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Purmalek MM, Kopelman ZA, Griffis JD, Mehlhaff KM, Gonzalez-Brown VM. Mediastinal Mass Discovered in the Second Trimester, a Rare Presentation of Hodgkin's Lymphoma in Pregnancy. Mil Med 2023; 188:e3256-e3260. [PMID: 36399369 DOI: 10.1093/milmed/usac346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/05/2022] [Accepted: 10/26/2022] [Indexed: 08/31/2023] Open
Abstract
Newly diagnosed malignancy during pregnancy is rare affecting approximately 1 in 1,000 pregnancies. Breast followed by hematologic malignancies are most common. Hodgkin's lymphoma (HL) is a lymphoid neoplasm which can present with lymphadenopathy or mediastinal mass and represents 6% of all malignancies diagnosed during pregnancy. Treatment involves a combination of chemotherapy with or without adjuvant radiation which poses significant challenges when diagnosed antepartum. We highlight a 28-year-old primigravida at 26 weeks gestation who presented to the emergency department in Japan with cough, dyspnea, and sore throat for 3-5 days. Initial chest radiography demonstrated a large perihilar mass with mediastinal shift. Follow-up CT chest revealed an anterior mediastinal mass measuring 8 cm × 19 cm × 16 cm with features concerning for aggressive lymphoma. The patient was subsequently transferred to a stateside tertiary care center for expedited workup. She underwent two core needle biopsies, both of which were non-diagnostic. Cardiothoracic surgery performed a cervical mediastinoscopy with excision of the enlarged right supraclavicular lymph node. Pathologic analysis revealed classical HL, nodular sclerosis subtype. Treatment was initiated with adriamycin, bleomycin, vinblastine, and dacarbazine with two cycles planned antepartum followed by additional cycles postpartum. The patient had an uncomplicated vaginal delivery at 38 weeks gestation. Diagnosis of HL in pregnancy is rare, and expedited diagnosis can be challenging as multiple diagnostic and treatment modalities may impact pregnancy. Management in pregnancy requires a multidisciplinary approach, and decisions regarding treatment and delivery timing should be weighed against risk to the fetus.
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Affiliation(s)
- Monica M Purmalek
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Zachary A Kopelman
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Jeffery D Griffis
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
| | - Krista M Mehlhaff
- Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Veronica M Gonzalez-Brown
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
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2
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Arter ZL, Meghpara S, Mignano S, Berenberg J. A Rare Coexistence of Seminoma and Hodgkin's Lymphoma in Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:295-297. [PMID: 34877541 PMCID: PMC8646864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Both Hodgkin's lymphoma and testicular cancers can present in young men; however, concurrent Hodgkin's lymphoma with seminoma is very rare. When they do coexist, careful consideration must be made to avoid missing new cancer by assuming the presence of primary metastatic disease when lymphadenopathy presents. Here we present a rare case of coexistence of seminoma and Hodgkin's lymphoma and the staging and treatment challenges associated with a 2-cancer diagnosis.
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Affiliation(s)
- Zhaohui Liao Arter
- Tripler Army Medical Center, Medicine Department, Honolulu, HI (ZLA, S.Meghpara, S. Mignano)
| | - Sanket Meghpara
- Tripler Army Medical Center, Medicine Department, Honolulu, HI (ZLA, S.Meghpara, S. Mignano)
| | - Salvatore Mignano
- Tripler Army Medical Center, Medicine Department, Honolulu, HI (ZLA, S.Meghpara, S. Mignano)
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3
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Brice P, de Kerviler E, Friedberg JW. Classical Hodgkin lymphoma. Lancet 2021; 398:1518-1527. [PMID: 33493434 DOI: 10.1016/s0140-6736(20)32207-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 06/11/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022]
Abstract
Classical Hodgkin lymphoma is one of the more frequent lymphomas and is generally considered a highly curable disease with standard first-line chemotherapy and radiotherapy in some cases. Despite these outstanding results, major problems remain unresolved. First, there are still patients who will not be cured with front-line regimens and, second, many patients who are cured of classical Hodgkin lymphoma continue to die prematurely due to the late toxic effects of their therapy. Because the median age of patients with classical Hodgkin lymphoma is in the mid-30s, the disease's impact on the number of years lost from productive life is remarkable. In recent years, the gold standard of chemotherapy (often combined with radiotherapy) has changed, with the approval of immunotherapy mostly in relapse settings.
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Affiliation(s)
- Pauline Brice
- Department of Oncohaematology, Hôpital saint Louis APHP, Université Paris 7, Paris, France.
| | - Eric de Kerviler
- Department of Radiology, Hôpital saint Louis APHP, Université Paris 7, Paris, France
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4
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Wu B, Wang J, Zhu J, Zhen ZZ, Lu SY, Sun FF, Huang JT, Sun XF. [A single-center retrospective analysis of 85 children and adolescents with limited-stage Hodgkin lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:649-654. [PMID: 32942818 PMCID: PMC7525178 DOI: 10.3760/cma.j.issn.0253-2727.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To summarize the efficiency and long-term outcomes of limited-stage Hodgkin lymphoma in children and adolescents with ABVD therapy and determined whether omitting radiotherapy for a low-risk patient enabled the achievement of complete response (CR) after chemotherapy. Methods: We retrospectively analyzed data from 13 y (2004-2016) from patients aged ≤18 y with limited-stage HL admitted to the Sun Yat-sen University Cancer Center. Patients received treatment with ABVD chemotherapy alone or ABVD chemotherapy followed by low-dose involved field radiotherapy. Results: Total 85 subjects were eligible for study inclusion; the median age was 12 (3-18) y; 66 (77.6%) were men, 80 (94.1%) had stage-II disease, 56 (65.9%) were at low-risk, and the median follow-up duration was 72 (8-196) months; 12 relapsed, 2 had secondary neoplasm, and 2 died. The 5-year event free survival (EFS) was (85.6±3.8) %, and the overall survival (OS) was 100%. The 5-year EFS and OS was (89.1±4.2) % and 100%, respectively, for the low-risk cohort and (79.3±7.5) % and 100%, respectively for the intermediate-risk cohort. Among the 39 low-risk patients who achieved CR after chemotherapy, 15 received treatment with chemotherapy followed by LD-IFRT. In the exploratory subset analysis, the low-risk cohort who achieved CR after chemotherapy, the 5-year EFS for comparing ABVD alone with chemotherapy followed by LD-IFRT was (87.0±7.0) % versus 100% (P=0.506) , and the OS was 100% for both the groups. Conclusions: Our retrospective analysis showed excellent survival of limited-stage HL patients with ABVD therapy. For patients who achieving CR after chemotherapy with low-risk HL, received chemotherapy followed by LD-IFRT does not improve 5-year OS and EFS. The use of risk- and response-based stratification may facilitate the development of effective and less toxic protocols.
