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Tamjid B, Mckendrick J, Schwarer A, Doig R, James P, Hosking P, Hawkes EA. Efficacy and toxicity of PACEBOM chemotherapy in relapsed/refractory aggressive lymphoma in the rituximab era. Asia Pac J Clin Oncol 2016; 13:226-233. [PMID: 28004881 DOI: 10.1111/ajco.12611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/28/2016] [Accepted: 09/06/2016] [Indexed: 11/26/2022]
Abstract
AIM Relapsed/refractory (R/R) aggressive lymphoma outcomes are poor. There is no standard treatment. PACEBOM (prednisolone, doxorubicin, cyclophosphamide, etoposide, bleomycin, vincristine and methotrexate) has shown efficacy for several lymphoma subtypes in published reports. We evaluate PACEBOM+/-rituximab for R/R aggressive lymphomas in this millennium. METHODS In this retrospective, single-center study, R/R aggressive lymphoma patients who received PACEBOM or its derivatives were identified from the pharmacy database. Demographic, treatment, toxicity and survival data were collected. RESULTS A total of 37 eligible patients were identified. Histological subtypes included 20 Diffuse Large B-Cell Lymphoma (DLBCL), 10 T-Cell Lymphoma (TCL) and 7 Hodgkin lymphoma. All DLBCL patients had received prior rituximab. Thirty-one (84%) received second-line PACEBOM. Median number of cycles was six (1-6). Eighteen out of 20 B-cell lymphoma patients received R-PACEBOM. Overall response rate was 65%, 70% and 71% in patients with DLBCL, TCL and Hodgkin lymphoma respectively. Thirteen patients underwent autologous stem cell transplant post-PACEBOM. Median follow-up was 49 months (3-201). Most common grade 3-4 toxicities were neutropenia (46%), anemia (24%) and thrombocytopenia (16%). No additional toxicity was seen in patients who received rituximab. CONCLUSION In this cohort, PACEBOM is active in R/R aggressive lymphoma with manageable toxicity and can be safely combined with rituximab. Outcomes were similar to reports of other salvage regimens. PACEBOM remains a suitable option for R/R aggressive lymphoma, in patients exposed to prior rituximab and those planned for autologous stem cell transplant.
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Affiliation(s)
- Babak Tamjid
- Oncology and Haematology Department, Box Hill Hospital, Melbourne, Victoria, Australia
- Department of Medical Oncology & Clinical Haematology, Olivia Newton John Cancer Research Institute, Austin Hospital, Melbourne, Victoria, Australia
| | - Joseph Mckendrick
- Oncology and Haematology Department, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Anthony Schwarer
- Oncology and Haematology Department, Box Hill Hospital, Melbourne, Victoria, Australia
- Department of Medical Oncology & Clinical Haematology, Olivia Newton John Cancer Research Institute, Austin Hospital, Melbourne, Victoria, Australia
| | - Rowan Doig
- Oncology and Haematology Department, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Philip James
- Oncology and Haematology Department, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Patrick Hosking
- Pathology Department, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Eliza A Hawkes
- Oncology and Haematology Department, Box Hill Hospital, Melbourne, Victoria, Australia
- Department of Medical Oncology & Clinical Haematology, Olivia Newton John Cancer Research Institute, Austin Hospital, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
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Hoskin PJ, Lowry L, Horwich A, Jack A, Mead B, Hancock BW, Smith P, Qian W, Patrick P, Popova B, Pettitt A, Cunningham D, Pettengell R, Sweetenham J, Linch D, Johnson PW. Randomized Comparison of the Stanford V Regimen and ABVD in the Treatment of Advanced Hodgkin's Lymphoma: United Kingdom National Cancer Research Institute Lymphoma Group Study ISRCTN 64141244. J Clin Oncol 2009; 27:5390-6. [DOI: 10.1200/jco.2009.23.3239] [Citation(s) in RCA: 142] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This multicenter, prospective, randomized controlled trial compared the efficacy and toxicity of two chemotherapy regimens in advanced Hodgkin's lymphoma (HL): the weekly alternating Stanford V and the standard, twice-weekly regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Patients and Methods Patients had stage IIB, III, or IV disease or had stages I to IIA disease with bulky disease or other adverse features. Radiotherapy was administered in both arms to sites of previous bulk (> 5 cm) and to splenic