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Kusumoto S, Munakata W, Machida R, Terauchi T, Onaya H, Oguchi M, Iida S, Nosaka K, Suzuki Y, Harada Y, Miyazaki K, Maruta M, Fukuhara N, Toubai T, Kubota N, Ohmachi K, Saito T, Rai S, Mizuno I, Fukuhara S, Takeuchi M, Tateishi U, Maruyama D, Tsukasaki K, Nagai H. Interim PET-guided ABVD or ABVD/escalated BEACOPP for newly diagnosed advanced-stage classic Hodgkin lymphoma (JCOG1305). Cancer Sci 2024. [PMID: 39034771 DOI: 10.1111/cas.16281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 06/22/2024] [Accepted: 06/30/2024] [Indexed: 07/23/2024] Open
Abstract
This single-arm confirmatory study (JCOG1305) aimed to evaluate the utility of interim positron emission tomography (iPET)-guided therapy for newly diagnosed advanced-stage classic Hodgkin lymphoma (cHL). Patients aged 16-60 years with cHL received two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and then underwent an iPET scan (PET2), which was centrally reviewed using a five-point Deauville scale. PET2-negative patients continued an additional four cycles of ABVD, whereas PET2-positive patients switched to six cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP). The co-primary endpoints were 2-year progression-free survival (PFS) among all eligible and PET2-positive patients. Ninety-three patients were enrolled between January 2016 and December 2019. One patient was ineligible because of a diagnostic error. The median age of the 92 eligible patients was 35 (interquartile range, 28-48) years. Forty (43%) patients had stage III disease, and 43 (47%) had stage IV disease. The remaining nine (10%) patients had stage IIB disease with risk factors. Nineteen PET2-positive (21%) patients received eBEACOPP, 18 completed six cycles of eBEACOPP, 73 PET2-negative (79%) patients continued ABVD, and 70 completed an additional four cycles of ABVD. With a median follow-up period of 41.1 months, the 2-year PFS of 92 eligible patients and 19 PET2-positive patients were 84.8% (80% confidence interval [CI], 79.2-88.9) and 84.2% (80% CI, 69.7-92.1), respectively. Both primary endpoints were met at the prespecified threshold. This study demonstrates that iPET-guided therapy is a useful treatment option for younger patients with newly diagnosed advanced-stage cHL. Registration number: jRCTs031180218.
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Affiliation(s)
- Shigeru Kusumoto
- Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Wataru Munakata
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Takashi Terauchi
- Japanese Foundation for Cancer Research Department of Nuclear Medicine, Cancer Institute Hospital, Tokyo, Japan
| | - Hiroaki Onaya
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masahiko Oguchi
- Radiation Oncology Department, Cancer Institute Hospital, The Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinsuke Iida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Yasuhiro Suzuki
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yasuhiko Harada
- Department of Hematology, Toyota Kosei Hospital, Toyota, Japan
| | - Kana Miyazaki
- Department of Hematology and Oncology, Mie University School of Medicine, Tsu, Japan
| | - Masaki Maruta
- Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Hospital, Toon, Japan
| | - Noriko Fukuhara
- Department of Hematology, Tohoku University School of Medicine, Sendai, Japan
| | - Tomomi Toubai
- Department of Internal Medicine III, Division of Hematology and Cell Therapy, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Nobuko Kubota
- Division of Hematology, Saitama Cancer Center, Ina, Japan
| | - Ken Ohmachi
- Department of Hematology and Oncology, School of Medicine, Tokai University, Isehara, Japan
| | - Toko Saito
- Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shinya Rai
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ishikazu Mizuno
- Department of Hematology, Hyogo Cancer Center, Akashi, Japan
| | - Suguru Fukuhara
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Mai Takeuchi
- Department of Pathology, Kurume University, Kurume, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Dai Maruyama
- Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kunihiro Tsukasaki
- Department of Hematology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Hirokazu Nagai
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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2
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Kuczmarski TM, Lynch RC. Managing common toxicities associated with checkpoint inhibitor and chemotherapy combinations for untreated classic Hodgkin lymphoma. Br J Haematol 2024; 205:100-108. [PMID: 38698683 DOI: 10.1111/bjh.19478] [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: 02/29/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 05/05/2024]
Abstract
Combination checkpoint inhibitor (CPI) and chemotherapy is an effective and safe treatment strategy for patients with untreated classic Hodgkin lymphoma. Recent studies of programmed cell death protein 1 inhibitors combined with doxorubicin, vinblastine and dacarbazine have demonstrated high overall and complete response rates. This combination has a unique toxicity profile that should be managed appropriately so as not to compromise treatment efficacy. Common toxicities include rash, hepatoxicity, neutropenia and thyroid dysfunction. Here, we present four cases and the management strategies around such toxicities. In addition, we highlight key clinical decision-making around the administration of subsequent doses of CPI and chemotherapy.
