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Ghesquières H, Krzisch D, Nicolas-Virelizier E, Kanoun S, Gac AC, Guidez S, Touati M, Laribi K, Morschhauser F, Bonnet C, Waultier-Rascalou A, Orsini-Piocelle F, André M, Fournier M, Morand F, Berriolo-Riedinger A, Burroni B, Damotte D, Traverse-Glehen A, Quittet P, Casasnovas O. The phase 2 LYSA study of prednisone, vinblastine, doxorubicin, and bendamustine for untreated Hodgkin lymphoma in older patients. Blood 2024; 143:983-995. [PMID: 37979133 DOI: 10.1182/blood.2023021564] [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: 06/20/2023] [Revised: 10/10/2023] [Accepted: 10/29/2023] [Indexed: 11/19/2023] Open
Abstract
ABSTRACT Older patients with classical Hodgkin lymphoma (cHL) require more effective and less toxic therapies than younger patients. In this multicenter, prospective, phase 2 study, we investigated a new firstline therapy regimen comprising 6 cycles of prednisone (40 mg/m2, days 1-5), vinblastine (6 mg/m2, day 1), doxorubicin (40 mg/m2, day 1), and bendamustine (120 mg/m2, day 1) (PVAB regimen) every 21 days for patients with newly diagnosed cHL aged ≥61 years with an advanced Ann Arbor stage. A Mini Nutritional Assessment score ≥17 was the cutoff value for patients aged ≥70 years. The primary end point was the complete metabolic response (CMR) rate after 6 cycles. The median age of the 89 included patients was 68 years (range, 61-88 years), with 35 patients (39%) aged ≥70 years. Seventy-eight patients (88%) completed the 6 cycles. The toxicity rate was acceptable, with a 20% rate of related serious adverse events. CMR was achieved by 69 patients (77.5%; 95% confidence interval [CI], 67-86). After a median follow-up of 42 months, 31 patients progressed or relapsed (35%), and 24 died (27%) from HL (n = 11), toxicity during treatment (n = 4), secondary cancers (n = 6), or other causes (n = 3). The 4-year progression-free survival (PFS) and overall survival rates were 50% and 69%, respectively. Multivariate analysis showed that liver involvement (P = .001), lymphopenia (P = .001), CRP (P = .0005), and comedications (P = .003) were independently associated with PFS. The PVAB regimen yielded a high CMR rate with acceptable toxicity. Over long-term follow-up, survival end points were influenced by unrelated lymphoma events. This trial was registered at www.clinicaltrials.gov as #NCT02414568 and at EudraCT as 2014-001002-17.
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Affiliation(s)
- Hervé Ghesquières
- Department of Hematology, Hopital Lyon Sud, Claude Bernard Lyon 1 University, Pierre Benite, France
| | - Daphné Krzisch
- Department of Hematology, Assistance Publique Hopitaux de Paris, Hopital Saint Louis, Paris, France
| | | | - Salim Kanoun
- Department of Hematology, Cancer Research Center of Toulouse, Team 9, INSERM Unité Mixte de Recherche 1037, Toulouse, France
| | - Anne Claire Gac
- Department of Hematology, Institut d'Hematologie de Basse Normandie, Caen, France
| | - Stéphanie Guidez
- Hematology Department, Centre Hospitalier Universitaire, Poitiers, France
| | - Mohamed Touati
- Department of Hematology, Hôpital Dupuytren, Centre Hospitalier Universitaire, Limoges, France
| | - Kamel Laribi
- Hematology Department, Centre Hospitalier, Le Mans, France
| | - Franck Morschhauser
- Department of Hematology, Centre Hospitalier Universitaire Lille, Universite de Lille, ULR 7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | | | | | | | - Marc André
- Department of Hematology, Centre Hospitalier Universitaire, Université Catholique de Louvain Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Marguerite Fournier
- Department of Statistics, Lymphoma Study Association Clinical Research, Hopital Lyon Sud, Pierre Benite, France
| | - Fabienne Morand
- Department of Statistics, Lymphoma Study Association Clinical Research, Hopital Lyon Sud, Pierre Benite, France
| | | | - Barbara Burroni
- Department of Pathology, Université de Paris Cité, Centre de Recherche des Cordeliers UMRS U1138 et GH Paris Centre APHP, Paris, France
| | - Diane Damotte
