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Jacob LA, Begum T, Halder A, Babu MCS, Lokesh KN, Rudresha AH, Rajeev LK, Saldanha SC. Clinical Profile and Outcome of Adult Classical Hodgkin's Lymphoma: Real World Single Centre Experience. Indian J Hematol Blood Transfus 2024; 40:392-399. [PMID: 39011262 PMCID: PMC11246344 DOI: 10.1007/s12288-024-01735-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/11/2024] [Indexed: 07/17/2024] Open
Abstract
Hodgkin's lymphoma treatment outcomes have been the true success story of modern medicine. Various data from western as well as Indian studies are available for classical Hodgkin's lymphoma (cHL). Here we report treatment outcomes from a tertiary cancer care centre in Karnataka over a 5 year period. This was a retrospective review of cHL cases aged 15 years and above diagnosed between January 2015 and December 2019 at Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India. The case files of the patients were retrieved and relevant data was collected. Two hundred patients of cHL were included in this study. Median age was 28 years with male to female ratio of 1.56:1. B symptoms were present in 58% cases. Mixed cellularity (46.5%) was the most common histological subtype. Majority patients had advanced stage at presentation (stage III/IV) (62.5%). Extranodal disease was present in 19.5% cases. GHSG early-favourable cases were 15.5%, early-unfavourable cases were 22.0%, while 62.5% were advanced cases. The most common chemotherapy regimen used was ABVD. Eighty-three (41.5%) patients received radiation therapy. Median follow-up was 34.2 months (range 4.1-67.8). The rates for complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) were 84.5%, 8.5%, 5.0% and 2.0% respectively. PFS and OS rate at 6 years were 69.5% and 84.1% respectively. HL is one of the malignancies with high cure rate. The treatment outcome at our centre is comparable to western data and data from other tertiary centres from India.
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Affiliation(s)
- Linu Abraham Jacob
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M. H. Marigowda Road, Bengaluru, Karnataka India
| | - Tarjina Begum
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M. H. Marigowda Road, Bengaluru, Karnataka India
| | - Arkoprovo Halder
- Department of Medical Oncology, Medica Cancer Hospital, Rangapani, Siliguri, West Bengal India
| | - M C Suresh Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M. H. Marigowda Road, Bengaluru, Karnataka India
| | - K N Lokesh
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M. H. Marigowda Road, Bengaluru, Karnataka India
| | - A H Rudresha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M. H. Marigowda Road, Bengaluru, Karnataka India
| | - L K Rajeev
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M. H. Marigowda Road, Bengaluru, Karnataka India
| | - Smitha C Saldanha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Dr. M. H. Marigowda Road, Bengaluru, Karnataka India
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Expanding the armory for treating lymphoma: Targeting redox cellular status through thioredoxin reductase inhibition. Pharmacol Res 2022; 177:106134. [DOI: 10.1016/j.phrs.2022.106134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 12/12/2022]
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Wahlin BE, Övergaard N, Peterson S, Digkas E, Glimelius I, Lagerlöf I, Johansson A, Palma M, Hansson L, Linderoth J, Goldkuhl C, Molin D. Real‐world data on treatment concepts in classical Hodgkin lymphoma in Sweden 2000–2014, focusing on patients aged >60 years. EJHAEM 2021; 2:400-412. [PMID: 35844675 PMCID: PMC9175745 DOI: 10.1002/jha2.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/08/2022]
Abstract
Treatment for patients > 60 years with classical Hodgkin lymphoma (cHL) is problematic; there is no gold standard, and outcome is poor. Using the Swedish Lymphoma Registry, we analysed all Swedish patients diagnosed with cHL between 2000 and 2014 (N = 2345; median age 42 years; 691 patients were >60 years). The median follow‐up time was 6.7 years. Treatment for elderly patients consisted mainly of ABVD or CHOP, and the younger patients were treated with ABVD or BEACOPP (with no survival difference). In multivariable analysis of patients > 60 years, ABVD correlated with better survival than CHOP (p = 0.027), and ABVD became more common over time among patients aged 61–70 years (p = 0.0206). Coinciding with the implementation of FDG‐PET/CT, the fraction of advanced‐stage disease increased in later calendar periods, also in the older patient group. Survival has improved in cHL patients > 60 years (p = 0.027), for whom ABVD seems superior to CHOP.
