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Friedberg JW, Bordoni R, Patel-Donnelly D, Larson T, Goldschmidt J, Boccia R, Cline VJM, Mamidipalli A, Liu J, Akyol A, Yasenchak CA. Brentuximab vedotin with dacarbazine or nivolumab as frontline cHL therapy for older patients ineligible for chemotherapy. Blood 2024; 143:786-795. [PMID: 37946283 DOI: 10.1182/blood.2022019536] [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: 01/24/2023] [Revised: 09/29/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023] Open
Abstract
ABSTRACT Older patients with advanced-stage classical Hodgkin lymphoma (cHL) have inferior outcomes compared with younger patients, potentially due to comorbidities and frailty. This noncomparative phase 2 study enrolled patients aged ≥60 years with cHL unfit for conventional chemotherapy to receive frontline brentuximab vedotin (BV; 1.8 mg/kg) with dacarbazine (DTIC; 375 mg/m2) (part B) or nivolumab (part D; 3 mg/kg). In parts B and D, 50% and 38% of patients, respectively, had ≥3 general comorbidities or ≥1 significant comorbidity. Of the 22 patients treated with BV-DTIC, 95% achieved objective response, and 64% achieved complete response (CR). With a median follow-up of 63.6 months, median duration of response (mDOR) was 46.0 months. Median progression-free survival (mPFS) was 47.2 months; median overall survival (mOS) was not reached. Of 21 patients treated with BV-nivolumab, 86% achieved objective response, and 67% achieved CR. With 51.6 months of median follow-up, mDOR, mPFS, and mOS were not reached. Ten patients (45%) with BV-DTIC and 16 patients (76%) with BV-nivolumab experienced grade ≥3 treatment-emergent adverse events; sensory peripheral neuropathy (PN; 27%) and neutropenia (9%) were most common with BV-DTIC, and increased lipase (24%), motor PN (19%), and sensory PN (19%) were most common with BV-nivolumab. Despite high median age, inclusion of patients aged ≤88 years, and frailty, these results demonstrate safety and promising durable efficacy of BV-DTIC and BV-nivolumab combinations as frontline treatment, suggesting potential alternatives for older patients with cHL unfit for initial conventional chemotherapy. This trial was registered at www.clinicaltrials.gov as #NCT01716806.
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Affiliation(s)
| | | | | | | | | | - Ralph Boccia
- Center for Cancer and Blood Disorders, Bethesda, MD
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Shah H, Jang H, Kim S, Halwani AS. A comprehensive SEER registry analysis of elderly patients with classical Hodgkin lymphoma based on treatment era and race. Br J Haematol 2023; 200:579-586. [PMID: 36400571 DOI: 10.1111/bjh.18564] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/10/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022]
Abstract
We conducted a Surveillance, Epidemiology, and End Results Program (SEER-18) registry analysis of classical Hodgkin lymphoma (cHL) patients more than 60 years old and compared outcomes of those diagnosed between 2006 and 2010 (cohort 1) to those identified between 2011 and 2015 (cohort 2) based on treatment era and race. Cohort 1 had a median overall survival (OS) of 4 years and cohort 2 had a median OS of 4.75 years [hazard ratio (HR): 0.92 (0.85-1.00); p = 0.052]. Non-Hispanic blacks (NHBs) had a similar 5-year OS compared to non-Hispanic whites (NHWs) of 48.6% vs. 50.2% (HR: 0.95 [0.79-1.15]; p > 0.99); on the contrary, Hispanics had worse 5-year OS of 41.8% vs. 48.6% (HR: 1.24 [1.09-1.41]; p < 0.001). NHW was the only race that had improvement in 5-year OS in 2011-2015 compared to 2006-2010 (51% vs. 46.5%, p = 0.002). In the multivariable analysis, older age, male gender, stage III-IV, unmarried status, Hispanic race, lack of chemotherapy, and diagnosis in 2006-2010 were associated with worse OS. Lymphoma was the most common cause of death in 60% of patients. In conclusion, elderly cHL patients diagnosed after 2010 had improved OS by nine months that was most prevalent in NHWs, and disparity in OS existed between NHWs and Hispanics throughout the study period.