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Affiliation(s)
- Thomas M Kuczmarski
- Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington, USA
| | - Ryan C Lynch
- Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington, USA
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3
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Rodday AM, Parsons SK, Upshaw JN, Friedberg JW, Gallamini A, Hawkes E, Hodgson D, Johnson P, Link BK, Mou E, Savage KJ, Zinzani PL, Maurer M, Evens AM. The Advanced-Stage Hodgkin Lymphoma International Prognostic Index: Development and Validation of a Clinical Prediction Model From the HoLISTIC Consortium. J Clin Oncol 2023; 41:2076-2086. [PMID: 36495588 PMCID: PMC10082254 DOI: 10.1200/jco.22.02473] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The International Prognostic Score (IPS) has been used in classic Hodgkin lymphoma (cHL) for 25 years. However, analyses have documented suboptimal performance of the IPS among contemporarily treated patients. Harnessing multisource individual patient data from the Hodgkin Lymphoma International Study for Individual Care consortium, we developed and validated a modern clinical prediction model. METHODS Model development via Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis guidelines was performed on 4,022 patients with newly diagnosed advanced-stage adult cHL from eight international phase III clinical trials, conducted from 1996 to 2014. External validation was performed on 1,431 contemporaneously treated patients from four real-world cHL registries. To consider association over a full range of continuous variables, we evaluated piecewise linear splines for potential nonlinear relationships. Five-year progression-free survival (PFS) and overall survival (OS) were estimated using Cox proportional hazard models. RESULTS The median age in the development cohort was 33 (18-65) years; nodular sclerosis was the most common histology. Kaplan-Meier estimators were 0.77 for 5-year PFS and 0.92 for 5-year OS. Significant predictor variables included age, sex, stage, bulk, absolute lymphocyte count, hemoglobin, and albumin, with slight variation for PFS versus OS. Moreover, age and absolute lymphocyte count yielded nonlinear relationships with outcomes. Optimism-corrected c-statistics in the development model for 5-year PFS and OS were 0.590 and 0.720, respectively. There was good discrimination and calibration in external validation and consistent performance in internal-external validation. Compared with the IPS, there was superior discrimination for OS and enhanced calibration for PFS and OS. CONCLUSION We rigorously developed and externally validated a clinical prediction model in > 5,000 patients with advanced-stage cHL. Furthermore, we identified several novel nonlinear relationships and improved the prediction of patient outcomes. An online calculator was created for individualized point-of-care use.
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Affiliation(s)
- Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Susan K. Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Jenica N. Upshaw
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- The CardioVascular Center and Advanced Heart Failure Program, Tufts Medical Center, Boston, MA
| | - Jonathan W. Friedberg
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | - Andrea Gallamini
- Research and Clinical Innovation Department, Antoine Lacassagne Cancer Center, Nice, France
| | - Eliza Hawkes
- Australasian Lymphoma and Related Diseases Registry, Monash University, Melbourne, Australia
| | - David Hodgson
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Peter Johnson
- Faculty of Medicine, School of Cancer Sciences, University of Southampton, United Kingdom
| | - Brian K. Link
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Eric Mou
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Kerry J. Savage
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seragnoli” Dipartimento di Medicina Specialistica, Diagnostica Sperimentale Università di Bologna, Bologna, Italy
| | - Matthew Maurer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Andrew M. Evens
- Division of Blood Disorders, Rutgers Cancer Institute New Jersey, New Brunswick, NJ
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4
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Mahdi Seyedzadeh Sani S, Sahranavard M, Jannati Yazdanabad M, Seddigh Shamsi M, Elyasi S, Hooshang Mohammadpour A, Sathyapalan T, Arasteh O, Ghavami V, Sahebkar A. The effect of concomitant use of Colony-Stimulating factors on bleomycin pulmonary toxicity - A systematic review and meta-analysis. Int Immunopharmacol 2022; 112:109227. [PMID: 36099787 DOI: 10.1016/j.intimp.2022.109227] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/06/2022] [Accepted: 08/31/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Changes in the incidence of bleomycin pulmonary toxicity (BPT) as a result of adding colony-stimulating factors (CSF) to bleomycin regimens has been investigated in numerous studies. We performed a systematic review and meta-analysis to assess the outcomes of these studies. METHODS A systematic search was performed using Pubmed, Scopus, Web of Science, and Embase on April 2021. Studies evaluating the incidence of BPT in patients receiving bleomycin with and without CSF were included. In addition, meta-analysis was performed by pooling odds ratios using R. RESULTS Out of 340 obtained records, our qualitative and quantitative analysis included 3234 and 1956 patients from 22 and 14 studies, respectively. The quantitative synthesis showed that addition of CSF significantly increased the risk of BPT incidence (OR = 1.82, 95 % CI: 1.37-2.40, p < 0.0001; I2 = 10.7 %). Subgroup analysis did not show any association between continent, bleomycin dose, cancer type, type of study, and pulmonary function test with BPT incidence. CONCLUSION This systematic review and meta-analysis showed that co-administration of CSF with bleomycin increases the incidence of BPT. The physicians need to consider this finding while deciding the best strategy for this cohort of patients.