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Affiliation(s)
- Björn Engelbrekt Wahlin
- Division of Haematology, Department of Medicine, Huddinge Karolinska Institutet Stockholm Sweden
- Haematology unit Karolinska University Hospital Stockholm Sweden
| | - Ninja Övergaard
- Department of Immunology, Genetics and Pathology Uppsala University Uppsala Sweden
| | | | | | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology Uppsala University Uppsala Sweden
| | - Ingemar Lagerlöf
- Department of Immunology, Genetics and Pathology Uppsala University Uppsala Sweden
- Department of Haematology University Hospital of Linköping Linköping Sweden
| | | | - Marzia Palma
- Haematology unit Karolinska University Hospital Stockholm Sweden
| | - Lotta Hansson
- Haematology unit Karolinska University Hospital Stockholm Sweden
| | | | - Christina Goldkuhl
- Department of Oncology Sahlgrenska University Hospital Gothenburg Sweden
| | - Daniel Molin
- Department of Immunology, Genetics and Pathology Uppsala University Uppsala Sweden
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Sykorova A, Mocikova H, Lukasova M, Koren J, Stepankova P, Prochazka V, Belada D, Klaskova K, Gaherova L, Chroust K, Buresova L, Markova J. Outcome of elderly patients with classical Hodgkin’s lymphoma. Leuk Res 2020; 90:106311. [DOI: 10.1016/j.leukres.2020.106311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 01/18/2020] [Accepted: 01/22/2020] [Indexed: 11/27/2022]
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Guru Murthy GS, Szabo A, Hamadani M, Fenske TS, Shah NN. Contemporary Outcomes for Advanced-Stage Classical Hodgkin Lymphoma in the U.S.: Analysis of Surveillance, Epidemiology, and End Results Database. Oncologist 2019; 24:1488-1495. [PMID: 31467178 DOI: 10.1634/theoncologist.2019-0172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/17/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Advanced-stage Hodgkin lymphoma (HL) is a curable malignancy, although outcomes remain poor in certain patients. It remains unclear if recent advances have improved their population-level survival over time. MATERIALS AND METHODS Using the Surveillance, Epidemiology, and End Results database, we identified patients aged ≥18 years with stage III or IV classical HL as the first primary malignancy, diagnosed between 2000 and 2014 and treated with chemotherapy. Patients were stratified by date of diagnosis into three groups (2000-2004, 2005-2009, 2010-2014) to assess the trends in overall survival (OS). RESULTS A total of 9,042 patients with a median age of 41 years were included. The use of frontline radiation therapy decreased in each period (21.3% [2000-2004] vs. 15.5% [2005-2009] vs. 10.7% [2010-2014]; p < .001). Three-year OS was significantly higher for patients diagnosed between 2010 and 2014 (81.8%) and 2005 and 2009 (80.6%) compared with 2000 and 2004 (78.5%; p = .0008 and .02, respectively). Whereas outcomes were poorest in the age >60 cohort, similar improvements were also seen in 3-year OS over the three time periods within this patient population. On multivariate analysis, diagnosis in the earlier period and minority race were associated with higher mortality. Females and married patients had significantly lower mortality risk. CONCLUSION Survival of patients with advanced-stage HL has continued to improve over time, suggesting the impact of evolving treatment approaches. Three-year OS in the contemporary period remains inadequate at 81.8%, highlighting the need for continued research to improve their outcomes. IMPLICATIONS FOR PRACTICE This article evaluates contemporary outcomes for advanced-stage Hodgkin lymphoma (HL) in the U.S. using the Surveillance, Epidemiology, and End Results database. Although overall survival (OS) has improved in each 5-year period since 2000, the 3-year OS from 2010 to 2014 remains inadequate at 81.8% and is limited by patient demographics. New therapies are indicated to improve clinical outcomes in advanced-stage HL.
