and trends in incidence, treatment and survival of nodal and EN DLBCL in a population-based cohort. All patients newly diagnosed with localized (Ann Arbor stage [AAS] I and II) nodal (n = 5124) and EN (n = 4776) DLBCL, and primary mediastinal B-cell lymphoma (PMBL; n = 88), diagnosed between 1989 and 2010, were selected from the Netherlands Cancer Registry. Primary EN disease was correlated with older age and more favorable clinical stage (AAS I). The age standardized incidence rates for men with localized EN DLBCL, and for men and women with localized PMBL, increased significantly, whereas the age standardized incidence rates of all other subgroups remained stable. The stomach was the most common EN localization. Patients with EN disease received less chemotherapy and targeted therapy than their nodal counterparts, irrespective of age and period of diagnosis. Their 5-year overall survival (OS) was 48% vs. 54% in the nodal group, but in multivariate analysis primary extranodal presentation was not independently associated with inferior survival. This population-based study shows clinically relevant differences between localized nodal and EN DLBCL and PMBL. Since patients with EN were significantly less often optimally treated, we advocate better interaction between medical disciplines.
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35
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van de Schans SAM, Wymenga ANM, van Spronsen DJ, Schouten HC, Coebergh JWW, Janssen-Heijnen MLG. Two sides of the medallion: poor treatment tolerance but better survival by standard chemotherapy in elderly patients with advanced-stage diffuse large B-cell lymphoma. Ann Oncol 2012; 23:1280-1286. [PMID: 21948810 DOI: 10.1093/annonc/mdr411] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND We investigated treatment of unselected elderly patients with diffuse large B-cell lymphoma (DLBCL) and its subsequent impact on treatment tolerance and survival. PATIENTS AND METHODS Data from all 419 advanced-stage DLBCL patients, aged 75 or older and newly diagnosed between 1997 and 2004, were included from five regional population-based cancer registries in The Netherlands. Subsequent data on comorbidity, performance status, treatment, motives for adaptations or refraining from chemotherapy and toxic effects was collected from the medical records. Follow-up was completed until 1st January 2009. RESULTS Only 46% of patients received the standard therapy [aggressive chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP)-like chemotherapy]. Motives for withholding chemotherapy were refusal by patient/family, poor performance status or estimated short life expectancy. Of all patients receiving CHOP-like chemotherapy, only 56% could complete at least six cycles. Grade 3 or 4 toxicity occurred in 67% of patients receiving standard therapy. The independent effect of therapy on survival remained after correction for the age-adjusted International Prognostic Index. CONCLUSIONS Standard therapy was applied less often in elderly patients with a subsequent independent negative impact on survival. Furthermore, high toxicity rate and the impossibility of the majority of patients to complete treatment were seen. This implies that better treatment strategies should be devised including a proper selection of senior patients for this aggressive chemotherapy.
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Affiliation(s)
- S A M van de Schans
- Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven
| | - A N M Wymenga
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede
| | - D J van Spronsen
- Department of Internal Medicine, Canisius-Wilhelmina Hospital, Nijmegen; Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen
| | - H C Schouten
- Department of Internal Medicine, University Hospital Maastricht, Maastricht
| | - J W W Coebergh
- Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M L G Janssen-Heijnen
- Department of Research, Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven; Department of Public Health, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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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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Extermann M, Wedding U. Comorbidity and geriatric assessment for older patients with hematologic malignancies: A review of the evidence. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2011.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Nabhan C, Smith SM, Helenowski I, Ramsdale E, Parsons B, Karmali R, Feliciano J, Hanson B, Smith S, McKoy J, Larsen A, Hantel A, Gregory S, Evens AM. Analysis of very elderly (≥80 years) non-hodgkin lymphoma: impact of functional status and co-morbidities on outcome. Br J Haematol 2011; 156:196-204. [PMID: 22084970 DOI: 10.1111/j.1365-2141.2011.08934.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Data on outcome, prognostic factors, and treatment for very elderly non-Hodgkin lymphomas (NHL) is sparse. We conducted a multicentre retrospective analysis of NHL patients ≥80 years (at diagnosis) treated between 1999 and 2009. Detailed characteristics were obtained including geriatric syndromes, activities of daily living (ADLs), and co-morbidities using the Cumulative Illness Rating Scale-Geriatrics (CIRS-G). We identified 303 patients: 170 aggressive NHL (84% B cell/16% T cell) and 133 indolent NHL (82% B cell/18% T cell). Median age was 84 years (80-95). A geriatric syndrome was present in 26% of patients, 18% had ≥1 grade 4 CIRS-G, and 14% had loss of ADLs. At 49-month median follow-up, 4-year progression-free (PFS) and overall survival (OS) for aggressive NHLs were 31% and 44% respectively (stage I/II: PFS 53% and OS 66%; stage III/IV: PFS 20% and OS 32%; P < 0·0001 and 0·0002, respectively). Four-year PFS and OS for indolent NHL were 44% and 66% respectively, regardless of stage. Multivariate regression analysis identified two key factors that predicted inferior PFS and OS for both NHL groups: lack of CR and loss of ADLs. Prospective studies for very elderly NHL that incorporate geriatric tools, especially ADLs, are warranted.