- Department of Pathology, Université de Paris Cité, Centre de Recherche des Cordeliers UMRS U1138 et GH Paris Centre APHP, Paris, France
| | | | - Philippe Quittet
- Department of Hematology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Olivier Casasnovas
- Department of Hematology, University Hospital F. Mitterrand and INSERM Unité Mixte de Recherche 1231, Dijon, France
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2
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Goveia L, Castro N, de Souza C, Colaço Villarim C, Traina F, Chiattone CS, Praxedes M, Solza C, Perobelli L, Baiocchi O, Gaiolla R, Boquimpani C, Buccheri V, Bonamin Sola C, de Oliveira Paula E Silva R, Ribas AC, Steffenello G, Pagnano K, Soares A, Souza Medina S, Silveira T, Zattar Cecyn K, Carvalho Palma L, de Oliveira Marques M, Spector N, Biasoli I. Treatment patterns and outcomes for Hodgkin Lymphoma patients aged 60 and older: a report from the Brazilian Prospective Hodgkin Lymphoma Registry. Ann Hematol 2023; 102:2815-2822. [PMID: 37474632 DOI: 10.1007/s00277-023-05352-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/30/2023] [Indexed: 07/22/2023]
Abstract
The treatment of older patients with Hodgkin lymphoma (HL) remains a challenge. We sought to identify the treatment patterns and outcomes in older HL patients included in the Brazilian HL registry (NCT02589548). A total of 136 patients with HIV-negative classic HL, aged ≥ 60 years, diagnosed between 2009 and 2018, were analyzed. The median age was 66 years old (60-90), 72% had advanced disease, 62% had a high IPS, and 49% had a nodular sclerosis subtype. Median follow-up was 64 months for alive patients. ABVD was the front-line treatment in 96% of patients. Twenty-one patients (15%) died during front-line treatment. The 5-year PFS and 5-year OS rates were 55% and 59%, respectively. The 5-year OS rates in localized and advanced disease were 81% and 51% (p=0.013). Lung toxicity developed in 11% of the patients treated with ABVD. Bleomycin was administered for > 2 cycles in 65% of patients. Compared with 2009-2014, there was a decrease in the use of bleomycin for > 2 cycles in 2015-2018 (88% × 45%, p<0.0001). The impact of socioeconomic status (SES) on outcomes was studied in patients treated with ABVD. After adjusting for potential confounders, lower SES remained independently associated with poorer survival (HR 2.22 [1.14-4.31] for OS and HR 2.84 [1.48-5.45] for PFS). Treatment outcomes were inferior to those observed in developed countries. These inferior outcomes were due to an excess of deaths during front-line treatment and the excessive use of bleomycin. SES was an independent factor for shorter survival.
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Affiliation(s)
- Lilian Goveia
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rua Prof Paulo Rocco 255 - Cidade Universitária, Rio de Janeiro, 21914-913, Brazil
| | - Nelson Castro
- Hospital de Câncer de Barretos, Barretos, São Paulo, Brazil
| | - Carmino de Souza
- Hematology and Hemotherapy Center, University of Campinas, Sao Paulo, Brazil
| | | | - Fabiola Traina
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Sao Paulo, Brazil
| | | | - Monica Praxedes
- Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Cristiana Solza
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Rafael Gaiolla
- Hospital das Clínicas, Faculdade de Medicina de Botucatu, UNESP, Sao Jose, Brazil
| | | | - Valeria Buccheri
- Instituto do Câncer do Estado de São Paulo/Hospital das Clinicas - Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Katia Pagnano
- Hematology and Hemotherapy Center, University of Campinas, Sao Paulo, Brazil
| | - Andrea Soares
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Samuel Souza Medina
- Hematology and Hemotherapy Center, University of Campinas, Sao Paulo, Brazil
| | | | | | | | | | - Nelson Spector
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rua Prof Paulo Rocco 255 - Cidade Universitária, Rio de Janeiro, 21914-913, Brazil
| | - Irene Biasoli
- School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rua Prof Paulo Rocco 255 - Cidade Universitária, Rio de Janeiro, 21914-913, Brazil.