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Affiliation(s)
| | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mehdi Hamadani
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Timothy S Fenske
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nirav N Shah
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Boyne DJ, Mickle AT, Brenner DR, Friedenreich CM, Cheung WY, Tang KL, Wilson TA, Lorenzetti DL, James MT, Ronksley PE, Rabi DM. Long-term risk of cardiovascular mortality in lymphoma survivors: A systematic review and meta-analysis. Cancer Med 2018; 7:4801-4813. [PMID: 30112841 PMCID: PMC6143935 DOI: 10.1002/cam4.1572] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular disease has been identified as one of the late complications of cancer therapy. The purpose of this study was to quantify the long-term risk of cardiovascular mortality among lymphoma survivors relative to that of the general population. A systematic review and meta-analysis were conducted. Articles were identified in November 2016 by searching EMBASE, MEDLINE, and CINAHL databases. Observational studies were included if they assessed cardiovascular mortality in patients with lymphoma who survived for at least 5 years from time of diagnosis or if they had a median follow-up of 10 years. A pooled standardized mortality ratio (SMR) was estimated using a DerSimonian and Laird random-effects model. The Q and I2 statistics were used to assess heterogeneity. Funnel plots and Begg's and Egger's tests were used to evaluate publication bias. Of the 7450 articles screened, 27 studies were included in the systematic review representing 46 829 Hodgkin and 14 764 non-Hodgkin lymphoma survivors. The pooled number of deaths attributable to cardiovascular disease among Hodgkin and non-Hodgkin disease was estimated to be 7.31 (95% CI: 5.29-10.10; I2 = 95.4%) and 5.35 (95% CI: 2.55-11.24; I2 = 94.0%) times that of the general population, respectively. This association was greater among Hodgkin lymphoma survivors treated before the age of 21 (pooled SMR = 13.43; 95% CI: 9.22-19.57; I2 = 78.9%). There was a high degree of heterogeneity and a high risk of bias due to confounding in this body of literature. Lymphoma survivors have an increased risk of fatal cardiovascular events compared to the general population and should be targeted for cardiovascular screening and prevention campaigns.
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Affiliation(s)
- Devon J. Boyne
- Department of Cancer Epidemiology and Prevention ResearchCancer Control AlbertaAlberta Health ServicesCalgaryABCanada
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Alexis T. Mickle
- Department of Cancer Epidemiology and Prevention ResearchCancer Control AlbertaAlberta Health ServicesCalgaryABCanada
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Darren R. Brenner
- Department of Cancer Epidemiology and Prevention ResearchCancer Control AlbertaAlberta Health ServicesCalgaryABCanada
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
- Department of OncologyCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Christine M. Friedenreich
- Department of Cancer Epidemiology and Prevention ResearchCancer Control AlbertaAlberta Health ServicesCalgaryABCanada
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
- Department of OncologyCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Winson Y. Cheung
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
- Department of OncologyCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Karen L. Tang
- Department of MedicineCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Todd A. Wilson
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Diane L. Lorenzetti
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Matthew T. James
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
- Department of MedicineCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Paul E. Ronksley
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
| | - Doreen M. Rabi
- Department of Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
- Department of MedicineCumming School of MedicineUniversity of CalgaryCalgaryABCanada
- Department of Cardiac SciencesCumming School of MedicineUniversity of CalgaryCalgaryABCanada