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Affiliation(s)
- B Wu
- State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; Department of Hematology and Oncology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, China
| | - J Wang
- State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - J Zhu
- State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Z Z Zhen
- State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - S Y Lu
- State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - F F Sun
- State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - J T Huang
- State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - X F Sun
- State Key Laboratory Department of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
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Abstract
PURPOSE OF REVIEW Pregnancy-associated lymphoma (PAL) is an uncommon entity that lacks detailed prospective data. It poses significant management challenges that incorporate maternal and fetal risks associated with treatment or delayed intervention. Herein, we review the current literature for the diagnosis, management, and supportive care strategies for PAL. RECENT FINDINGS Establishment of a multidisciplinary team, including hematology-oncology, maternal-fetal medicine, and neonatology, is critical in the management of PAL. For staging, ultrasound and MRI are preferred modalities with use of computerized tomography in select situations. Data for the safety and effectiveness of therapy for PAL is largely based on retrospective studies. The timing of lymphoma-directed antenatal systemic therapy depends on the trimester, gestational age, lymphoma subtype and aggressiveness, and patient wishes. Therapy in the first trimester is usually not advocated, while treatment in the second and third trimesters appears to result in similar outcomes for PAL compared with non-pregnant patients with lymphoma. An overarching goal in most PAL cases should be to plan for delivery at term (i.e., gestational age > 37 weeks). For supportive care, most antiemetics, including agents such as neurokinin-1 receptor antagonists, have been used safely during pregnancy. For prevention or treatment of infections, particular antibiotics (i.e., macrolides, cephalosporins, penicillins, metronidazole), antivirals (i.e., acyclovir, valacyclovir, famciclovir), and antifungals (amphotericin B) have demonstrated safety and with use of growth factors reserved for treatment of neutropenia (vs. primary prophylaxis). Therapy for PAL should be individualized with goals of care that balance maternal and fetal well-being, which should include a multidisciplinary care team and overall intent for term delivery in most cases.
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Mazzola R, Corradini S, Eidemüeller M, Figlia V, Fiorentino A, Giaj-Levra N, Nicosia L, Ricchetti F, Rigo M, Musola M, Ceccaroni M, Gori S, Magrini SM, Alongi F. Modern radiotherapy in cancer treatment during pregnancy. Crit Rev Oncol Hematol 2019; 136:13-19. [PMID: 30878124 DOI: 10.1016/j.critrevonc.2019.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/10/2019] [Accepted: 02/04/2019] [Indexed: 12/30/2022] Open
Abstract
Breast cancer, gynecological malignancies and lymphomas are the most frequently diagnosed tumors in pregnant women. The feasibility of radiotherapy during pregnancy remains a subject of debate and clinicians continue to hesitate on this approach, trying to avoid radiotherapy in most cases. Since the 1990s, several technological advances, including intensity modulated and image guided radiation delivery, have been implemented in radiation oncology to improve the radiation treatment in terms of effectiveness and tolerability. It remains uncertain which short- and long-term health effects the radiation exposure of the fetus may have through advanced radiotherapy techniques. The present systematic literature review aims to summarize the limited current evidences of the feasibility and clinical results of "modern" radiotherapy procedures for the treatment of the most frequently diagnosed tumors in pregnant women.
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Affiliation(s)
- Rosario Mazzola
- Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy.
| | | | - Markus Eidemüeller
- Institute of Radiation Protection, Helmholtz Zentrum München, Neuherberg, Germany
| | - Vanessa Figlia
- Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Alba Fiorentino
- Radiation Oncology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti-Bari, Italy
| | - Niccolò Giaj-Levra
- Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Luca Nicosia
- Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Francesco Ricchetti
- Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Michele Rigo
- Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Mariella Musola
- Department of Obstetrics and Gynecology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Stefania Gori
- Medical Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | | | - Filippo Alongi
- Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy; University of Brescia, Italy
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7
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Abstract
Arising from the immune system and located primarily in lymphoid organs, Hodgkin lymphoma (HL) is one of the most common cancers in young adults. Risk-adapted first-line treatment usually consisting of multi-agent chemotherapy and often incorporating consolidative radiation therapy aims at long-term cure. Although this is achieved in the vast majority of patients, therapy-related side effects such as organ damage, second cancers, and fatigue constitute considerable sequelae and outweigh HL as the cause of mortality after successful first-line treatment. In addition, intensive conventional therapy is seldom feasible in elderly or frail patients, diminishing chances of cure in this growing population of patients. The rapidly growing understanding of HL biology, innovative clinical trials, and the incorporation of novel drugs might help to overcome these obstacles in the management of HL. In this review, recent advances in the understanding and care of HL will be summarized with a focus on ongoing and future strategies which might help move things forward.