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Affiliation(s)
| | - Mehrdad Sahranavard
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Science, Mashhad, Iran
| | - Mahdi Jannati Yazdanabad
- Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Science, Mashhad, Iran
| | - Mohsen Seddigh Shamsi
- Department of Hematology Oncology, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Sepideh Elyasi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Science, Mashhad, Iran
| | - Amir Hooshang Mohammadpour
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Science, Mashhad, Iran
| | - Thozhukat Sathyapalan
- Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, UK
| | - Omid Arasteh
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Science, Mashhad, Iran.
| | - Vahid Ghavami
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Science, Mashhad, Iran.
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; School of Medicine, The University of Western Australia, Perth, Australia; School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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5
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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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6
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Straus D, Collins G, Walewski J, Zinzani PL, Grigg A, Sureda A, Illes A, Kim TM, Alekseev S, Specht L, Buccheri V, Younes A, Connors J, Forero-Torres A, Fenton K, Gautam A, Purevjal I, Liu R, Gallamini A. Primary prophylaxis with G-CSF may improve outcomes in patients with newly diagnosed stage III/IV Hodgkin lymphoma treated with brentuximab vedotin plus chemotherapy. Leuk Lymphoma 2020; 61:2931-2938. [PMID: 32842815 DOI: 10.1080/10428194.2020.1791846] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We investigate the impact of granulocyte-colony stimulating factor (G-CSF) primary prophylaxis (G-PP, N = 83) versus no G-PP (N = 579) on safety and efficacy of brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine (A + AVD) in the ECHELON-1 study of previously untreated stage III/IV classical Hodgkin lymphoma. G-PP was associated with lower incidence of ≥ grade 3 neutropenia (29% versus 70%) and febrile neutropenia (11% versus 21%). Fewer dose delays (35% versus 49%), reductions (20% versus 26%), and hospitalizations (29% versus 38%) were observed. Seven neutropenia-associated deaths occurred in the A + AVD arm; none received G-PP. A + AVD with G-PP was associated with decreased risk of a modified progression-free survival event by 26% compared with A + AVD alone (95% CI: 0.40-1.37). G-PP reduced the rate and severity of adverse events, including febrile neutropenia, reduced treatment delays, dose reductions, and discontinuations, and may thus improve efficacy outcomes. These data support G-PP for all patients treated with A + AVD.