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Arts LPJ, Oerlemans S, Tick L, Koster A, Roerdink HTJ, van de Poll-Franse LV. More frequent use of health care services among distressed compared with nondistressed survivors of lymphoma and chronic lymphocytic leukemia: Results from the population-based PROFILES registry. Cancer 2018; 124:3016-3024. [PMID: 29698556 PMCID: PMC6055849 DOI: 10.1002/cncr.31410] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Follow-up care for a growing population of survivors of lymphoma and chronic lymphocytic leukemia (CLL) together with the adverse effects these survivors may experience as a result of their cancer and treatment have led to more pressure being placed on health care services. The objectives of the current study were to: 1) compare the use of medical care services by survivors with that of a normative population; 2) evaluate the use of medical and psychosocial care services among distressed and nondistressed survivors; and 3) identify associated sociodemographic and clinical factors. METHODS Survivors of lymphoma and CLL diagnosed between 1999 and 2012 were selected via the population-based Netherlands Cancer Registry and completed the Hospital Anxiety and Depression Scale questionnaire and questions regarding health care. Outcomes were compared with an age-matched and sex-matched normative population. RESULTS A total of 1444 survivors responded (69%). Survivors of lymphoma and CLL contacted their general practitioner (3.8 vs 2.3; P<.001) and medical specialist (5.7 vs 1.6; P<.001) more often within the last year compared with a normative population. In addition, psychologically distressed survivors had even more medical contacts and received psychosocial care more often compared with nondistressed survivors. In addition to psychological distress, comorbidity, female sex, and older age were found to be associated with a greater use of medical services, whereas younger age was associated with receiving psychosocial care. CONCLUSIONS Survivors of lymphoma and CLL, especially those who are psychologically distressed, report an increased use of health care services compared with a normative population. Further studies are needed to explore whether the use of widely applicable psychosocial interventions could reduce the frequency of medical contacts. Cancer 2018;124:3016-24. © 2018 Netherlands Comprehensive Cancer Organisation. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
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Affiliation(s)
- Lindy P J Arts
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Simone Oerlemans
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, the Netherlands
| | - Lidwine Tick
- Department of Internal Medicine, Maxima Medical Centre, Eindhoven and Veldhoven, the Netherlands
| | - Ad Koster
- Department of Internal Medicine, VieCuri Medical Centre, Venlo and Venray, the Netherlands
| | - Henk T J Roerdink
- Department of Internal Medicine, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, the Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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Sasse S, Bröckelmann PJ, Goergen H, Plütschow A, Müller H, Kreissl S, Buerkle C, Borchmann S, Fuchs M, Borchmann P, Diehl V, Engert A. Long-Term Follow-Up of Contemporary Treatment in Early-Stage Hodgkin Lymphoma: Updated Analyses of the German Hodgkin Study Group HD7, HD8, HD10, and HD11 Trials. J Clin Oncol 2017; 35:1999-2007. [DOI: 10.1200/jco.2016.70.9410] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose Combined-modality treatment is widely considered the standard of care in early-stage Hodgkin lymphoma (HL), and treatment intensity has been reduced over the last years. Long-term follow-up is important to judge both efficacy and safety of the different therapies used. Patients and Methods We analyzed updated follow-up data on 4,276 patients treated within the German Hodgkin Study Group trials HD7 and HD10 for early-stage favorable HL and HD8 and HD11 for early-stage unfavorable HL between 1993 and 2003. Results In HD7 (N = 627; median follow-up, 120 months), combined-modality treatment was superior to extended-field radiotherapy (RT), with 15-year progression-free survival (PFS) of 73% versus 52% (hazard ratio [HR], 0.5; 95% CI, 0.3 to 0.6; P < .001), without differences in overall survival (OS). In HD10 (N = 1,190; median follow-up, 98 months), noninferiority of two cycles of doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) plus 20 Gy involved-field (IF)–RT to more intensive four cycles of ABVD plus 30 Gy IF-RT was confirmed with 10-year PFS of 87% each (HR, 1.0; 95%, 0.6 to 1.5) and OS of 94% each (HR, 0.9; 95% CI, 0.5 to 1.6), respectively. In both trials, no differences in second neoplasias were observed. In HD8 (N = 1,064; median follow-up, 153 months), noninferiority of involved-field RT to extended-field RT regarding PFS was confirmed (HR, 1.0; 95% CI, 0.8 to 1.2). In HD11 (N = 1,395; median follow-up, 106 months), superiority of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone at baseline over ABVD was not observed. After BEACOPPbaseline, 20 Gy IF-RT was noninferior to 30 Gy (10-year PFS, 84% v 84%; HR, 1.0; 95% CI, 0.7 to 1.5). In contrast, PFS was inferior in ABVD-treated patients receiving 20 Gy instead of 30 Gy IF-RT (10-year PFS, 76% v 84%; HR, 1.5; 95% CI, 1.0 to 2.1). No differences in OS or second neoplasias were observed in in both trials. Conclusion Long-term follow-up data of the four randomized trials largely support the current risk-adapted therapeutic strategies in early-stage HL. Nevertheless, continued follow-up is necessary to assess the long-term safety of currently applied therapeutic strategies.