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Wilson MR, Haynes E, Parsons K, Hopkins D, Robertson E, Ferguson G, Quinn D, Murray J, Osborne W, Leach M, McKay P. 'ACOPP' chemotherapy for older and less fit patients with Hodgkin lymphoma-A multicentre, retrospective study. Br J Haematol 2023; 202:796-800. [PMID: 37357380 DOI: 10.1111/bjh.18947] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
Management of classical Hodgkin lymphoma in older patients is challenging due to poor tolerance of the chemotherapy regimens used in younger patients. We modified the BEACOPP regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisolone), whereby bleomycin and etoposide were removed and cyclophosphamide dose was reduced, for older patients with co-morbidities. Here we present data from the first 41 patients treated with 'ACOPP' across 3 centres, demonstrating that it can be delivered, with a favourable toxicity profile (TRM 2%) and promising efficacy (2-year PFS and OS, 73% (95% CI: 52-94) and 93% (95% CI: 80-100) respectively).
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Affiliation(s)
- Matthew R Wilson
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Euan Haynes
- Department of Haematology, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Katrina Parsons
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - David Hopkins
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Graeme Ferguson
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Daire Quinn
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Jim Murray
- Department of Haematology, Royal United Hospital Bath NHS Trust, Bath, UK
| | - Wendy Osborne
- Department of Haematology, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Mike Leach
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Pam McKay
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
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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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5
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Rodday AM, Hahn T, Kumar AJ, Lindenauer PK, Friedberg JW, Evens AM, Parsons SK. Association of Treatment Intensity With Survival in Older Patients With Hodgkin Lymphoma. JAMA Netw Open 2021; 4:e2128373. [PMID: 34673965 PMCID: PMC8531990 DOI: 10.1001/jamanetworkopen.2021.28373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Hodgkin lymphoma is an aggressive blood cancer that is highly curable in younger patients who receive multiagent chemotherapy. Worse survival in older patients may reflect less-aggressive treatment, competing risks of death, or different disease biological factors. OBJECTIVE To examine the association between treatment intensity and cause-specific mortality among older adults with Hodgkin lymphoma. DESIGN, SETTING, AND PARTICIPANTS This was a population-based cohort study of patients aged 65 years or older with Medicare Part A and B fee-for-service coverage who received a diagnosis of Hodgkin lymphoma from 2000 to 2013. The association between treatment intensity and cause-specific mortality was estimated separately for early-stage and advanced-stage disease with Cox proportional hazards models. Multivariable adjustment and propensity score weighting helped control for confounding. Data are from the 1999 to 2016 Surveillance, Epidemiology, and End Results Medicare database. Data analysis was performed from April 2020 to June 2021. EXPOSURES First-line treatment categorized as (1) full chemotherapy regimen, (2) partial chemotherapy regimen, (3) single chemotherapy agent or radiotherapy, or (4) no treatment. MAIN OUTCOMES AND MEASURES The main outcome was 3-year Hodgkin lymphoma-specific and other-cause mortality. RESULTS Among 2686 patients (mean [SD] age, 75.7 [6.9] years; 1333 men [50%]), 1307 had early-stage disease and 1379 had advanced-stage disease. For Hodgkin lymphoma-specific mortality in patients with early-stage disease, hazard ratios (HRs) were higher for partial regimens (HR, 1.77; 95% CI, 1.22-2.57) or no treatment (HR, 1.91; 95% CI, 1.31-2.79) than for full regimens; there was no difference between single-agent chemotherapy or radiotherapy and full regimens. For other-cause mortality in patients with early-stage disease, HRs were higher for partial regimens (HR, 1.69; 95% CI, 1.18-2.44), single-agent chemotherapy or radiotherapy (HR, 1.62; 95% CI, 1.13-2.33), or no treatment (HR, 2.71; 95% CI, 1.95-3.78) than for full regimens. For Hodgkin lymphoma-specific mortality in patients with advanced-stage disease, HRs were higher for partial regimens (HR, 3.26; 95% CI, 2.44-4.35), single-agent chemotherapy or radiotherapy (HR, 2.85; 95% CI, 1.98-4.11), or no treatment (HR, 4.06; 95% CI, 3.06-5.37) than for full regimens. For other-cause mortality in patients with advanced-stage disease, HRs were higher for partial regimens (HR, 1.76; 95% CI, 1.32-2.33), single-agent chemotherapy or radiotherapy (HR, 1.65; 95% CI, 1.15-2.37), or no treatment (HR, 2.24; 95% CI, 1.71-2.94) than for full regimens. CONCLUSIONS AND RELEVANCE This cohort study found variability in the magnitude of the association between treatment intensity and mortality by stage and cause-specific mortality, possibly reflecting competing risks of death. However, full chemotherapy regimens were associated with lower mortality and could be considered for older adults who can tolerate them.