deposits, although this was omitted in the latter part of the trial for patients achieving complete remission (CR) in the ABVD arm. A total of 520 patients were randomly assigned and were assessed for the primary outcome measure of progression-free survival (PFS). Five hundred patients received protocol treatment, and radiotherapy was administered to 73% in the Stanford V arm and to 53% in the ABVD arm. Results The overall response rates after completion of all treatment were 91% for Stanford V and 92% for ABVD. During a median follow-up of 4.3 years, there was no evidence of a difference in projected 5-year PFS and overall survival (OS) rates (76% and 90%, respectively, for ABVD; 74% and 92%, respectively, for Stanford V). More pulmonary toxicity was reported for ABVD, whereas other toxicities were more frequent with Stanford V. Conclusion In a large, randomized trial, the efficacies of Stanford V and ABVD were comparable when given in combination with appropriate radiotherapy.
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Affiliation(s)
- Peter J. Hoskin
- From the Mount Vernon Cancer Centre, Department of Clinical Oncology; Lymphoma Trials Office, Cancer Research United Kingdom and University College London Cancer Trials Centre; Department of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital; Medical Research Council Cancer Trials Unit; St George's Hospital Medical School; Royal Marsden Hospital; and University College London Cancer Institute, London; St James' Institute of Oncology, Haematological Malignancy Diagnostic Service, Leeds
| | - Lisa Lowry
- From the Mount Vernon Cancer Centre, Department of Clinical Oncology; Lymphoma Trials Office, Cancer Research United Kingdom and University College London Cancer Trials Centre; Department of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital; Medical Research Council Cancer Trials Unit; St George's Hospital Medical School; Royal Marsden Hospital; and University College London Cancer Institute, London; St James' Institute of Oncology, Haematological Malignancy Diagnostic Service, Leeds
| | - Alan Horwich
- From the Mount Vernon Cancer Centre, Department of Clinical Oncology; Lymphoma Trials Office, Cancer Research United Kingdom and University College London Cancer Trials Centre; Department of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital; Medical Research Council Cancer Trials Unit; St George's Hospital Medical School; Royal Marsden Hospital; and University College London Cancer Institute, London; St James' Institute of Oncology, Haematological Malignancy Diagnostic Service, Leeds
| | - Andrew Jack
- From the Mount Vernon Cancer Centre, Department of Clinical Oncology; Lymphoma Trials Office, Cancer Research United Kingdom and University College London Cancer Trials Centre; Department of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital; Medical Research Council Cancer Trials Unit; St George's Hospital Medical School; Royal Marsden Hospital; and University College London Cancer Institute, London; St James' Institute of Oncology, Haematological Malignancy Diagnostic Service, Leeds
| | - Ben Mead
- From the Mount Vernon Cancer Centre, Department of Clinical Oncology; Lymphoma Trials Office, Cancer Research United Kingdom and University College London Cancer Trials Centre; Department of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital; Medical Research Council Cancer Trials Unit; St George's Hospital Medical School; Royal Marsden Hospital; and University College London Cancer Institute, London; St James' Institute of Oncology, Haematological Malignancy Diagnostic Service, Leeds
| | - Barry W. Hancock
- From the Mount Vernon Cancer Centre, Department of Clinical Oncology; Lymphoma Trials Office, Cancer Research United Kingdom and University College London Cancer Trials Centre; Department of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital; Medical Research Council Cancer Trials Unit; St George's Hospital Medical School; Royal Marsden Hospital; and University College London Cancer Institute, London; St James' Institute of Oncology, Haematological Malignancy Diagnostic Service, Leeds
| | - Paul Smith
- From the Mount Vernon Cancer Centre, Department of Clinical Oncology; Lymphoma Trials Office, Cancer Research United Kingdom and University College London Cancer Trials Centre; Department of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital; Medical Research Council Cancer Trials Unit; St George's Hospital Medical School; Royal Marsden Hospital; and University College London Cancer Institute, London; St James' Institute of Oncology, Haematological Malignancy Diagnostic Service, Leeds