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Affiliation(s)
- Stephanie Sasse
- All authors: German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Paul J. Bröckelmann
- All authors: German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Helen Goergen
- All authors: German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Annette Plütschow
- All authors: German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Horst Müller
- All authors: German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Stefanie Kreissl
- All authors: German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Carolin Buerkle
- All authors: German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Sven Borchmann
- All authors: German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Michael Fuchs
- All authors: German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Peter Borchmann
- All authors: German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Volker Diehl
- All authors: German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Andreas Engert
- All authors: German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
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Pulte D, Jansen L, Castro FA, Brenner H. Changes in the survival of older patients with hematologic malignancies in the early 21st century. Cancer 2016; 122:2031-40. [DOI: 10.1002/cncr.30003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/16/2016] [Accepted: 03/01/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Dianne Pulte
- Division of Clinical Epidemiology and Aging Research; German Cancer Research Center; Heidelberg Germany
- Division of Hematology; Department of Medicine; Thomas Jefferson University; Philadelphia Pennsylvania
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research; German Cancer Research Center; Heidelberg Germany
| | - Felipe A. Castro
- Division of Clinical Epidemiology and Aging Research; German Cancer Research Center; Heidelberg Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research; German Cancer Research Center; Heidelberg Germany
- Division of Preventive Oncology; German Cancer Research Center and National Center for Tumor Diseases; Heidelberg Germany
- German Cancer Consortium; German Cancer Research Center; Heidelberg Germany
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Maddi RN, Linga VG, Iyer KK, Chowdary JS, Gundeti S, Digumarti R, Paul TR. Clinical profile and outcome of adult Hodgkin lymphoma: Experience from a tertiary care institution. Indian J Med Paediatr Oncol 2016; 36:255-60. [PMID: 26811596 PMCID: PMC4711225 DOI: 10.4103/0971-5851.171550] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
UNLABELLED Treatment and outcome of Hodgkin lymphoma (HL) are the true success story of modern medicine. The data from the developing countries on long-term outcome of patients with HL is sparse. AIMS Primary objective is to assess the progression-free survival (PFS). Secondary objective are overall survival (OS) and toxicities. SETTINGS AND DESIGN This is a retrospective analysis from the case records from a single institution. MATERIALS AND METHODS Institutional Ethical Committee approval was obtained. Between January 1991 and December 2010, 301 patients (age ≥18 years) underwent treatment at our institution. STATISTICAL ANALYSIS Kaplan-Meyer curves were used to calculate the PFS and OS. RESULTS The median age at presentation was 36 years, range from 19 to 75 years. The male to female ratio was 2.9:1. Seventy-five percent of patients had B symptoms. Majority presented in advanced stage (Stage III and IV) disease (64.7%). Mixed cellularity (74.4%) was the most common histology, followed by nodular sclerosis (13.9%). The most common chemotherapy regimen used was ABVD (61%). CONCLUSIONS Median follow-up of the cohort was 18.5 months (range 2-225). PFS and OS rate at 5 years is 66.3% and 79.7% respectively.