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Affiliation(s)
- Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Theresa Hahn
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Anita J. Kumar
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Peter K. Lindenauer
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School Baystate, Springfield
| | | | | | - Susan K. Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
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6
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Multicenter analysis of geriatric fitness and real-world outcomes in older patients with classical Hodgkin lymphoma. Blood Adv 2021; 5:3623-3632. [PMID: 34448831 DOI: 10.1182/bloodadvances.2021004645] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/29/2021] [Indexed: 11/20/2022] Open
Abstract
We performed a multicenter retrospective analysis across 10 US academic medical centers to evaluate treatment patterns and outcomes in patients age ≥60 years with classic Hodgkin lymphoma (cHL) from 2010-2018. Among 244 eligible patients, median age was 68, 63% had advanced stage (III/IV), 96% had Eastern Cooperative Oncology Group performance status (PS) 0-2, and 12% had documented loss of ≥1 activity of daily living (ADL). Medical comorbidities were assessed by the Cumulative Illness Rating Scale-Geriatric (CIRS-G), where n = 44 (18%) had total scores ≥10. Using multivariable Cox models, only ADL loss predicted shorter progression-free (PFS; hazard ratio [HR] 2.13, P = .007) and overall survival (OS; HR 2.52, P = .02). Most patients (n = 203, 83%) received conventional chemotherapy regimens, including doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD; 56%), AVD (14%), and AVD with brentuximab vedotin (BV; 9%). Compared to alternative therapies, conventional regimens significantly improved PFS (HR 0.46, P = .0007) and OS (HR 0.31, P = .0003). Survival was similar following conventional chemotherapy in those ages 60-69 vs ≥70: PFS HR 0.88, P = .63; OS HR 0.73, P = .55. Early treatment discontinuation due to toxicity was more common with CIRS-G ≥10 (28% vs 12%, P = .016) or documented geriatric syndrome (28% vs 13%, P = .02). A competing risk analysis demonstrated improved disease-related survival with conventional therapy (HR 0.29, P = .02) and higher mortality from causes other than disease or treatment with high CIRS-G or geriatric syndromes. This study suggests conventional chemotherapy regimens remain a standard of care in fit older patients with cHL, and highlights the importance of geriatric assessments in defining fitness for cHL therapy going forward.
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7
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Cochrane T, Campbell BA, Gangatharan SA, Latimer M, Khor R, Christie DRH, Gilbertson M, Ratnasingam S, Palfreyman E, Lee HP, Trotman J, Hertzberg M, Dickinson M. Assessment and management of newly diagnosed classical Hodgkin lymphoma: a consensus practice statement from the Australasian Lymphoma Alliance. Intern Med J 2021; 51:2119-2128. [PMID: 34505342 DOI: 10.1111/imj.15503] [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: 05/07/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022]
Abstract
The management of Hodgkin lymphoma (HL) has undergone significant changes in recent years. Due to the predilection of HL to affect younger patients, balancing cure and treatment-related morbidity is a constant source of concern for physicians and patients alike. Positron emission tomography adapted therapy has been developed for both early and advanced stage HL to try and improve the outcome of treatment, while minimising toxicities. The aim of this review is to digest the plethora of studies recently conducted and provide some clear, evidence-based practice statements to simplify the management of HL.