| | - Wendi Qian
- From the Mount Vernon Cancer Centre, Department of Clinical Oncology; Lymphoma Trials Office, Cancer Research United Kingdom and University College London Cancer Trials Centre; Department of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital; Medical Research Council Cancer Trials Unit; St George's Hospital Medical School; Royal Marsden Hospital; and University College London Cancer Institute, London; St James' Institute of Oncology, Haematological Malignancy Diagnostic Service, Leeds
| | - Philippa Patrick
- From the Mount Vernon Cancer Centre, Department of Clinical Oncology; Lymphoma Trials Office, Cancer Research United Kingdom and University College London Cancer Trials Centre; Department of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital; Medical Research Council Cancer Trials Unit; St George's Hospital Medical School; Royal Marsden Hospital; and University College London Cancer Institute, London; St James' Institute of Oncology, Haematological Malignancy Diagnostic Service, Leeds
| | - Bilyana Popova
- From the Mount Vernon Cancer Centre, Department of Clinical Oncology; Lymphoma Trials Office, Cancer Research United Kingdom and University College London Cancer Trials Centre; Department of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital; Medical Research Council Cancer Trials Unit; St George's Hospital Medical School; Royal Marsden Hospital; and University College London Cancer Institute, London; St James' Institute of Oncology, Haematological Malignancy Diagnostic Service, Leeds
| | - Andrew Pettitt
- From the Mount Vernon Cancer Centre, Department of Clinical Oncology; Lymphoma Trials Office, Cancer Research United Kingdom and University College London Cancer Trials Centre; Department of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital; Medical Research Council Cancer Trials Unit; St George's Hospital Medical School; Royal Marsden Hospital; and University College London Cancer Institute, London; St James' Institute of Oncology, Haematological Malignancy Diagnostic Service, Leeds
| | - David Cunningham
- From the Mount Vernon Cancer Centre, Department of Clinical Oncology; Lymphoma Trials Office, Cancer Research United Kingdom and University College London Cancer Trials Centre; Department of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital; Medical Research Council Cancer Trials Unit; St George's Hospital Medical School; Royal Marsden Hospital; and University College London Cancer Institute, London; St James' Institute of Oncology, Haematological Malignancy Diagnostic Service, Leeds
| | - Ruth Pettengell
- From the Mount Vernon Cancer Centre, Department of Clinical Oncology; Lymphoma Trials Office, Cancer Research United Kingdom and University College London Cancer Trials Centre; Department of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital; Medical Research Council Cancer Trials Unit; St George's Hospital Medical School; Royal Marsden Hospital; and University College London Cancer Institute, London; St James' Institute of Oncology, Haematological Malignancy Diagnostic Service, Leeds
| | - John Sweetenham
- From the Mount Vernon Cancer Centre, Department of Clinical Oncology; Lymphoma Trials Office, Cancer Research United Kingdom and University College London Cancer Trials Centre; Department of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital; Medical Research Council Cancer Trials Unit; St George's Hospital Medical School; Royal Marsden Hospital; and University College London Cancer Institute, London; St James' Institute of Oncology, Haematological Malignancy Diagnostic Service, Leeds
| | - David Linch
- From the Mount Vernon Cancer Centre, Department of Clinical Oncology; Lymphoma Trials Office, Cancer Research United Kingdom and University College London Cancer Trials Centre; Department of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital; Medical Research Council Cancer Trials Unit; St George's Hospital Medical School; Royal Marsden Hospital; and University College London Cancer Institute, London; St James' Institute of Oncology, Haematological Malignancy Diagnostic Service, Leeds
| | - Peter W.M. Johnson