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Affiliation(s)
- Rahul Narayan Maddi
- Department of Medical Oncology, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana, India
| | - Vijay Gandhi Linga
- Department of Medical Oncology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Joseph Stalin Chowdary
- Department of Medical Oncology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sadashivudu Gundeti
- Department of Medical Oncology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Raghunadharao Digumarti
- Director and Department of Medical Oncology, Tata Memorial Center, Vishakapatnam, Andhra Pradesh, India
| | - Tara Roshini Paul
- Department of Pathology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
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Ocias LF, Larsen TS, Vestergaard H, Friis LS, Abildgaard N, Frederiksen H. Trends in hematological cancer in the elderly in Denmark, 1980-2012. Acta Oncol 2016; 55 Suppl 1:98-107. [PMID: 26783877 DOI: 10.3109/0284186x.2015.1115124] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The number of hematological malignancies is expected to increase as the Danish population ages within the next few decades. Despite this, data on the course of hematological cancers among the oldest patients are sparse with many intervention studies focusing on younger age groups. The aim of this study is to present Danish incidence and mortality rates among older patients with non-Hodgkin lymphomas (NHL), multiple myeloma (MM), chronic lymphocytic leukemia (CLL), and acute myeloid leukemia (AML). MATERIAL AND METHODS Nationwide population-based study presenting the incidence, prevalence and mortality rates of NHL, MM, and AML with a focus on the elderly population in Denmark during the last few decades. Data were drawn from the NORDCAN database. RESULTS Incidence rates of NHL, MM, CLL and AML were 10-50 times higher among the population aged 70 years or more than among the younger population. An increasing incidence with stable or decreased mortality rates was seen mainly among elderly patients with NHL during the last few decades, leading to increased survival and a greater prevalence of patients with NHL. Increased relative survival and prevalence could also be seen among elderly patients with MM and CLL, while the trends of the incidence rates were inconclusive for these diseases. Survival among patients with AML improved most notably in those aged below 70 years leading to an increased prevalence of AML patients predominantly in this age group. CONCLUSION Improvements in diagnostics and treatment have led to increased survival and therefore prevalence of elderly patients with NHL, MM, CLL and AML during the past decades.
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Affiliation(s)
- Lukas F Ocias
- a Department of Hematology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Thomas S Larsen
- a Department of Hematology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Hanne Vestergaard
- a Department of Hematology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Lone S Friis
- a Department of Hematology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Niels Abildgaard
- a Department of Hematology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Henrik Frederiksen
- a Department of Hematology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
- b Department of Clinical Epidemiology , Aarhus University Hospital , Aarhus , Denmark
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Glimelius I, Ekberg S, Jerkeman M, Chang ET, Björkholm M, Andersson TM, Smedby KE, Eloranta S. Long-term survival in young and middle-aged Hodgkin lymphoma patients in Sweden 1992-2009-trends in cure proportions by clinical characteristics. Am J Hematol 2015; 90:1128-34. [PMID: 26349012 DOI: 10.1002/ajh.24184] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/04/2015] [Indexed: 12/16/2022]
Abstract
Trends in Hodgkin lymphoma (HL) survival among patients treated outside of clinical trials provide real-world benchmark estimates of prognosis and help identify patient subgroups for targeted trials. In a Swedish population-based cohort of 1947 HL patients diagnosed in 1992-2009 at ages 18-59 years, we estimated relative survival (RS), cure proportions (CP), and median survival times using flexible parametric cure models. Overall, the CP was 89% (95% CI: 0.87-0.91) and median survival of the uncured was 4.6 years (95% CI: 3.0-6.3). For patients aged 18-50 years diagnosed after the year 2000, CP was high and stable, whereas for patients of 50-59 years, cure was not reached. The survival of relapse-free patients was similar to that of the general population (RS5-year : 0.99; 95% CI: 0.98-0.99, RS15-year : 0.95; 95% CI: 0.92-0.97). The excess mortality of relapsing patients was 19 times (95% CI: 12-31) that of relapse-free patients. Despite modern treatments, patients with adverse prognostic factors (e.g., advanced stage) still had markedly worse outcomes [CP stage: IIIB 0.82 (95% CI: 0.73-0.89); CP stage: IVB 0.72, (95% CI: 0.60-0.81)] and patients with international prognostic score (IPS) ≥3 had 2.7 times higher excess mortality (95% CI: 1.0-7.0, p = 0.04) than patients with IPS <3. High-risk patients selected for 6-8 courses of BEACOPP (bleomycin, etoposide, doxorubicin, cyclofosphamide, vincristine, procarbazine, prednisone)-chemotherapy had a 15-year relative survival of 87%, (95% CI: 0.80-0.92), whereas the corresponding estimate for patients selected for 6-8 courses of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) was 93% (95% CI: 0.88-0.97). These population-based results indicate limited fatal side-effects in the 15-year perspective with contemporary treatments, while the unmet need of effective relapse treatment remains of concern. BEACOPP-chemotherapy was still not sufficient in high-risk HL patients.