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Affiliation(s)
- Tara Cochrane
- Department of Haematology, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Medicine, Griffiths University, Gold Coast, Queensland, Australia
| | - Belinda A Campbell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Shane A Gangatharan
- Fiona Stanley Hospital, Perth, Western Australia, Australia.,University of Western Australia, Perth, Western Australia, Australia
| | - Maya Latimer
- ACT Pathology and Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | | | - David R H Christie
- Genesiscare, Gold Coast, Queensland, Australia.,Bond University, Gold Coast, Queensland, Australia
| | - Michael Gilbertson
- Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Haematology and Oncology, Western Health, Melbourne, Victoria, Australia
| | - Sumita Ratnasingam
- Andrew Love Cancer Centre, University Hospital Geelong, Geelong, Victoria, Australia
| | - Emma Palfreyman
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Hui-Peng Lee
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Judith Trotman
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Mark Hertzberg
- Department of Haematology, Prince of Wales Hospital, Sydney, New South Wales, Australia.,University of NSW, Sydney, New South Wales, Australia
| | - Michael Dickinson
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
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8
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Plasticity of Mature B Cells Between Follicular and Classic Hodgkin Lymphomas: A Series of 22 Cases Expanding the Spectrum of Transdifferentiation. Am J Surg Pathol 2021; 46:58-70. [PMID: 34265801 DOI: 10.1097/pas.0000000000001780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Follicular lymphoma and classic Hodgkin lymphoma can be associated in composite and/or sequential lymphomas. Common IGH and BCL2 rearrangements have already been identified between both contingents of these entities, but mutation profiles have not yet been investigated. The main objective of this study was to analyze the transdifferentiation process that may occur between Hodgkin and follicular contingents in sequential and composite lymphomas to better characterize these entities. From 2004 to 2020, a retrospective multicentric study was performed, including 9 composite and 13 sequential lymphomas. Clinical data were retrospectively collected. Fluorescent in situ hybridization of BCL2 and BCL6 rearrangements, polymerase chain reaction of IGH and IGK rearrangements, next-generation sequencing of IGK rearrangement, and targeted next-generation sequencing (TNGS) on a panel of genes frequently mutated in lymphomas were performed on each contingent of composite and sequential lymphomas. For TNGS, each contingent was isolated by laser capture microdissection. Clinical presentation and evolution were more aggressive in sequential than composite lymphomas. By fluorescent in situ hybridization, common rearrangements of BCL6 and BCL2 were identified between both contingents. Similarly, a common clonal relationship was established by evaluating IGH and IGK rearrangement by polymerase chain reaction or next-generation sequencing. By TNGS, the same pathogenic variants were identified in both contingents in the following genes: CREBBP, KMT2D, BCL2, EP300, SF3B1, SOCS1, ARID1A, and BCOR. Specific pathogenic variants for each contingent were also identified: XPO1 for Hodgkin lymphoma contingent and FOXO1, TNFRSF14 for follicular lymphoma contingent. This study reinforces the hypothesis of a transdifferentiation process between Hodgkin and follicular contingent of sequential/composite lymphomas.
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Garrido D, Granja M, Rojas J. Mortality Trend of Hodgkin Lymphoma in Ecuador from 2000 to 2019. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/9359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Kobayashi H, Seki R, Ujita M, Hirayama K, Yamada S, Ohashi R, Otsuki Y, Watanabe T, Yoshino T. An Autopsy Case of an Elderly Patient with Classic Hodgkin Lymphoma Presenting with a Plethora of Clinical Symptoms and Signs. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926177. [PMID: 33087692 PMCID: PMC7588351 DOI: 10.12659/ajcr.926177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/14/2020] [Accepted: 07/25/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Hodgkin lymphoma (HL) is a potentially curable disease with favorable outcomes. However, elderly patients with HL usually have more adverse prognostic factors and hence a much worse prognosis than younger patients. CASE REPORT The patient was a woman in her 80s. She reported high fever, anorexia, and a weight loss of 8 kg within 5 months. She had been on treatment for diabetes mellitus and hypertension. She had undergone percutaneous coronary intervention and pacemaker implantation to treat acute coronary syndrome and sinus arrhythmia, respectively. Blood tests showed elevation of alkaline phosphatase, C-reactive protein, leukocyte count, CA 19-9, and carcinoembryonic antigen. Computed tomography did not show tumors in the liver, and cholangitis and sepsis were suspected. Aspartate transaminase, alanine aminotransferase, and total bilirubin gradually increased through the course of the patient's hospital stay. Despite treatment, her condition deteriorated and she died 22 days after hospital admission. At autopsy, we found stage IV HL with lymph node swelling on both sides of the diaphragm, as well as diffusely disseminated nodules in the liver and spleen. CONCLUSIONS Our patient had several poor prognostic factors including B symptoms, comorbidity, advanced stage, Epstein-Barr virus infection, and expression of programmed death-ligand 1 and interleukin-6, all of which were closely connected with her advanced age. Her age and comorbidities may have been the most adverse prognostic factors for her illness. An effective HL screening method for elderly individuals should be developed to ameliorate poor prognosis and adverse outcomes.