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Affiliation(s)
- Chadi Nabhan
- Division of Hematology/Oncology, Advocate Lutheran General Hospital, 1700 Luther Lane, Park Ridge, IL, USA.
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van Herpt T, van de Schans S, Haak H, van Spronsen D, Dercksen M, Janssen-Heijnen M. Treatment and outcome in non-Hodgkin's lymphoma patients with and without prevalent diabetes mellitus in a population-based cancer registry. J Geriatr Oncol 2011. [DOI: 10.1016/j.jgo.2011.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Can first cycle CBCs predict older patients at very low risk of neutropenia during further chemotherapy? Crit Rev Oncol Hematol 2011; 79:43-50. [DOI: 10.1016/j.critrevonc.2010.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 03/02/2010] [Accepted: 07/07/2010] [Indexed: 11/19/2022] Open
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Louwman WJ, Aarts MJ, Houterman S, van Lenthe FJ, Coebergh JWW, Janssen-Heijnen MLG. A 50% higher prevalence of life-shortening chronic conditions among cancer patients with low socioeconomic status. Br J Cancer 2010; 103:1742-8. [PMID: 20978508 PMCID: PMC2994221 DOI: 10.1038/sj.bjc.6605949] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Comorbidity and socioeconomic status (SES) may be related among cancer patients. Method: Population-based cancer registry study among 72 153 patients diagnosed during 1997–2006. Results: Low SES patients had 50% higher risk of serious comorbidity than those with high SES. Prevalence was increased for each cancer site. Low SES cancer patients had significantly higher risk of also having cardiovascular disease, chronic obstructive pulmonary diseases, diabetes mellitus, cerebrovascular disease, tuberculosis, dementia, and gastrointestinal disease. One-year survival was significantly worse in lowest vs highest SES, partly explained by comorbidity. Conclusion: This illustrates the enormous heterogeneity of cancer patients and stresses the need for optimal treatment of cancer patients with a variety of concomitant chronic conditions.
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Affiliation(s)
- W J Louwman
- Comprehensive Cancer Centre South (IKZ), Eindhoven Cancer Registry, PO Box 231, Eindhoven 5600 AE, The Netherlands.
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Terschüren C, Gierer S, Brillant C, Paulus U, Löffler M, Hoffmann W. Are patients with Hodgkin lymphoma and high-grade non-Hodgkin lymphoma in clinical therapy optimization protocols representative of these groups of patients in Germany? Ann Oncol 2010; 21:2045-2051. [PMID: 20423912 DOI: 10.1093/annonc/mdq214] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Improvement of lymphoma therapy is largely driven by clinical therapy optimization protocols (TOPs). It is unclear, however, whether the patients treated in clinical TOP are representative for all patients. PATIENTS AND METHODS TOP participants were compared with nonstudy patients in a population-based approach. The study included patients with Hodgkin lymphoma (HL) and high-grade non-Hodgkin lymphoma (hgNHL). Incident cases (N = 743) were ascertained in a large population-based epidemiologic survey. Each patient's status with respect to exclusion criteria of the pertinent TOP was abstracted from primary data sources. TOP participants were identified on the basis of the trial databases. Baseline characteristics and risk factor prevalence were compared between nonstudy and TOP patients. RESULTS Eligible for the respective TOPs were 64.1% of all incident HL patients and 29.6% of all hgNHL patients in the population. Main exclusion criterion was age (HL: 15.2%; hgNHL: 27.4%). Only 71 HL patients (23.0%) and 11 hgNHL patients (3.4%) had actually been enrolled in the respective TOPs. CONCLUSIONS TOP participants do not represent all patients with hgNHL and HL in the population. TOP inclusion criteria caused considerable selection among the participants. Further investigation is required to clarify possible limitations for the application of the outcomes observed in TOP patients for all patients with these diseases.