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Affiliation(s)
- Paul J. Bröckelmann
- German Hodgkin Study Group and Department I of Internal Medicine, University Hospital of Cologne, Cologne, 50937, Germany
| | - Boris Böll
- German Hodgkin Study Group and Department I of Internal Medicine, University Hospital of Cologne, Cologne, 50937, Germany
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8
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Spinner MA, Advani RH, Connors JM, Azzi J, Diefenbach C. New Treatment Algorithms in Hodgkin Lymphoma: Too Much or Too Little? Am Soc Clin Oncol Educ Book 2018; 38:626-636. [PMID: 30231319 DOI: 10.1200/edbk_200679] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hodgkin lymphoma treatment continues to evolve as new means of assessing response to treatment, new appreciation of important risk factors, and more effective therapeutic agents become available. Treatment algorithms integrating functional imaging now provide the opportunity to modify therapy during its delivery, allowing adjustment of duration and intensity of chemotherapy and rationale identification of patients who may benefit from the addition of therapeutic irradiation. Novel agents, including the antibody drug conjugate brentuximab vedotin and checkpoint inhibitors such as nivolumab and pembrolizumab can improve the effectiveness of treatment while keeping toxicity within acceptable limits. Carefully designed clinical trials permit the identification of superior approaches in which efficacy is enhanced and toxicity minimized. Clinicians treating patients with Hodgkin lymphoma now have access to novel treatment approaches, which will require detailed assessment of each patient and careful discussion of the goals and risks of treatment at the time of planning primary treatment, again during delivery of that treatment as data indicating ongoing effectiveness become available, at the conclusion of initial intervention, and, when the need arises, at the time of recurrence of disease.
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Affiliation(s)
- Michael A Spinner
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Ranjana H Advani
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Joseph M Connors
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Jacques Azzi
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Catherine Diefenbach
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
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9
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Parsons SK, Kelly MJ, Cohen JT, Castellino SM, Henderson TO, Kelly KM, Keller FG, Henzer TJ, Kumar AJ, Johnson P, Meyer RM, Radford J, Raemaekers J, Hodgson DC, Evens AM. Early-stage Hodgkin lymphoma in the modern era: simulation modelling to delineate long-term patient outcomes. Br J Haematol 2018; 182:212-221. [PMID: 29707774 PMCID: PMC6055753 DOI: 10.1111/bjh.15255] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/05/2018] [Indexed: 12/17/2022]
Abstract
We developed a novel simulation model integrating multiple data sets to project long-term outcomes with contemporary therapy for early-stage Hodgkin lymphoma (ESHL), namely combined modality therapy (CMT) versus chemotherapy alone (CA) via 18 F-fluorodeoxyglucose positron emission tomography response-adaption. The model incorporated 3-year progression-free survival (PFS), probability of cure with/without relapse, frequency of severe late effects (LEs), and 35-year probability of LEs. Furthermore, we generated estimates for quality-adjusted life years (QALYs) and unadjusted survival (life years, LY) and used model projections to compare outcomes for CMTversusCA for two index patients. Patient 1: a 25-year-old male with favourable ESHL (stage IA); Patient 2: a 25-year-old female with unfavourable ESHL (stage IIB). Sensitivity analyses assessed the impact of alternative assumptions for LE probabilities. For Patient 1, CMT was superior to CA (CMT incremental gain = 0·11 QALYs, 0·21 LYs). For Patient 2, CA was superior to CMT (CA incremental gain = 0·37 QALYs, 0·92 LYs). For Patient 1, the advantage of CMT changed minimally when the proportion of severe LEs was reduced from 20% to 5% (0·15 QALYs, 0·43 LYs), whereas increasing the severity proportion for Patient 2's LEs from 20% to 80% enhanced the advantage of CA (1·1 QALYs, 6·5 LYs). Collectively, this detailed simulation model quantified the long-term impact that varied host factors and alternative contemporary treatments have in ESHL.
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Affiliation(s)
- Susan K Parsons
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA.,Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.,Institute for Clinical Research and Health Policy Studies, Tufts MC, Boston, MA, USA.,Division of Hematology/Oncology, Tufts MC, Boston, MA, USA
| | - Michael J Kelly
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA.,Division of Pediatric Hematology/Oncology, The Floating Hospital for Children at Tufts Medical Center (MC), Boston, MA, USA
| | - Joshua T Cohen
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.,Institute for Clinical Research and Health Policy Studies, Tufts MC, Boston, MA, USA.,Center for the Evaluation of Value and Risk in Health, Tufts MC, Boston, MA, USA
| | - Sharon M Castellino
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Tara O Henderson
- Department of Pediatrics, Section of Hematology, Oncology and Stem Cell Transplantation, University of Chicago, Chicago, IL, USA
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Cancer Institute, University of Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Frank G Keller
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Tobi J Henzer
- Institute for Clinical Research and Health Policy Studies, Tufts MC, Boston, MA, USA
| | - Anita J Kumar
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.,Institute for Clinical Research and Health Policy Studies, Tufts MC, Boston, MA, USA.,Division of Hematology/Oncology, Tufts MC, Boston, MA, USA
| | | | - Ralph M Meyer
- Department of Oncology, Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, ON, Canada
| | - John Radford
- University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - John Raemaekers
- Department of Haematology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - David C Hodgson
- Radiation Medicine Programme, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
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10
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Balancing risk and benefit in early-stage classical Hodgkin lymphoma. Blood 2018; 131:1666-1678. [DOI: 10.1182/blood-2017-10-772665] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/07/2018] [Indexed: 01/23/2023] Open
Abstract
Abstract
With defined chemotherapy and radiotherapy (RT) and risk-adapted treatment, early-stage classical Hodgkin lymphoma (HL) has become curable in a majority of patients. Hence, a major current goal is to reduce treatment-related toxicity while maintaining long-term disease control. Patients with early-stage favorable disease (ie, limited stage without risk factors [RFs]) are frequently treated with 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (2×ABVD) followed by 20-Gy involved-field or involved-site RT (IF/ISRT). In patients with early-stage unfavorable disease (ie, limited stage with RFs), 4 cycles of chemotherapy are usually consolidated with 30-Gy IF/ISRT. Compared with 4×ABVD, 2 cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (2×BEACOPPescalated) followed by 2×ABVD improved 5-year progression-free survival (PFS), with similar 5-year overall survival. Recently, treatment strategies based on [18F]fluorodeoxyglucose positron emission tomography (PET) response were evaluated. In early-stage unfavorable HL, a majority of patients achieved a negative interim PET after 2×ABVD and an excellent outcome after 4×ABVD, whereas in those with a positive interim PET, 2×BEACOPPescalated improved 5-year PFS. Furthermore, a PET-guided RT approach was evaluated to decrease long-term toxicity. Although both the RAPID and H10 trials reported poorer disease control without RT, PET-guided omission of RT can constitute a valid therapeutic option in patients with an increased risk of RT-associated toxicity (eg, because of sex, age, or disease localization). Implementation of drugs such as the anti-CD30 antibody-drug conjugate brentuximab vedotin or the anti–programmed death 1 antibodies nivolumab or pembrolizumab might allow further reduction of overall mortality and improve quality of life in affected patients.