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Affiliation(s)
- Hiroshi Kobayashi
- Department of Pathology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Ryouya Seki
- Department of of Gastroenterology, Tachikawa General Hopspital, Nagaoka, Niigata, Japan
| | - Masuo Ujita
- Department of Radiology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Kana Hirayama
- Department of Dermatology, Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan
| | - Satoshi Yamada
- Health Examination Center, Nagaoka Central General Hospital, Nagaoka, Niigata, Japan
| | - Riuko Ohashi
- Histopathology Core Facility, Niigata University School of Medicine, Niigata City, Niigata, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Takuya Watanabe
- Department of General Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University, Okayama City, Okayama, Japan
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Allen PB, Ayers A, Behera M, Evens AM, Flowers C. A systematic review of therapeutic regimens for older patients with newly diagnosed Hodgkin lymphoma. Leuk Lymphoma 2020; 61:1555-1564. [PMID: 32102579 DOI: 10.1080/10428194.2020.1731497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Classical Hodgkin lymphoma (cHL) in older adults is associated with inferior outcomes and increased toxicity compared to younger patients. Novel therapies like brentuximab vedotin (BV) have yielded promising results, yet their optimal use in older cHL remains unclear. We performed a systematic review to assess outcomes and toxicity associated with frontline regimens in older cHL. We screened 196 references involving chemotherapy without BV and 662 references containing BV and included 9 studies (12 arms) without BV and 6 studies (7 arms) with BV. Progression-free survival (PFS) ranged from 47 to 84% at 2 years in BV-containing arms and 42-79% at 5 years in non-BV containing trials. Pulmonary toxicity was more common in arms receiving >2 cycles of bleomycin, whereas peripheral neuropathy was associated with cumulative BV dose. This review summarizes available treatment outcomes in newly diagnosed older cHL patients and may aid clinicians in decision-making regarding available frontline approaches.Key PointsThis systematic review suggests that >2 cycles of bleomycin is associated with excess pulmonary toxicity in cHL patients older than 60 years of age.Peripheral neuropathy was more frequent in patients receiving BV-containing regimens and was associated with cumulative BV dose.BV-containing regimens are associated with high response rates in advanced-stage patients, but follow-up is limited.
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Affiliation(s)
- Pamela B Allen
- Department of Hematology and Oncology, Winship Cancer Institution of Emory University, Atlanta, GA, USA
| | - Amy Ayers
- Department of Hematology and Oncology, Winship Cancer Institution of Emory University, Atlanta, GA, USA
| | - Madhusmita Behera
- Department of Research Informatics, Winship Cancer Institution of Emory University, Atlanta, GA, USA
| | - Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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12
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Bastos-Oreiro M, Muntañola A, Panizo C, Gonzalez-Barca E, de Villambrosia SG, Córdoba R, López JLB, González-Sierra P, Terol MJ, Gutierrez A, Grande C, Ramirez MJ, Iserte L, Perez E, Navarro B, Gomez P, Salar A, Luzardo H, López A, Del Campo R, García-Belmonte D, Vida MJ, Infante M, Queizan-Hernandez JA, Novelli S, Moreno M, Penarrubia M, Gómez J, Domingo A, Donato E, Viguria MC, López F, Rodriguez MJ, Pardal E, Noriega V, Andreu R, Peñalver J, Martín A, Caballero D, López-Guillermo A. RELINF: prospective epidemiological registry of lymphoid neoplasms in Spain. A project from the GELTAMO group. Ann Hematol 2020; 99:799-808. [PMID: 32076827 DOI: 10.1007/s00277-020-03918-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/13/2020] [Indexed: 12/17/2022]
Abstract