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Affiliation(s)
- Ingrid Glimelius
- Department of Medicine; Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital; Stockholm Sweden
- Department of Immunology, Genetics and Pathology Clinical and Experimental Oncology; Uppsala University and Uppsala Akademiska Hospital; Sweden
| | - Sara Ekberg
- Department of Medicine; Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital; Stockholm Sweden
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Mats Jerkeman
- Department of Oncology; Skåne University Hospital; Lund Sweden
| | - Ellen T. Chang
- California and Department of Health Research and Policy; Health Sciences Practice, Exponent, Inc., Menlo Park, Stanford University School of Medicine; Stanford California
| | - Magnus Björkholm
- Department of Medicine Division of Hematology; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - Therese M.L. Andersson
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Karin E. Smedby
- Department of Medicine; Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital; Stockholm Sweden
| | - Sandra Eloranta
- Department of Medicine; Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital; Stockholm Sweden
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Glaser SL, Clarke CA, Keegan THM, Chang ET, Weisenburger DD. Time Trends in Rates of Hodgkin Lymphoma Histologic Subtypes: True Incidence Changes or Evolving Diagnostic Practice? Cancer Epidemiol Biomarkers Prev 2015; 24:1474-88. [PMID: 26215294 PMCID: PMC4592457 DOI: 10.1158/1055-9965.epi-15-0281] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/20/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Histologic subtypes of classical Hodgkin lymphoma [cHL; e.g., nodular sclerosis, mixed cellularity, not otherwise specified (NOS)] are epidemiologically and prognostically distinctive. Therefore, unexplained, ongoing incidence rate declines for mixed cellularity and increases for NOS require examination. METHODS We analyzed detailed histology-specific Hodgkin lymphoma incidence rates in 1992 through 2011 U.S. SEER data (n = 21,372) and reviewed a regional subset of 2007 through 2011 NOS pathology reports for insight into diagnostic practices. RESULTS cHL rates were stable until 2007, then decreased for whites [annual percent change (APC) and 95% confidence interval (CI), -3.6% (-5.6% to -1.5%)]. Nodular sclerosis rates declined after 2007 by 5.9% annually, with variation by gender, age, and race/ethnicity. In 1992 through 2011, mixed cellularity rates declined [APC -4.0% (-4.7% to -3.3%)], whereas NOS rates rose [5.3% (4.5%-6.2%)] overall and in most patient groups. The 2007-2011 NOS age-specific rates were more similar to mixed cellularity rates for 1992-1996 than 2007-2011. Trends in combined rates were minimal, supporting increasing misclassification of mixed cellularity, lymphocyte depletion, and specific nodular sclerosis subtypes as NOS. Eighty-eight of 165 reviewed NOS pathology reports addressed classification choice. Twenty (12.1%) justified the classification, 21 (12.7%) described insufficient biopsy material, and coders missed specific subtype information for 27 (16.4%). CONCLUSION Recent nodular sclerosis rate declines largely represent true incidence changes. Long-term rate decreases for mixed cellularity and other less common subtypes, and increases for NOS (comprising ∼30% of cHL cases in 2011), likely reflect changes in diagnostic and/or classification practice. IMPACT Diminishing histologic subtyping undermines future surveillance and epidemiologic study of Hodgkin lymphoma. Guideline-based use of excisional biopsies and more coding quality control are warranted.