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11
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Allen PB, Gordon LI. Frontline Therapy for Classical Hodgkin Lymphoma by Stage and Prognostic Factors. Clin Med Insights Oncol 2017; 11:1179554917731072. [PMID: 28989291 PMCID: PMC5624347 DOI: 10.1177/1179554917731072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 06/20/2017] [Indexed: 02/04/2023] Open
Abstract
Hodgkin lymphoma is a highly curable malignancy in early and advanced stages. Most patients are diagnosed in their teens or twenties and are expected to live decades beyond their treatment. Therefore, the toxicity of treatment must be balanced with the goal of cure. Thus, treatment has been refined through prognostic models and positron emission tomography-computed tomography (PET-CT)-directed therapy. Stratification by prognostic models defines groups of patients with favorable characteristics who may be treated with less intensive therapy upfront, including fewer cycles of chemotherapy, lower doses of radiation, or omission of radiation altogether. Alternatively, high-risk patients may be assigned to a more aggressive initial approach. The modern use of interim PET-CT allows further tailoring of treatment by response.
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Affiliation(s)
- Pamela B Allen
- Robert H. Lurie Comprehensive Cancer Center and Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Leo I Gordon
- Department of Hematology and Medical Oncology, Emory University Winship Cancer Institute, Atlanta, GA, USA
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12
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Affiliation(s)
- Ralph M. Meyer
- Ralph M. Meyer, McMaster University and Juravinski Hospital and Cancer Centre, Hamilton, Ontario, Canada
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13
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Gonzalez VJ. Role of Radiation Therapy in the Treatment of Hodgkin Lymphoma. Curr Hematol Malig Rep 2017; 12:244-250. [DOI: 10.1007/s11899-017-0385-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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14
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Kwan A, Chadwick N, Hancock B. Improving Survival of Patients With Hodgkin Lymphoma Over 4 Decades: Experience of the British National Lymphoma Investigation (BNLI) With 6834 Patients. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2017; 17:108-119. [PMID: 28027894 DOI: 10.1016/j.clml.2016.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/30/2016] [Accepted: 11/10/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The management of Hodgkin lymphoma (HL) has changed markedly over the last 50 years. This is due to the expanding understanding about the biology of the disease, the development of increasingly efficacious multimodal treatment, and the recognition of how to reduce late effects. The British National Lymphoma Investigation (BNLI) was formed in the 1970s to coordinate UK research in the diagnosis and treatment of lymphoma. We describe the improvement in trial patient survival over 4 decades. PATIENTS AND METHODS This analysis is of data on 6834 patients with a de novo diagnosis of HL registered onto studies with BNLI oversight from January 1, 1970, to December 31, 2009. Patients were subdivided in 4 groups according to their decade of registration; 1970s, 1980s, 1990s, and 2000s. Because of the lengthy data collection period, there is a difference in duration of follow-up between decade groups, with median follow-up in the 1970s group of 28.2 years, 18.0 years in the 1980s group, 9.4 years in the 1990s group, and 5.4 years in the 2000s group. Comparison between data in all 4 groups is not possible beyond 13.4 years (maximum duration of follow-up in the 2000s group), and so a cutoff has been applied at 14 years. Data on overall survival, cause of death, primary treatment modality, and incidence of secondary malignancy were collected. RESULTS Clear and statistically significant improvements in survival curves between the decades were present, with 10-year overall survival increasing from 62.4% in the 1970s to 89.6% in the 2000s. There was a suggestion that second malignancy and cardiac-related deaths have been reducing over time, but longer follow-up is needed for the later decades to confirm this trend. CONCLUSION Results support existing registry data demonstrating that survival for HL has improved over the 4 decades analyzed. This data set is robust and validated, and it adds valuable understanding to the reasons behind the survival curves, which are a balance between efficacious therapies and decreased death related to cardiac conditions and second malignancies.
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Affiliation(s)
- Amy Kwan
- Academic Unit of Clinical Oncology, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Nick Chadwick
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | - Barry Hancock
- Academic Unit of Clinical Oncology, University of Sheffield, Weston Park Hospital, Sheffield, UK.
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Diefenbach CS, Connors JM, Friedberg JW, Leonard JP, Kahl BS, Little RF, Baizer L, Evens AM, Hoppe RT, Kelly KM, Persky DO, Younes A, Kostakaglu L, Bartlett NL. Hodgkin Lymphoma: Current Status and Clinical Trial Recommendations. J Natl Cancer Inst 2016; 109:2742050. [PMID: 28040700 DOI: 10.1093/jnci/djw249] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/24/2016] [Accepted: 09/26/2016] [Indexed: 12/12/2022] Open
Abstract
The National Clinical Trials Network lymphoid malignancies Clinical Trials Planning Meeting (CTPM) occurred in November of 2014. The scope of the CTPM was to prioritize across the lymphoid tumors clinically significant questions and to foster strategies leading to biologically informed and potentially practice changing clinical trials. This review from the Hodgkin lymphoma (HL) subcommittee of the CTPM discusses the ongoing clinical challenges in HL, outlines the current standard of care for HL patients from early to advanced stage, and surveys the current science with respect to biomarkers and the landscape of ongoing clinical trials. Finally, we suggest areas of unmet need in HL and elucidate promising therapeutic strategies to guide future HL clinical trials planning across the NCTN.