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Affiliation(s)
- David Straus
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Graham Collins
- Oxford Cancer and Hematology Center, Churchill Hospital, Oxford, UK
| | - Jan Walewski
- Maria Sklodowska-Curie Memorial Institute and Oncology Center, Warsaw, Poland
| | - Pier Luigi Zinzani
- Institute of Hematology Seragnoli, University of Bologna, Bologna, Italy
| | - Andrew Grigg
- Department of Clinical Haematology, Austin Hospital, Melbourne, Australia
| | - Anna Sureda
- Institut Català d'Oncologia-Hospitalet, Hospital Quirón Dexeus, Barcelona, Spain
| | - Arpad Illes
- University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Tae Min Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Sergey Alekseev
- Petrov Research Institute of Oncology, St. Petersburg, Russia
| | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Valeria Buccheri
- Hematology Service, Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Anas Younes
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | | | | | | | | | | | - Rachael Liu
- Millennium Pharmaceuticals, Cambridge, MA, USA
| | - Andrea Gallamini
- Research and Clinical Innovation, Antoine-Lacassagne Cancer Center, Nice, France
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7
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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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8
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Merdin A, Çakar MK, Dal MS, Mert D, Yıldız J, Başçı S, Bakırtaş M, Darçın T, Şahin D, Ulu BU, Yiğenoğlu TN, Batgi H, Tetik A, İskender D, Altuntaş F. Evaluation of neutropenia-related outcomes in Hodgkin's lymphoma patients with moderate or severe neutropenia who received ABVD chemotherapy without using granulocyte-colony stimulating factor. J Oncol Pharm Pract 2019; 26:929-932. [PMID: 31822199 DOI: 10.1177/1078155219891663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the possible neutropenia-related effects of administering adriamycin [doxorubicin], bleomycin, vinblastin, dacarbazine (ABVD) chemotherapy in Hodgkin's lymphoma patients with moderate or severe neutropenia without granulocyte-colony stimulating factor supplementation. METHODS This study evaluated neutropenia-related outcomes and the need for granulocyte-colony stimulating factor use during the periods between chemotherapy rounds. Forty-three rounds of ABVD chemotherapy were evaluated in the study. The outcomes that could be related to neutropenia were analyzed. In addition, rounds of ABVD chemotherapy given in the presence of severe neutropenia were compared with ABVD chemotherapy rounds given in the presence of moderate neutropenia in terms of neutropenia-related outcomes and the need for granulocyte-colony stimulating factor use. The study only included patients with classical Hodgkin's disease (lymphoma). Patients with a final neutrophil count of <1 × 103 cells/µL (<1000 cells/µL) prior to chemotherapy round and those receiving ABVD chemotherapy for Hodgkin's lymphoma were included in the study. RESULTS We observed that none of the patients with moderate neutropenia before the start of chemotherapy round needed granulocyte-colony stimulating factor, and four patients with severe neutropenia prior to the start of chemotherapy round required granulocyte-colony stimulating factor. However, there was no statistically significant relationship between the severity of neutropenia (in terms of moderate and severe) before chemotherapy and granulocyte-colony stimulating factor requirement after chemotherapy (p> 0.05). Furthermore, none of the patients included in the study had bleomycin-related lung toxicity during the treatment periods included in the study. CONCLUSION Administering ABVD chemotherapy to patients with moderate neutropenia seems to be safe.
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Affiliation(s)
- Alparslan Merdin
- Hematology Clinic and Bone Marrow Transplantation Unit, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Merih Kızıl Çakar
- Hematology Clinic and Bone Marrow Transplantation Unit, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Mehmet Sinan Dal
- Hematology Clinic and Bone Marrow Transplantation Unit, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Duygu Mert
- Infectious Diseases and Microbiology Clinic, University of Health Sciences Ankara, Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Jale Yıldız
- Hematology Clinic and Bone Marrow Transplantation Unit, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Semih Başçı
- Hematology Clinic and Bone Marrow Transplantation Unit, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Mehmet Bakırtaş
- Hematology Clinic and Bone Marrow Transplantation Unit, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Tahir Darçın
- Hematology Clinic and Bone Marrow Transplantation Unit, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Derya Şahin
- Hematology Clinic and Bone Marrow Transplantation Unit, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Bahar Uncu Ulu
- Hematology Clinic and Bone Marrow Transplantation Unit, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Tuğçe Nur Yiğenoğlu
- Hematology Clinic and Bone Marrow Transplantation Unit, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Hikmetullah Batgi
- Internal Medicine Clinic, University of Health Sciences, Ankara Education and Research Hospital, Ankara, Turkey
| | - Ayşegül Tetik
- Hematology Clinic and Bone Marrow Transplantation Unit, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Dicle İskender
- Hematology Clinic and Bone Marrow Transplantation Unit, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Fevzi Altuntaş
- Hematology Clinic and Bone Marrow Transplantation Unit, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
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9
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Huntington SF. Cure at what (systemic) financial cost? Integrating novel therapies into first-line Hodgkin lymphoma treatment. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:252-259. [PMID: 31808838 PMCID: PMC6913455 DOI: 10.1182/hematology.2019000030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Classic Hodgkin lymphoma (cHL) stands out as success story in the field of medical oncology, with multiagent chemotherapy with or without radiation leading to durable remission for most patients. Large-scale clinical trials during the past 40 years have sought to minimize toxicities while maintaining strong efficacy, including efforts to reduce the size of radiation fields, minimize alkylator chemotherapy, reduce the number of chemotherapy cycles, and omit radiation in select populations. The last decade has also ushered in novel therapies, including brentuximab vedotin (BV), that have improved clinical outcomes for patients with cHL resistant to standard cytotoxic therapies. More recently, a large randomized trial compared BV plus chemotherapy with chemotherapy alone for first-line treatment of advanced stage cHL. With ∼24 months of available follow-up, the BV containing regimen was found to be associated with a reduction in the risk of progression, death, or incomplete response to first-line treatment (modified progression-free survival). Whether this early signal of improved efficacy is worth the additional acute toxicities and added drug-related expenses associated with incorporating BV into first-line treatment remains controversial. This chapter provides historical background; reviews the cost-effectiveness of available cHL therapies; and summarizes potential ways to balance innovation, affordability, and patient access to novel therapeutics.