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Affiliation(s)
- Harsh Shah
- University of Utah/Huntsman Cancer Center, Salt Lake City, Utah, USA
| | - Hyejeong Jang
- Biostatistics and Bioinformatics Core, Karmanos Cancer Institute, Detroit, Michigan, USA.,Department of Oncology, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Seongho Kim
- Biostatistics and Bioinformatics Core, Karmanos Cancer Institute, Detroit, Michigan, USA.,Department of Oncology, School of Medicine, Wayne State University, Detroit, Michigan, USA
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Goh Z, Latimer M, Lewis KL, Cheah CY, Ciaccio PD, Cushion T, Hawkes EA, Harrop S, Ku M, Campbell A, Hamad N, Wood EM, Chung E, Chen PY, Cochrane T. Characteristics and Outcomes of Older Patients With Classical Hodgkin Lymphoma: An Australasian Lymphoma Alliance, and Lymphoma and Related Diseases Registry Study. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:370-378. [PMID: 36804727 DOI: 10.1016/j.clml.2023.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/21/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is no standard front-line therapy for older patients with classical Hodgkin lymphoma (cHL). We analyzed the clinical presentation and front-line management of older Australian patients with cHL and explored factors associated with unplanned hospital admission and survival. METHODS Patients aged ≥ 61 years and diagnosed between 2011 and 2020, were retrospectively identified through the Lymphoma and Related Diseases Registry (LaRDR) and Australasian Lymphoma Alliance (ALA) institutional databases. Descriptive statistics and Kaplan-Meier survival analyses were performed using STATA-v17. RESULTS 195 patients were identified, 72 from LaRDR,123 from ALA. Median age of the combined cohort was 72 years (range 61-93); 56.4% male, 35.3% had stage I-II, bulk present in 9.2%, 33.9% had extra-nodal disease and 48.2% had B-symptoms. Chemotherapy was commenced in 91.3% of patients, with an anthracycline-based regimen used in 81%. Median number of cycles given for stage I-II was 2 and for stage III-IV was 6. Radiotherapy was administered in 26.2% of patients. A complete remission to front-line chemotherapy was achieved in 60.7% of patients. During front-line therapy in the ALA cohort, 89 unplanned hospitalizations occurred in 58 patients, with infection accounting for 59.6% of admissions. Treatment-related mortality was 5.2%. Only performance status and anthracycline use correlated with unplanned hospitalizations. Estimated 2-year progression free survival was 63.7% and 2-year overall survival was 71.2%. Anthracycline use and younger age were independently associated with improved survival. CONCLUSION The management of older patients with cHL in Australia is diverse but aligns with international data. Anthracycline-based therapy improved survival but resulted in frequent unplanned hospitalizations.
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Affiliation(s)
- Zhong Goh
- Department of Haematology, Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia
| | - Maya Latimer
- ACT Pathology and Canberra Hospital, Canberra, Australia; Australian National University, Canberra, Australia
| | - Katharine L Lewis
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia; Division Medical School, University of Western Australia, Perth, WA, Australia; WA Linear Clinical Research, Nedlands, WA, Australia
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, WA, Australia; Division Medical School, University of Western Australia, Perth, WA, Australia
| | - Pietro Di Ciaccio
- Australian National University, Canberra, Australia; Department of Haematology Sydney Adventist Hospital, Wahroonga NSW, Australia; University of New South Wales, Randwick, NSW, Australia
| | - Tania Cushion
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Eliza A Hawkes
- Olivia Newton John Cancer Research and Wellness Centre, Austin Health, Heidelberg, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sean Harrop
- Department of Haematology, St Vincent's hospital, Fitzroy, Victoria, Australia
| | - Matthew Ku
- Department of Haematology, St Vincent's hospital, Fitzroy, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Ashlea Campbell
- Department of Haematology and Bone Marrow Transplant, St Vincent's Hospital, Sydney, NSW, Australia
| | - Nada Hamad
- Department of Haematology and Bone Marrow Transplant, St Vincent's Hospital, Sydney, NSW, Australia; School of Clinical Medicine, UNSW Medicine and Health, Sydney, Australia; School of Medicine, Sydney, University of Notre Dame Australia, Sydney, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Monash Health, Clayton, Victoria, Australia
| | - Eliza Chung
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Pin-Yen Chen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tara Cochrane
- Department of Haematology, Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia.