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Affiliation(s)
- Catherine S Diefenbach
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Joseph M Connors
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Jonathan W Friedberg
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - John P Leonard
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Brad S Kahl
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Richard F Little
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Lawrence Baizer
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Andrew M Evens
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Richard T Hoppe
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Kara M Kelly
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Daniel O Persky
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Anas Younes
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Lale Kostakaglu
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Nancy L Bartlett
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
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Ali S, Basit A, Kazmi AS, Sidhu A, Badar F, Hameed A. Chemotherapy alone or combined chemotherapy and involved field radiotherapy in favorable risk early-stage classical Hodgkin lymphoma-a 10 years experience. Pak J Med Sci 2016; 32:1408-1413. [PMID: 28083035 PMCID: PMC5216291 DOI: 10.12669/pjms.326.11080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/15/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the outcome of patients with early-stage (stage I-II) favorable risk classical Hodgkin lymphoma treated with chemotherapy alone or combined modality treatment (CMT) utilizing chemotherapy and involved field radiotherapy. METHODS This retrospective study was done at Department of Medical oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan from January 2004 to December 2013. RESULTS There were 101 patients, with male predominance (71.3%). Mean age was 34 years. Sixty three (62.4%) patients received CMT and 38 (37.6%) patients had chemotherapy alone. Ninety eight percent patients had ABVD chemotherapy. Dose of radiotherapy ranged from 20 to 36 gray. Difference between baseline characteristics and major toxicities among the two groups was insignificant. Patients treated with CMT had better overall survival compared to chemotherapy alone: 100% versus 91% at five years and 96% versus 81% at 10 years, respectively (p=0.03). Progression free survival was also better with CMT against chemotherapy alone at five years (98% versus 81%) and 10 years (82% versus 71%) (p=0.01). CONCLUSION Favorable risk classical Hodgkin lymphoma patients had better overall survival and progression free survival when treated with CMT against chemotherapy alone.
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Affiliation(s)
- Sheeraz Ali
- Dr. Sheeraz Ali, MBBS, FCPS (Medicine), Fellow Medical Oncology, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Abdul Basit
- Dr. Abdul Basit, MBBS, FCPS (Medicine), Fellow Medical Oncology, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Ather S. Kazmi
- Dr. Ather Saeed Kazmi, MBBS, MRCP FRCR. Clinical Oncologist, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Armughan Sidhu
- Dr. Farhana Badar, Sr. Biostatistician & Cancer Epidemiologist Cancer Registry, & Clinical Data Management, Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Farhana Badar
- Dr. Armughan Sidhu, MBBS. Resident Medical Oncology, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Abdul Hameed
- Dr. Abdul Hameed MBBS, MD, FRCP (Edin). Consultant Hematologist, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
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17
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Abou Yehia Z, Mikhaeel GN, Smith G, Pinnix CC, Milgrom SA, Tang C, Jiang W, Fanale MA, Oki Y, Shank JH, Horace T, Reddy J, Akhtari M, Gunther JR, Suki T, Allen PK, Turner S, Mawlawi O, Dabaja BS. Does Bleomycin Lung Toxicity Increase the Risk of Radiation Pneumonitis in Hodgkin Lymphoma? Int J Radiat Oncol Biol Phys 2016; 96:951-958. [PMID: 27742539 DOI: 10.1016/j.ijrobp.2016.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/17/2016] [Accepted: 08/15/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE Bleomycin pulmonary toxicity (BPT) is a well-known complication of treatment in patients with Hodgkin lymphoma (HL). We undertook the present study to investigate the risk of radiation pneumonitis (RP) in the setting of BPT and to determine the need for delay or omission of radiation therapy (RT) in these patients. METHODS AND MATERIALS We identified 123 HL patients treated with ABVD (Adriamycin, bleomycin, vinblastine, dacarbazine) followed by RT to the chest from January 2009 to December 2014. The medical records were reviewed for clinical, pathologic, and treatment information and toxicities. Our primary outcome was RP of any grade. Univariate and multivariate analyses were used to assess the association of BPT, baseline patient characteristics, and treatment variables with the incidence of RP. RESULTS A total of 123 patients were included, of whom 99 (80%) received consolidation intensity modulated RT after ABVD treatment. We identified 31 patients (25.2%) with BPT after frontline ABVD. Seventeen patients (13.8%) developed RP a median of 8 weeks (range 1-39) after RT completion. BPT did not correlate with the risk of developing RP (P=.36). We evaluated the RP outcomes with respect to the bleomycin to RT interval (≤6 weeks vs >6 weeks), and we found that this interval did not predict for RP risk (P=.60). Dosimetric parameters such as the volume covered by 5 Gy and the mean lung dose were analyzed. A volume covered by 5 Gy of >55% and mean lung dose >13.5 Gy increased the risk of RP by 1.14-fold (P=.002) and 4.24-fold (P=.007), respectively. CONCLUSIONS The results of our study suggest that BPT does not increase the risk of developing RP. Furthermore, RT initiation does not need to be delayed after chemotherapy, except to allow for the completion of steroid therapy or clinical recovery from BPT.