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Affiliation(s)
- Sally L Glaser
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California.
| | - Christina A Clarke
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California
| | - Theresa H M Keegan
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California
| | - Ellen T Chang
- Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California. Health Sciences Practice, Exponent, Inc., Menlo Park, California
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Chihara D, Ito H, Izutsu K, Hattori M, Nishino Y, Ioka A, Matsuda T, Ito Y. Advance and stagnation in the treatment of patients with lymphoma and myeloma: Analysis using population-based cancer registry data in Japan from 1993 to 2006. Int J Cancer 2015; 137:1217-23. [PMID: 25694231 DOI: 10.1002/ijc.29477] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/02/2015] [Indexed: 12/13/2022]
Abstract
There have been significant advances in the treatment of patients with lymphoma and myeloma. Although the improvements in survival outcome have been clearly addressed by clinical trials, these studies includes patients who are otherwise healthy and would be eligible for trials that the actual improvement in survival in the general patient population over time is yet to be elucidated. Therefore, we reviewed the cancer-registry data of patients with lymphoma and myeloma in Japan from 1993 to 2006 and estimated relative survival (adjusted for competing causes of death in same-age members of the general population) according to three periods of diagnosis (1993-1997, 1998-2002 and 2003-2006). We also estimated conditional 5-year relative survival (5-year survival rate of patients who have survived 5 years). A total of 26,141 patients were reviewed and analyzed. Relative survival improved in Hodgkin lymphoma (HL, N = 853, +20% improvement), diffuse large B-cell lymphoma (DLBCL, N = 4,919, +14% improvement) and follicular lymphoma (FL, N = 1,333, +13% improvement). In contrast, we found no significant improvement in survival since 1993 in peripheral T-cell lymphoma (PTCL, N = 667, +4% improvement), adult T-cell leukemia/lymphoma (ATLL, N = 2,166, -5% improvement) or multiple myeloma (MM, N = 4,914, -2% improvement). Conditional 5-year survival of HL, DLBCL, FL, PTCL, ATLL and MM was 88, 87, 79, 63, 53 and 45%, respectively. Relative survival of patients with HL, DLBCL and FL significantly improved from 1993 to 2006 in Japan; in contrast, no improvement was seen in other diseases, suggesting unmet need of novel treatment strategies.
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Affiliation(s)
- Dai Chihara
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan.,Department of Lymphoma and Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Hidemi Ito
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Koji Izutsu
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Masakazu Hattori
- Department of Cancer Therapy Center, Fukui Prefectural Hospital, Fukui, Japan
| | - Yoshikazu Nishino
- Division of Cancer Epidemiology and Prevention, Miyagi Cancer Center Research Institute, Natori, Japan
| | - Akiko Ioka
- Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Tomohiro Matsuda
- Division of Surveillance, Center for Cancer Control and Information Services, National Cancer Center, Osaka, Japan
| | - Yuri Ito
- Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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Pulte D, Redaniel MT, Lowry L, Bird J, Jeffreys M. Age disparities in survival from lymphoma and myeloma: a comparison between US and England. Br J Haematol 2014; 165:824-31. [DOI: 10.1111/bjh.12837] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 01/10/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Dianne Pulte
- Cardeza Foundation for Hematologic Research; Thomas Jefferson University; Philadelphia PA USA
| | - Maria T. Redaniel
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - Lisa Lowry
- Bristol Haematology and Oncology Centre; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - Jenny Bird
- Bristol Haematology and Oncology Centre; University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - Mona Jeffreys
- School of Social and Community Medicine; University of Bristol; Bristol UK
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