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Do all patients with primary refractory/first relapse of HL need autologous stem cell transplant? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:699-705. [PMID: 36485099 PMCID: PMC9821042 DOI: 10.1182/hematology.2022000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The standard approach to treatment of primary refractory/first relapse of classical Hodgkin lymphoma (cHL) is administration of second-line therapy (SLT) followed by consolidation with high-dose therapy and autologous hematopoietic cell transplantation (HDT/AHCT). Historically, this approach cured about 50% of patients. Due to improvements in supportive care, positron emission tomography-adaptive strategies, and incorporation of novel agents into SLT, contemporary studies show that about 75% of patients with primary refractory or first relapse of cHL can be cured. Recent studies evaluating incorporation of PD-1 blockade in SLT appear to show even further improvement in remission rates and bring into question whether an aggressive approach that includes HDT/AHCT is needed for everyone. To address this question, several ongoing studies are beginning to explore the possibility of avoiding or delaying HDT/AHCT for patients with primary refractory or first relapse of cHL.
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Gadó K, Khodier M, Virág A, Domján G, Dörnyei G. Anemia of geriatric patients. Physiol Int 2022; 109:119-134. [DOI: 10.1556/2060.2022.00218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/14/2022] [Accepted: 02/22/2022] [Indexed: 11/19/2022]
Abstract
Abstract
Anemia is a common finding in the elderly. Approximately 10 percent of the elderly suffers from anemia. Anemia per se is an independent factor of mortality in older patients regardless its cause. Frailty is also frequent in geriatric patients. That means that there is a decreased reserve capacity to react to different stress factors including anemia. The frequent presence of heart failure and also impaired cerebrovascular circulation makes more difficult to tolerate anemia in older age.
Anemia is a symptom, finding and treating the underlying cause is also important.
Treatment always depends on clinical findings: the more severe the symptoms, the more important to treat them. Severity of anemia depends not only the underlying cause, degree of anemia, co-morbidities and frailty of the patients, but also the speed of its development. Sudden blood loss due to an accident is less well tolerated than the same degree of anemia due to B12 deficiency.
Main causes of anemia in the elderly include nutritional deficiencies, chronic diseases, tumors, and certain hematological malignancies such as chronic lymphocytic leukemia, multiple myeloma, myelodysplastic syndrome.
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Affiliation(s)
- Klara Gadó
- Department of Clinical Studies, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
- Department of Geriatrics and Center of Nursing Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Malaz Khodier
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Andrea Virág
- Department of Geriatrics and Center of Nursing Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Gyula Domján
- Department of Clinical Studies, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Gabriella Dörnyei
- Department of Morphology and Physiotherapy, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
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Marin K, Auvinen P, Kuitunen H, Kuittinen O. Chronic Cutaneous Disorders Are Associated with a More Favorable Disease Presentation and Outcome in Patients with Hodgkin Lymphoma. Oncol Res Treat 2022; 45:241-247. [PMID: 35134808 DOI: 10.1159/000522480] [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: 10/06/2021] [Accepted: 01/17/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In epidemiological studies, chronic inflammation or previous major infection have revealed to be associated with an increased risk of developing Hodgkin lymphoma (HL). The association of chronic inflammation with disease outcome is poorly defined. In this retrospective study based on 92 consecutive HL patients, we explored the incidence of previous inflammatory processes or previous major infection in newly diagnosed HL patients and their association with treatment outcome. METHODS Medical history before lymphoma diagnosis including previous infection, dental inflammation, cutaneous problems, inflammatory respiratory, gastrointestinal or musculoskeletal diseases was collected from the patient records. Also clinical HL presentation, given treatments and disease outcome were recorded. RESULTS 46% of HL patients had some of the studied inflammatory factor at the time of diagnosis. Chronic dermatological diseases were present in 16.3 % of patients and they were associated with an improved relapse free survival (p=0.028). Dermatological issues were also associated with early stage disease and absence of B-symptoms. Other studied inflammatory factors were not associated with any clinical variables or treatment outcome. CONCLUSION Our results demonstrated that among patients with Hodgkin lymphoma, pre-existing cutaneous symptoms are associated with a limited stage disease, absence of B-symptoms and favourable prognosis.