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Affiliation(s)
- Zeinab Abou Yehia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - George N Mikhaeel
- Department of Clinical Oncology, Guy's & St Thomas' Hospital, London, United Kingdom
| | - Grace Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chelsea C Pinnix
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sarah A Milgrom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wen Jiang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle A Fanale
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yasuhiro Oki
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - JoAnn H Shank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Trisha Horace
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jay Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mani Akhtari
- Department of Radiation Oncology, The University of Texas Medical Branch Hospitals, Galveston, Texas
| | - Jillian R Gunther
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tina Suki
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pamela K Allen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shryll Turner
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Osama Mawlawi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bouthaina S Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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18
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Mazzola R, Giaj Levra N, Alongi F. Radiation Dose-Response Relationship for Risk of Coronary Heart Disease in Survivors of Hodgkin Lymphoma. J Clin Oncol 2016; 34:2940-1. [DOI: 10.1200/jco.2016.66.7840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rosario Mazzola
- Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy
| | | | - Filippo Alongi
- Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy
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Abstract
Hodgkin's lymphoma (HL) is a relatively rare disease accounting for 15 % of all lymphoma. This disease has developed from an incurable disease to the adult malignancy with the most favorable prognosis. With current therapeutic approaches consisting of polychemo- and small-field radiotherapy, up to 80 % of all patients can be cured long term. In refractory or relapsed HL, intensified treatment including high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT) is associated with progression-free survival (PFS) of 50 %. Evaluation of novel drugs in multiple relapsed or refractory cases, better treatment options for elderly patients and reducing treatment-related side effects are the main focus of current research. Recent clinical developments and future approaches in the treatment of HL will be discussed in this review.
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20
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Trends in Use of Radiation Therapy for Hodgkin Lymphoma From 2000 to 2012 on the Basis of the National Cancer Data Base. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:12-7. [DOI: 10.1016/j.clml.2015.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/12/2015] [Indexed: 11/21/2022]
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Portlock CS. Involved site radiation therapy for the treatment of early-stage Hodgkin lymphoma in adolescents and young adults. CLINICAL ONCOLOGY IN ADOLESCENTS AND YOUNG ADULTS 2015; 5:97-102. [PMID: 26767184 PMCID: PMC4708267 DOI: 10.2147/coaya.s70370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Radiation therapy technology has permitted the development of new treatment planning techniques. Involved field, involved node, and involved site radiotherapy fields are discussed and compared. Indications for and implications of combined modality therapy are examined, particularly as pertinent to the adolescent and young adult population.
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Affiliation(s)
- Carol S Portlock
- Division of Hematologic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
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22
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Bröckelmann PJ, Goergen H, Fuchs M, Kriz J, Semrau R, Baues C, Kobe C, Behringer K, Eichenauer DA, von Tresckow B, Klimm B, Halbsguth T, Wongso D, Plütschow A, Haverkamp H, Dietlein M, Eich HT, Stein H, Diehl V, Borchmann P, Engert A. Impact of centralized diagnostic review on quality of initial staging in Hodgkin lymphoma: experience of the German Hodgkin Study Group. Br J Haematol 2015; 171:547-56. [DOI: 10.1111/bjh.13646] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/23/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Paul J. Bröckelmann
- Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
- German Hodgkin Study Group (GHSG); Cologne Germany
| | | | - Michael Fuchs
- Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
- German Hodgkin Study Group (GHSG); Cologne Germany
| | - Jan Kriz
- German Hodgkin Study Group (GHSG); Cologne Germany
- Department of Radiation Oncology; University Hospital Münster; Münster Germany
| | - Robert Semrau
- German Hodgkin Study Group (GHSG); Cologne Germany
- Department of Radiation Oncology; University Hospital of Cologne; Cologne Germany
| | - Christian Baues
- German Hodgkin Study Group (GHSG); Cologne Germany
- Department of Radiation Oncology; University Hospital of Cologne; Cologne Germany
| | - Carsten Kobe
- German Hodgkin Study Group (GHSG); Cologne Germany
- Department of Nuclear Medicine; University Hospital of Cologne; Cologne Germany
| | - Karolin Behringer
- Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
- German Hodgkin Study Group (GHSG); Cologne Germany
| | - Dennis A. Eichenauer
- Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
- German Hodgkin Study Group (GHSG); Cologne Germany
| | - Bastian von Tresckow
- Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
- German Hodgkin Study Group (GHSG); Cologne Germany
| | - Beate Klimm
- German Hodgkin Study Group (GHSG); Cologne Germany
- Department III of Internal Medicine; Krankenhaus Düren; Düren Germany
| | - Teresa Halbsguth
- German Hodgkin Study Group (GHSG); Cologne Germany
- Department II of Internal Medicine; University Hospital of Frankfurt; Frankfurt Germany
| | - Diana Wongso
- German Hodgkin Study Group (GHSG); Cologne Germany
| | | | | | - Markus Dietlein
- German Hodgkin Study Group (GHSG); Cologne Germany
- Department of Nuclear Medicine; University Hospital of Cologne; Cologne Germany
| | - Hans T. Eich
- German Hodgkin Study Group (GHSG); Cologne Germany
- Department of Radiation Oncology; University Hospital Münster; Münster Germany
| | - Harald Stein
- German Hodgkin Study Group (GHSG); Cologne Germany
- Pathodiagnostik Berlin; Berlin Germany
| | - Volker Diehl
- German Hodgkin Study Group (GHSG); Cologne Germany
| | - Peter Borchmann
- Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
- German Hodgkin Study Group (GHSG); Cologne Germany
| | - Andreas Engert
- Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
- German Hodgkin Study Group (GHSG); Cologne Germany
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Torok JA, Wu Y, Prosnitz LR, Kim GJ, Beaven AW, Diehl LF, Kelsey CR. Low-dose consolidation radiation therapy for early stage unfavorable Hodgkin lymphoma. Int J Radiat Oncol Biol Phys 2015; 92:54-9. [PMID: 25863754 DOI: 10.1016/j.ijrobp.2015.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/14/2015] [Accepted: 02/02/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE The German Hodgkin Study Group (GHSG) trial HD11 established 4 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and 30 Gy of radiation therapy (RT) as a standard for early stage (I, II), unfavorable Hodgkin lymphoma (HL). Additional cycles of ABVD may allow for a reduction in RT dose and improved toxicity profile. METHODS AND MATERIALS Patients treated with combined modality therapy at the Duke Cancer Institute for early stage, unfavorable HL by GHSG criteria from 1994 to 2012 were included. Patients who did not undergo post-chemotherapy functional imaging (positron emission tomography or gallium imaging) or who failed to achieve a complete response were excluded. Clinical outcomes were estimated using the Kaplan-Meier method. Late effects were also evaluated. RESULTS A total of 90 patients met inclusion criteria for analysis. Median follow-up was 5 years. Chemotherapy consisted primarily of ABVD (88%) with a median number of 6 cycles. The median dose of consolidation RT was 23.4 Gy. Four patients had relapses, 2 of which were in-field. Ten-year progression-free survival (PFS) and overall survival (OS) were 93% (95% confidence interval [CI]: 0.82-0.97) and 98% (95% CI: 0.92-0.99), respectively. For the subset of patients (n=46) who received 5 to 6 cycles of chemotherapy and ≤ 24 Gy, the 10-year PFS and OS values were 88% (95% CI: 70%-96%) and 98% (95% CI: 85% - 99%), respectively. The most common late effect was hypothyroidism (20%) with no cardiac complications. Seven secondary malignancies were diagnosed, with only 1 arising within the RT field. CONCLUSIONS Lower doses of RT may be sufficient when combined with more than 4 cycles of ABVD for early stage, unfavorable HL and may result in a more favorable toxicity profile than 4 cycles of ABVD and 30 Gy of RT.