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Affiliation(s)
- Scott F. Huntington
- Department of Internal Medicine, Section of Hematology, Yale University, New Haven, CT
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Sureda A, Domingo-Domenech E, Gautam A. Neutropenia during frontline treatment of advanced Hodgkin lymphoma: Incidence, risk factors, and management. Crit Rev Oncol Hematol 2019; 138:1-5. [DOI: 10.1016/j.critrevonc.2019.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 01/15/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022] Open
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Laprise-Lachance M, Lemieux P, Grégoire JP. Risk of pulmonary toxicity of bleomycin and filgrastim. J Oncol Pharm Pract 2018; 25:1638-1644. [PMID: 30319063 DOI: 10.1177/1078155218804293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To estimate the relative risk of pulmonary toxicity in patients exposed to a bleomycin-based chemotherapy including filgrastim compared to a similar chemotherapy without filgrastim. METHODS We conducted a nested case-control study of patients treated with BEP (bleomycin, etoposide and cisplatin) for germ cell cancer or with ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) for Hodgkin's lymphoma at the Hôtel-Dieu de Lévis Hospital between 31 October 2000 and 30 June 2016. The relative risk was estimated by an adjusted odds ratio (aOR) using a propensity score-adjusted regression analysis. RESULTS Thirteen cases of pulmonary toxicity, representing 14.7% of the 88 patients included in the study, were matched with 65 controls. A higher proportion of women (31.8%) than men (11.3%) developed pulmonary toxicity although the difference was not statistically significant (P = 0.08). Within the cohort, two deaths related to lung toxicity were observed among cases where no filgrastim was used. The risk of pulmonary toxicity associated with the addition of filgrastim was not statistically significant (aOR = 2.48 95% CI = 0.50 to 12.19). CONCLUSION The results add further evidence that the concomitant use of filgrastim might not increase the risk of pulmonary toxicity of bleomycin. It also suggests that female patients might be more likely to develop this adverse effect. A clinical trial would be needed to confirm this result.
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Affiliation(s)
- Magali Laprise-Lachance
- 1 Department of Pharmacy, Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, site Hôtel-Dieu de Lévis, Lévis, Quebec, Canada
| | - Pierre Lemieux
- 2 Department of Pharmacy, Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec, site Centre hospitalier affilié universitaire régional de Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Jean-Pierre Grégoire
- 3 Faculté de Pharmacie, Université Laval, Quebec City, Quebec, Canada.,4 Population Health and Optimal Health Practices Unit, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
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Huntington SF, von Keudell G, Davidoff AJ, Gross CP, Prasad SA. Cost-Effectiveness Analysis of Brentuximab Vedotin With Chemotherapy in Newly Diagnosed Stage III and IV Hodgkin Lymphoma. J Clin Oncol 2018; 36:JCO1800122. [PMID: 30285558 PMCID: PMC6241679 DOI: 10.1200/jco.18.00122] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE In a recent randomized, open-label trial (ECHELON-1), brentuximab vedotin (BV) combined with doxorubicin, vinblastine, and dacarbazine (AVD+BV) decreased the risk of progression in adults diagnosed with stage III or IV Hodgkin lymphoma (HL) compared with standard bleomycin-containing chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine [ABVD]). However, the cost effectiveness of incorporating BV (US$6,970 per 50-mg vial) into the first-line setting is unknown. PATIENTS AND METHODS We constructed a Markov decision-analytic model to measure the costs and clinical outcomes for AVD+BV compared with ABVD as first-line therapy in a cohort of patients with stage III or IV HL. Transition probabilities were estimated from ECHELON-1 by fitting parametric survival distributions. Lifetime direct health care costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for AVD+BV compared with ABVD from a US payer perspective. Our model was also used to estimate BV price reductions that would achieve more favorable cost effectiveness under indication-specific pricing. RESULTS AVD+BV was associated with an improvement of 0.56 QALYs compared with treatment with standard ABVD. However, incorporating BV into first-line therapy led to significantly higher lifetime health care costs ($361,137 v $184,291), causing the ICER for AVD+BV to be $317,254 per QALY. If indication-specific pricing were implemented, acquisition costs for BV used in the first-line setting would need to be reduced by 56% to 73% for ICERs of $150,000 to $100,000 per QALY, respectively. CONCLUSION Substituting BV for bleomycin during first-line therapy for stage III or IV HL is unlikely to be cost effective under current drug pricing. Should indication-specific pricing be implemented, significant price reductions for BV used in the first-line setting would be needed to reduce ICERs to more widely acceptable values.