- From the Mount Vernon Cancer Centre, Department of Clinical Oncology; Lymphoma Trials Office, Cancer Research United Kingdom and University College London Cancer Trials Centre; Department of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital; Medical Research Council Cancer Trials Unit; St George's Hospital Medical School; Royal Marsden Hospital; and University College London Cancer Institute, London; St James' Institute of Oncology, Haematological Malignancy Diagnostic Service, Leeds
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Eghbali H, Soubeyran P, Tchen N, de Mascarel I, Soubeyran I, Richaud P. Current treatment of Hodgkin's disease. Crit Rev Oncol Hematol 2000; 35:49-73. [PMID: 10863151 DOI: 10.1016/s1040-8428(99)00070-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In spite of the fact that Hodgkin's disease (HD) remains still an enigma its management and treatment yield a cure rate of about 80% of all patients. However, this management has two limits: on one side favourable cases which should not be overtreated because of unacceptable side-effects, and on the other side very unfavourable cases which should be treated differently because of a very high rate of failure and/or relapse. Then it becomes necessary to precise as thoroughly as possible these two limits in order to choose the adequate treatment for the patient. Prognostic factors based on patient and disease characteristics allow a relatively exact classification of favourable and unfavourable cases. This distinction in two prognostic groups has therapeutic implications in terms of chemotherapy (regimen, duration) and radiotherapy (extension, doses). Other specific situations have to be considered, e.g. pediatric cases, pregnancy, old age and HIV-infected patients who need an adapted management according to very different situations.
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Affiliation(s)
- H Eghbali
- Institut Bergonié, Regional Cancer Centre, 180, rue de Saint-Genès, F-33076 Cedex, Bordeaux, France.
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Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin's disease. International Prognostic Factors Project on Advanced Hodgkin's Disease. N Engl J Med 1998; 339:1506-14. [PMID: 9819449 DOI: 10.1056/nejm199811193392104] [Citation(s) in RCA: 1178] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Two thirds of patients with advanced Hodgkin's disease are cured with current approaches to treatment. Prediction of the outcome is important to avoid overtreating some patients and to identify others in whom standard treatment is likely to fail. METHODS Data were collected from 25 centers and study groups on a total of 5141 patients treated with combination chemotherapy for advanced Hodgkin's disease, with or without radiotherapy. The data included the outcome and 19 demographic and clinical characteristics at diagnosis. The end point was freedom from progression of disease. Complete data were available for 1618 patients; the final Cox model was fitted to these data. Data from an additional 2643 patients were used for partial validation. RESULTS The prognostic score was defined as the number of adverse prognostic factors present at diagnosis. Seven factors had similar independent prognostic effects: a serum albumin level of less than 4 g per deciliter, a hemoglobin level of less than 10.5 g per deciliter, male sex, an age of 45 years or older, stage IV disease (according to the Ann Arbor classification), leukocytosis (a white-cell count of at least 15,000 per cubic millimeter), and lymphocytopenia (a lymphocyte count of less than 600 per cubic millimeter, a count that was less than 8 percent of the white-cell count, or both). The score predicted the rate of freedom from progression of disease as follows: 0, or no factors (7 percent of the patients), 84 percent; 1 (22 percent of the patients), 77 percent; 2 (29 percent of the patients), 67 percent; 3 (23 percent of the patients), 60 percent; 4 (12 percent of the patients), 51 percent; and 5 or higher (7 percent of the patients), 42 percent. CONCLUSIONS The prognostic score we developed may be useful in designing clinical trials for the treatment of advanced Hodgkin's disease and in making individual therapeutic decisions, but a distinct group of patients at very high risk could not be identified on the basis of routinely documented demographic and clinical characteristics.
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Affiliation(s)
- D Hasenclever
- Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Germany
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