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Affiliation(s)
- Jordan A Torok
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
| | - Yuan Wu
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Leonard R Prosnitz
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Grace J Kim
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Anne W Beaven
- Division of Hematologic Malignancy and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Louis F Diehl
- Division of Hematologic Malignancy and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Chris R Kelsey
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
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van Nimwegen FA, Cutter DJ, Schaapveld M, Rutten A, Kooijman K, Krol AD, Janus CP, Darby SC, van Leeuwen FE, Aleman BM. Simple Method to Estimate Mean Heart Dose From Hodgkin Lymphoma Radiation Therapy According to Simulation X-Rays. Int J Radiat Oncol Biol Phys 2015; 92:153-60. [DOI: 10.1016/j.ijrobp.2015.02.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/23/2015] [Accepted: 02/09/2015] [Indexed: 01/08/2023]
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Giulino-Roth L, Keller FG, Hodgson DC, Kelly KM. Current approaches in the management of low risk Hodgkin lymphoma in children and adolescents. Br J Haematol 2015; 169:647-60. [PMID: 25824371 DOI: 10.1111/bjh.13372] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The outcome for children and adolescents with low risk Hodgkin lymphoma (HL) is excellent, with event-free survival >85% and overall survival >95%. Historically, however, treatment has come at the cost of significant long-term toxicity from chemotherapy, radiation or a combination of these. Recent treatment strategies have focused on maintaining high event-free and overall survival while minimizing the use of therapy associated with late effects. The strategies used to achieve this vary greatly among paediatric cooperative groups and there is no one standard treatment for children with low risk HL. This review summaries recent clinical trials in paediatric low risk HL and addresses some of the important considerations when comparing trials, including differences in the definition of low risk HL, differences in outcome among histological subtypes and varying approaches to reduce or eliminate radiation therapy. Recommendations are provided for the treatment of children with low risk HL outside the setting of a clinical trial.
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Affiliation(s)
- Lisa Giulino-Roth
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.,Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Frank G Keller
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University, Atlanta, GA, USA
| | - David C Hodgson
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, USA
| | - Kara M Kelly
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
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26
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Evidence-based focused review of the role of radiation therapy in the treatment of early-stage Hodgkin lymphoma. Blood 2015; 125:1708-16. [PMID: 25605371 DOI: 10.1182/blood-2014-08-545152] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Abstract
Given the excellent survival rates for early-stage Hodgkin lymphoma (HL), the young age of many patients, and concerns regarding acute and late treatment-related toxicities, there is a desire to have a predictive tool that enables therapy to be tailored toward the individual patient. Early (or interim) 18F-fluorodeoxyglucose positron emission tomography with computerized tomography (FDG-PET/CT), as a test of tumor sensitivity to ongoing/planned therapy, has been shown to be prognostic for survival in HL. Based on results of interim FDG-PET/CT, therapy may be subsequently modified through minimization or via intensification for low- and high-risk patient populations, respectively (ie, response-adapted therapy). Important data have been generated to standardize the interpretability and reproducibility of interim FDG-PET/CT (eg, the Deauville 5-point system), and observational and noncontrolled prospective studies have produced evidence supporting the hypothesis that response-adapted therapy may potentially serve as a predictive tool. Furthermore, results from noninferiority phase 3 clinical trials randomizing early-stage HL patients with negative interim FDG-PET/CT to combined modality therapy versus chemotherapy alone have been reported. The current collective findings from these randomized early-stage HL studies have shown that acute relapse rates are lower with combined modality therapy, even in patients with negative interim FDG-PET/CT. Additional randomized response-adapted studies are ongoing and novel FDG-PET/CT applications involving quantitative techniques and innovative imaging modalities are being investigated to identify more robust imaging biomarkers. Treatment of early-stage HL remains a clinical management choice for physicians and patients to make with consideration of acute and long-term outcomes.