Lymphomas are a large, heterogeneous group of neoplasms with well-defined characteristics, and this heterogeneity highlights the importance of epidemiological data. Knowledge of local epidemiology is essential to optimise resources, design clinical trials, and identify minority entities. Given there are few published epidemiological data on lymphoma in Spain, the Spanish Lymphoma and Autologous Bone Marrow Transplant Group created the RELINF project. The aim of this project is to determine the frequencies and distribution of lymphoid neoplasms in Spain and to analyse survival. We developed an online platform for the prospective collection of data on newly diagnosed cases of lymphoma in Spain between January 2014 and July 2018; 11,400 patients were registered. Diffuse large B cell lymphoma (DLBCL) and follicular lymphoma (FL) were the most frequent lymphomas in our series. Marginal B cell lymphoma frequency was higher than that reported in other studies, representing more than 11% of mature B cell lymphomas. Peripheral T cell lymphoma not otherwise specified (PTCL-NOS) was the most common subtype of T cell lymphoma, and NK/T cell lymphomas were more frequent than expected (5.4% of total). Hodgkin's lymphoma accounted for 12% of lymphoproliferative syndromes. Overall survival was greater than 90% at 2 years for indolent B cell lymphomas, and approximately 60% for DLBCL, somewhat lower than that previously reported. Survival was poor for PTCL-NOS and angioimmunoblastic T cell lymphoma, as expected; however, it was somewhat better than that in other studies for anaplastic large cell anaplastic lymphoma kinase lymphomas. This is the first prospective registry to report the frequencies, distribution, and survival of lymphomas in Spain. The frequencies and survival data we report here are globally consistent with that reported in other Western countries. These updated frequencies and survival statistics are necessary for developing appropriate management strategies for neoplasias in the Spanish population.
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Affiliation(s)
- Mariana Bastos-Oreiro
- Haematology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain. .,Health Research Institute, Gregorio Marañon, Madrid, Spain.
| | - Ana Muntañola
- Haematology Department, Hospital Universitario Mutua Tarrasa, Tarrasa, Cataluña, Spain
| | - Carlos Panizo
- Haematology Department, Clínica Universitaria de Navarra, Navarra, Spain
| | - Eva Gonzalez-Barca
- Haematology Department, ICO Duran y Reinalds, Bellvitlle, Cataluña, Spain
| | | | - Raúl Córdoba
- Haematology Department, Fundación Jimenez Díaz, Madrid, Madrid, Spain
| | - Jose Luís Bello López
- Haematology Department, University of Santiago Hospital Clinic, Santiago de Compostela, Galicia, Spain
| | | | - María José Terol
- Haematology Department, Valencia Hospital Clinic, Valencia, Spain
| | - Antonio Gutierrez
- Haematology Department, Hospital Son Espases, Palma de Mallorca, Spain
| | - Carlos Grande
- Haematology Department, Hospital 12 de Octubre, Madrid, Spain
| | | | - Laura Iserte
- Haematology Department, Hospital Arnau de Vilanova, Lleida, Cataluña, Spain
| | - Elena Perez
- Haematology department, Hospital Morales Meseguer, Murcia, Murcia, Spain
| | - Belén Navarro
- Haematology Department, University Hospital Puerta de Hierro, Mahadahonda, Madrid, Spain
| | - Pilar Gomez
- Haematology Department, La Paz University Hospital, Madrid, Spain
| | - Antonio Salar
- Haematology Department, Hospital del Mar, Barcelona, Cataluña, Spain
| | - Hugo Luzardo
- Hospital Negrin, Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Andrés López
- Haematology Department, Hospital Vall d' Hebron, Barcelona, Cataluña, Spain
| | - Raquel Del Campo
- Haematology Department, Hospital Son Llátzer, Palma de Mallorca, Spain
| | | | - María Jesús Vida
- Haematology Department, Hospital of León, León, Castilla y León, Spain
| | - María Infante
- Haematology Department, Hospital Infanta Leonor, Madrid, Spain
| | | | - Silvana Novelli
- Haematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Cataluña, Spain
| | - Miriam Moreno
- Haematology Department, Hospital Germans Trials y Pujol, Badalona, Cataluña, Spain
| | - Miriam Penarrubia
- Haematology Department, Hospital Clinic of Valladolid, Castilla y León, Spain
| | - Joaquín Gómez
- Haematology Department, Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Abel Domingo
- Haematology Department, Hospital de Granollers, Barcelona, Cataluña, Spain