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Affiliation(s)
- Katja Marin
- Centre of Oncology, Kuopio University Hospital, Kuopio, Finland
- Oncology, Institute of Clinical Medicine, School of Medicine, Faculty of Health Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Päivi Auvinen
- Centre of Oncology, Kuopio University Hospital, Kuopio, Finland
- Oncology, Institute of Clinical Medicine, School of Medicine, Faculty of Health Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Hanne Kuitunen
- Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | - Outi Kuittinen
- Centre of Oncology, Kuopio University Hospital, Kuopio, Finland
- Oncology, Institute of Clinical Medicine, School of Medicine, Faculty of Health Medicine, University of Eastern Finland (UEF), Kuopio, Finland
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Lüke F, Harrer DC, Menhart K, Wolff D, Holler E, Hellwig D, Herr W, Grube M, Vogelhuber M, Reichle A, Heudobler D. Biomodulatory Treatment Regimen, MEPED, Rescues Relapsed and Refractory Classic Hodgkin's Disease. Front Pharmacol 2021; 12:599561. [PMID: 34220492 PMCID: PMC8249731 DOI: 10.3389/fphar.2021.599561] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Current combined intensive chemotherapy and radiation regimens yield excellent survival rates in advanced classic Hodgkin’s lymphoma (cHL). However, acute toxicity in elderly, comorbid patients can be challenging and long-term survival in refractory patients remains poor. Patients and Methods: We report on six patients with r/r HL, three patients with long-term follow-up, three newly treated, after biomodulatory therapy. All patients received MEPED (treosulfan 250 mg p.o. daily, everolimus 15 mg p.o. daily to achieve serum trough levels of 15 ng/ml, pioglitazone 45 mg p.o. daily, etoricoxib 60 mg p.o. daily and dexamethasone 0.5 mg p.o. daily). Patients had either received every at that time approved systemic treatment or were ineligible for standard treatment, including immune checkpoint inhibition (ICPi) due to prior demyelinating autoimmune polyneuropathy, myasthenia gravis and previous allogeneic hematopoietic-stem-cell transplant (alloHSCT). Medication was administered continuously from day 1. One patient with relapse after alloHSCT received trofosfamide 50 mg daily instead of treosulfan to avoid risk of increased myelotoxicity. The patients were treated in individual healing attempts outside a clinical trial after institutional review board approval. 18F-fluoro-2-deoxy-d-glucose positron emission tomography combined with computed tomography scan (FDG-PET/CT) was performed to monitor treatment and follow-up. Results: In the three newly treated patients, CT scans showed partial remissions after 2–5 months on MEPED treatment. Two patients had achieved PET Deauville score 2 and 3, while the third remained positive at Deauville score 5. One patient achieving PR became eligible for alloHSCT, while the other two patients continued treatment with MEPED. All patients eventually achieved continuous complete remission (cCR), one after consecutive alloHSCT, one after discontinuing MEPED consolidation for >1 year and one on on-going MEPED consolidation, respectively. Only one patient experienced Grade 3 toxicity (bacterial pneumonia) requiring temporary discontinuation of MEPED for 10 days. All three previously published patients received allo HSCT for consolidation and have achieved cCR. Conclusions: MEPED is well tolerated with low toxicity and highly efficacious in relapsed/refractory cHL, including severely comorbid patients. Due to its immunomodulatory components, MEPED might also have a synergistic potential when combined with ICPi but requires further evaluation within a clinical trial.
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Affiliation(s)
- Florian Lüke
- Department of Internal Medicine III, Hematology and Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - Dennis C Harrer
- Department of Internal Medicine III, Hematology and Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - Karin Menhart
- Department of Nuclear Medicine, University Hospital of Regensburg, Regensburg, Germany
| | - Daniel Wolff
- Department of Internal Medicine III, Hematology and Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - Ernst Holler
- Department of Internal Medicine III, Hematology and Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - Dirk Hellwig
- Department of Nuclear Medicine, University Hospital of Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, Hematology and Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - Matthias Grube
- Department of Internal Medicine III, Hematology and Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - Martin Vogelhuber
- Department of Internal Medicine III, Hematology and Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - Albrecht Reichle
- Department of Internal Medicine III, Hematology and Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - Daniel Heudobler
- Department of Internal Medicine III, Hematology and Oncology, University Hospital of Regensburg, Regensburg, Germany
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Momotow J, Borchmann S, Eichenauer DA, Engert A, Sasse S. Hodgkin Lymphoma-Review on Pathogenesis, Diagnosis, Current and Future Treatment Approaches for Adult Patients. J Clin Med 2021; 10:jcm10051125. [PMID: 33800409 PMCID: PMC7962816 DOI: 10.3390/jcm10051125] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 01/07/2023] Open
Abstract
Hodgkin lymphoma (HL) is a rare malignancy accounting for roughly 15% of all lymphomas and mostly affecting young patients. A second peak is seen in patients above 60 years of age. The history of HL treatment represents a remarkable success story in which HL has turned from an incurable disease to a neoplasm with an excellent prognosis. First-line treatment with stage-adapted treatment consisting of chemotherapy and/or radiotherapy results in cure rates of approximately 80%. Second-line treatment mostly consists of intensive salvage chemotherapy followed by high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT). Novel approaches such as antibody drug conjugates and immunomodulatory drugs have shown impressive results in clinical trials in refractory and relapsed HL and are now increasingly implemented in earlier treatment lines. This review gives a comprehensive overview on HL addressing epidemiology, pathophysiology and current treatment options as well as recent developments and perspectives.