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Affiliation(s)
- C Terschüren
- Institute for Community Medicine, Section of Health Care Epidemiology and Community Health, Ernst-Moritz-Arndt University of Greifswald, Greifswald
| | - S Gierer
- Institute for Community Medicine, Section of Health Care Epidemiology and Community Health, Ernst-Moritz-Arndt University of Greifswald, Greifswald
| | - C Brillant
- Cochrane Haematological Malignancies Group, University Hospital of Cologne, Cologne
| | - U Paulus
- Coordination Center for Clinical Trials, University Hospital of Cologne, Cologne
| | - M Löffler
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - W Hoffmann
- Institute for Community Medicine, Section of Health Care Epidemiology and Community Health, Ernst-Moritz-Arndt University of Greifswald, Greifswald.
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Sorror ML. Comorbidities and hematopoietic cell transplantation outcomes. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2010; 2010:237-247. [PMID: 21239800 DOI: 10.1182/asheducation-2010.1.237] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Conventional allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment option for various hematological diseases due, in part to high-dose conditioning and, in part, to graft-versus-tumor effects. Reduced-intensity or non-myeloablative conditioning regimens have relied mostly on graft-versus-tumor effects for disease control, and their advent has allowed relatively older and medically infirm patients to be offered allo-HCT. However, both HCT modalities have been associated with organ toxicities and graft-versus-host disease, resulting in substantial non-relapse mortality. It has become increasingly important to optimize pre-transplant risk assessment in order to improve HCT decision making and clinical trial assignments. Single-organ comorbidity involving liver, lung, heart, or kidney before HCT has been traditionally found to cause organ toxicity after HCT. Recent efforts have resulted in the advent of a weighted scoring system that could sensitively capture multiple-organ comorbidities prior to HCT. The HCT-comorbidity index (HCT-CI) has provided better prediction of HCT-related morbidity and mortality than other non-HCT-specific indices. Subsequent studies, with the exception of a few studies with modest numbers of patients, have confirmed the prognostic importance of the HCT-CI. Further, the HCT-CI has been consolidated with various disease-specific and patient-specific risk factors to refine assignments of patients to the appropriate HCT setting. Ongoing studies are addressing prospective validation of the HCT-CI, furthering our understanding of biological aging, and enhancing the applicability of the HCT-CI comorbidity coding. Future knowledge of the impacts of multiple comorbidities on post-HCT toxicities might guide new prophylactic and therapeutic interventions to lessen the procedure's mortality.
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Affiliation(s)
- Mohamed L Sorror
- Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, WA 98109, USA.
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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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Favier O, Heutte N, Stamatoullas-Bastard A, Carde P, van't Veer MB, Aleman BMP, Noordijk EM, Thomas J, Fermé C, Henry-Amar M. Survival after Hodgkin lymphoma. Cancer 2009; 115:1680-91. [DOI: 10.1002/cncr.24178] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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48
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Sorror M. Impacts of pretransplant comorbidities on allogeneic hematopoietic cell transplantation (HCT) outcomes. Biol Blood Marrow Transplant 2009; 15:149-53. [PMID: 19147097 DOI: 10.1016/j.bbmt.2008.12.498] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Mohammed Sorror
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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49
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Treatment of diffuse large B-cell lymphoma in the elderly: Strategies integrating oncogeriatric themes. Curr Oncol Rep 2008; 10:412-9. [DOI: 10.1007/s11912-008-0063-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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50
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Menvielle G, Kunst A. Social inequalities in cancer incidence and cancer survival: Lessons from Danish studies. Eur J Cancer 2008; 44:1933-7. [DOI: 10.1016/j.ejca.2008.06.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 06/20/2008] [Indexed: 11/25/2022]
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