| | - Eva Donato
- Haematology Department, Hospital Dr. Peset, Valencia, Spain
| | | | | | - María José Rodriguez
- Haematology Department, Hospital Universitario de Canarias SCT, Tenerife, Canary Islands, Spain
| | - Emilia Pardal
- Haematology Department, Hospital Virgen del Puerto, Cáceres, Extremadura, Spain
| | - Victor Noriega
- Haematology Department, University Hospital A Coruña, A Coruña, Galicia, Spain
| | - Rafael Andreu
- Haematology Department, Hospital La Fe, Valencia, Spain
| | - Javier Peñalver
- Haematology Department, Hospital of Alcorcón, Alcorcón, Madrid, Spain
| | - Alejandro Martín
- Haematology Department, Hospital Clinic of Salamanca, Salamanca, Castilla y León, Spain
| | - Dolores Caballero
- Haematology Department, Hospital Clinic of Salamanca, Salamanca, Castilla y León, Spain
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13
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Zhang J, Fan L, Li JY. [Research progress of treatment in Hodgkin lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 40:969-972. [PMID: 31856452 PMCID: PMC7342374 DOI: 10.3760/cma.j.issn.0253-2727.2019.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J Zhang
- Department of Hematology, the First Affiliated Hospital of NanJing Medical University, JiangSu Province Hospital, Nanjing 210029, China
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14
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Reid JH, Marini BL, Nachar VR, Brown AM, Devata S, Perissinotti AJ. Contemporary treatment options for a classical disease: Advanced Hodgkin lymphoma. Crit Rev Oncol Hematol 2020; 148:102897. [PMID: 32109715 DOI: 10.1016/j.critrevonc.2020.102897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/06/2020] [Accepted: 02/03/2020] [Indexed: 01/12/2023] Open
Abstract
Advanced classical Hodgkin lymphoma (cHL) is a rare lymphoid disease characterized by the presence of Hodgkin and Reed-Sternberg (HRS) cells. Each year, cHL accounts for 0.5% of all new cancer diagnoses and about 80% are diagnosed with advanced stage disease. Given the significant improvement in cure rates, the focus of treatment has shifted towards minimization of acute and long-term toxicities. PET-adapted strategies have largely been adopted as standard of care in the United States in an attempt to balance toxicities with adequate lymphoma control. However, the appropriate upfront chemotherapy regimen (ABVD versus eBEACOPP) remains controversial.
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Affiliation(s)
- Justin H Reid
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, 1540 E. Hospital Drive, CW 7-251B, Ann Arbor, MI 48109, United States
| | - Bernard L Marini
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, 1540 E. Hospital Drive, CW 7-251B, Ann Arbor, MI 48109, United States
| | - Victoria R Nachar
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, 1540 E. Hospital Drive, CW 7-251B, Ann Arbor, MI 48109, United States
| | - Anna M Brown
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, 1540 E. Hospital Drive, CW 7-251B, Ann Arbor, MI 48109, United States
| | - Sumana Devata
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Rogel Cancer Center, 1500 E Medical Center Drive, Ann Arbor, MI 48109, United States
| | - Anthony J Perissinotti
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, 1540 E. Hospital Drive, CW 7-251B, Ann Arbor, MI 48109, United States.
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15
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Cencini E, Fabbri A, Sicuranza A, Santoni A, Bocchia M. Hodgkin lymphoma in the elderly: new perspectives and a 10-year monocenter real-life experience. Hematol Oncol 2019; 37:493-495. [PMID: 31475736 DOI: 10.1002/hon.2675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Emanuele Cencini
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese & University of Siena, Siena, Italy
- University of Siena, Siena, Italy
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese & University of Siena, Siena, Italy
| | | | | | - Monica Bocchia
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese & University of Siena, Siena, Italy
- University of Siena, Siena, Italy
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