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Affiliation(s)
- Jesko Momotow
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (S.B.); (D.A.E.); (A.E.)
| | - Sven Borchmann
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (S.B.); (D.A.E.); (A.E.)
| | - Dennis A. Eichenauer
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (S.B.); (D.A.E.); (A.E.)
| | - Andreas Engert
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.M.); (S.B.); (D.A.E.); (A.E.)
| | - Stephanie Sasse
- Department IV of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital Aachen, University of Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
- Correspondence:
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9
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Rusconi C, Ciavarella S, Fabbri A, Flenghi L, Puccini B, Re A, Sorio M, Vanazzi A, Zanni M. Treatment of very high-risk classical Hodgkin Lymphoma: cases' selection from real life and critical review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:13-22. [PMID: 32525130 PMCID: PMC7944652 DOI: 10.23750/abm.v91is-5.9911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022]
Abstract
Over the last 4 decades, advances in radiation therapy and the addition of combination chemotherapy have significantly increased the cure rate of patients with HL, with a 5-year OS of about 90% . However, despite high rate of cure after first line of therapy, 5%-10% of HLs are refractory to the treatment, and 10-30% of patients have a disease relapse after a complete response (CR). Relapsed HL can be treated with salvage therapies with a long-lasting complete remission in 80% of cases. In recent years, novel drugs are available for the patients with relapsed/refractory HL, like Brentuximab Vedotin and immune checkpoint inhibitors. These drugs have been able to rescue a cohort of patients who subsequently could receive an allogeneic stem-cell transplant. Our cases have been chosen because they are representative of critical issues in the management of relapsed/refractory HL; our experiences are consistent with what reported by other Authors.
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Affiliation(s)
- Chiara Rusconi
- Division of Haematology, Department of Haematology and Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano.
| | - Sabino Ciavarella
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy.
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy.
| | | | - Benedetta Puccini
- Haematology Unit, Careggi Hospital-University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Alessandro Re
- Department of Hematology, ASST Spedali Civili di Brescia, Italy.
| | - Marco Sorio
- Department of Clinical and Experimental Medicine, Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy.
| | - Anna Vanazzi
- Division of Clinical Hemato-Oncology, Istituto Europeo di Oncologia, Milan, Italy.
| | - Manuela Zanni
- Hematology Unit, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy.
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Borchmann S, Engert A. Examining rare side effects in pooled trial data: symptomatic osteonecrosis in Hodgkin lymphoma. Oncotarget 2018; 9:37462-37463. [PMID: 30680059 PMCID: PMC6331024 DOI: 10.18632/oncotarget.26486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/12/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sven Borchmann
- Andreas Engert: Department of Internal Medicine and German Hodgkin Study Group, University Hospital of Cologne, Cologne, Germany
| | - Andreas Engert
- Andreas Engert: Department of Internal Medicine and German Hodgkin Study Group, University Hospital of Cologne, Cologne, Germany
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11
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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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12
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Cirillo M, Reinke S, Klapper W, Borchmann S. The translational science of hodgkin lymphoma. Br J Haematol 2018; 184:30-44. [DOI: 10.1111/bjh.15658] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/20/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Melita Cirillo
- Department of Haematology; Royal Perth Hospital; Perth Australia
- Department I of Internal Medicine; German Hodgkin Study Group (GHSG); Cologne Germany
| | - Sarah Reinke
- Department of Pathology; Hematopathology Section; University Hospital Schleswig-Holstein, Campus Kiel; Kiel Germany
| | - Wolfram Klapper
- Department of Pathology; Hematopathology Section; University Hospital Schleswig-Holstein, Campus Kiel; Kiel Germany
| | - Sven Borchmann
- Department I of Internal Medicine; German Hodgkin Study Group (GHSG); Cologne Germany
- Else Kröner Forschungskolleg Clonal Evolution in Cancer; University Hospital of Cologne; Cologne Germany
- Centre for Molecular Medicine Cologne; University of Cologne; Cologne Germany
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