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Evens AM, Kostakoglu L. The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease. Blood 2014; 124:3356-64. [PMID: 25428223 PMCID: PMC4467863 DOI: 10.1182/blood-2014-05-577627] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 07/08/2014] [Indexed: 01/06/2023] Open
Abstract
Given the excellent survival rates for early-stage Hodgkin lymphoma (HL), the young age of many patients, and concerns regarding acute and late treatment-related toxicities, there is a desire to have a predictive tool that enables therapy to be tailored toward the individual patient. Early (or interim) (18)F-fluorodeoxyglucose positron emission tomography with computerized tomography (FDG-PET/CT), as a test of tumor sensitivity to ongoing/planned therapy, has been shown to be prognostic for survival in HL. Based on results of interim FDG-PET/CT, therapy may be subsequently modified through minimization or via intensification for low- and high-risk patient populations, respectively (ie, response-adapted therapy). Important data have been generated to standardize the interpretability and reproducibility of interim FDG-PET/CT (eg, the Deauville 5-point system), and observational and noncontrolled prospective studies have produced evidence supporting the hypothesis that response-adapted therapy may potentially serve as a predictive tool. Furthermore, results from noninferiority phase 3 clinical trials randomizing early-stage HL patients with negative interim FDG-PET/CT to combined modality therapy versus chemotherapy alone have been reported. The current collective findings from these randomized early-stage HL studies have shown that acute relapse rates are lower with combined modality therapy, even in patients with negative interim FDG-PET/CT. Additional randomized response-adapted studies are ongoing and novel FDG-PET/CT applications involving quantitative techniques and innovative imaging modalities are being investigated to identify more robust imaging biomarkers. Treatment of early-stage HL remains a clinical management choice for physicians and patients to make with consideration of acute and long-term outcomes.
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Affiliation(s)
- Andrew M Evens
- Division of Hematology-Oncology, Tufts Medical Center, Boston, MA; and
| | - Lale Kostakoglu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
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29
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Hay AE, Meyer RM. Balancing risks and benefits of therapy for patients with favorable-risk limited-stage Hodgkin lymphoma: the role of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy alone. Hematol Oncol Clin North Am 2014; 28:49-63. [PMID: 24287067 DOI: 10.1016/j.hoc.2013.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Because long-term survival of patients with nonbulky stage IA to IIA Hodgkin lymphoma is dependent on disease control and avoidance of late toxic effects associated with the treatment received, the initial choice of treatment can be associated with trade-offs that balance optimum disease control with avoidance of these late effect risks. Health professionals and patients face the dilemma of making treatment decisions without the benefit of completely understanding the risk-benefit balances associated with how current treatments affect all outcomes of interest. Optimum management of these patients requires careful multidisciplinary evaluation and communication strategies that account for patient preferences.
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Affiliation(s)
- Annette E Hay
- NCIC Clinical Trials Group, Queen's University, 10 Stuart Street, Kingston, Ontario K7L 3N6, Canada
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Hoppe BS, Flampouri S, Zaiden R, Slayton W, Sandler E, Ozdemir S, Dang NH, Lynch JW, Li Z, Morris CG, Mendenhall NP. Involved-node proton therapy in combined modality therapy for Hodgkin lymphoma: results of a phase 2 study. Int J Radiat Oncol Biol Phys 2014; 89:1053-1059. [PMID: 24928256 DOI: 10.1016/j.ijrobp.2014.04.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/04/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE This study describes the early clinical outcomes of a prospective phase 2 study of consolidative involved-node proton therapy (INPT) as a component of combined-mode therapy in patients with stages I to III Hodgkin lymphoma (HL) with mediastinal involvement. METHODS AND MATERIALS Between September 2009 and June 2013, 15 patients with newly diagnosed HL received INPT after completing chemotherapy in an institutional review board-approved protocol comparing the dosimetric impact of PT with those of three-dimensional conformal radiation therapy (3DCRT) and intensity modulated RT. Based on (18)F-Fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) response, 5 children received 15 to 25.5 cobalt Gy equivalent (CGE) of INPT after receiving 4 cycles of Adriamycin, Bleomycin, Vincristine, Etoposide, Prednisone, Cyclophosphamide or Vincristine, adriamycin, methotrexate, Prednisone chemotherapy, and 10 adults received 30.6 to 39.6 CGE of INPT after 3 to 6 cycles of Adriamycin, Bleomycine, Vinblastine, Dacarbazine. Patients were routinely evaluated for toxicity during and after treatment, using Common Terminology Criteria for Adverse Events, version 3.0, and for relapse by physical examination and routine imaging. Relapse-free survival (RFS) and event-free survival (EFS) rates were calculated using the Kaplan-Meier method from the time of diagnosis. RESULTS The median follow-up was 37 months (range, 26-55). Two events occurred during follow-up: 1 relapse (inside and outside the targeted field) and 1 transformation into a primary mediastinal large B cell lymphoma. The 3-year RFS rate was 93%, and the 3-year EFS rate was 87%. No acute or late grade 3 nonhematologic toxicities were observed. CONCLUSIONS Although decades of follow-up will be needed to realize the likely benefit of PT in reducing the risk of radiation-induced late effects, PT following chemotherapy in patients with HL is well-tolerated, and disease outcomes were similar to those of conventional photon therapy.
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Affiliation(s)
- Bradford S Hoppe
- Radiation Oncology, University of Florida Proton Therapy Institute, Jacksonville, Florida.
| | - Stella Flampouri
- Radiation Oncology, University of Florida Proton Therapy Institute, Jacksonville, Florida
| | - Robert Zaiden
- Department of Medicine, Division of Hematology and Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - William Slayton
- Department of Pediatrics, Division of Hematology and Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Eric Sandler
- Department of Pediatrics, Division of Hematology/Oncology Nemours Children's Clinic, Jacksonville, Florida
| | - Savas Ozdemir
- Department of Radiology, Division of Functional and Molecular Imaging, University of Florida College of Medicine, Jacksonville, Florida
| | - Nam H Dang
- Department of Medicine, Division of Hematology and Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - James W Lynch
- Department of Medicine, Division of Hematology and Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Zuofeng Li
- Radiation Oncology, University of Florida Proton Therapy Institute, Jacksonville, Florida
| | - Christopher G Morris
- Radiation Oncology, University of Florida Proton Therapy Institute, Jacksonville, Florida
| | - Nancy P Mendenhall
- Radiation Oncology, University of Florida Proton Therapy Institute, Jacksonville, Florida
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Affiliation(s)
- Ralph M. Meyer
- McMaster University and the Juravinski Hospital and Cancer Centre, Hamilton, Ontario, Canada
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