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Affiliation(s)
- Scott F. Huntington
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Gottfried von Keudell
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Amy J. Davidoff
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Cary P. Gross
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Sapna A. Prasad
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
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Andersen MD, Kamper P, d'Amore A, Clausen M, Bentzen H, d'Amore F. The incidence of bleomycin induced lung toxicity is increased in Hodgkin lymphoma patients over 45 years exposed to granulocyte-colony stimulating growth factor †. Leuk Lymphoma 2018; 60:927-933. [PMID: 30277120 DOI: 10.1080/10428194.2018.1515939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In Hodgkin lymphoma (HL) bleomycin can induce pulmonary toxicity (BPT). BPT consists of respiratory tract symptoms during bleomycin-exposure and radiologic pulmonary lesions without concomitant infection. Older age, bleomycin dose, smoking history and the use of granulocyte-colony stimulating factor (G-CSF) have been suggested as possible risk factors for BPT. It is still debated whether BPT affects overall (OS) and progression-free survival (PFS). We investigated the incidence of BPT along with possible risk factors in 412 HL patients treated in 1990-2014. BPT occurred in 34 patients (8%) and was significantly associated with disseminated disease and B-symptoms. It was more frequent in elderly patients (p = .05) but not significantly correlated with a history of smoking. BPT occurred more often in patients receiving G-CSF (p = .03), particularly the poly-ethylenglycol-bound molecule. All significant risk correlations were limited to the age group >45 years. In the present cohort, BPT did not influence OS or PFS regardless of age.
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Affiliation(s)
- Maja D Andersen
- a Department of Haematology , Aarhus University Hospital , Aarhus C , Denmark
| | - Peter Kamper
- a Department of Haematology , Aarhus University Hospital , Aarhus C , Denmark
| | - Alexander d'Amore
- a Department of Haematology , Aarhus University Hospital , Aarhus C , Denmark
| | - Michael Clausen
- a Department of Haematology , Aarhus University Hospital , Aarhus C , Denmark
| | - Hans Bentzen
- a Department of Haematology , Aarhus University Hospital , Aarhus C , Denmark
| | - Francesco d'Amore
- a Department of Haematology , Aarhus University Hospital , Aarhus C , Denmark
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14
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Evens AM, Advani RH, Helenowski IB, Fanale M, Smith SM, Jovanovic BD, Bociek GR, Klein AK, Winter JN, Gordon LI, Hamlin PA. Multicenter Phase II Study of Sequential Brentuximab Vedotin and Doxorubicin, Vinblastine, and Dacarbazine Chemotherapy for Older Patients With Untreated Classical Hodgkin Lymphoma. J Clin Oncol 2018; 36:3015-3022. [PMID: 30179569 DOI: 10.1200/jco.2018.79.0139] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To improve the curability of older patients with newly diagnosed Hodgkin lymphoma. PATIENTS AND METHODS We conducted a multicenter phase II study that administered brentuximab vedotin (Bv) sequentially before and after standard doxorubicin, vinblastine, and dacarbazine (AVD) for untreated patients with Hodgkin lymphoma age 60 years or older. After two lead-in doses of single-agent Bv (1.8 mg/kg once every 3 weeks), patients received six cycles of AVD chemotherapy followed by four consolidative doses of Bv in responding patients. RESULTS Patient characteristics included median age of 69 years (range, 60 to 88 years), 63% male, median Eastern Cooperative Oncology Group performance status 1, 81% stage III to IV disease, 60% International Prognostic Score 3 to 7, median Cumulative Illness Rating Scale-Geriatric comorbidity score of 7 (52% grade 3 to 4); and 12% had loss of instrumental activities of daily living at diagnosis. Thirty-seven (77%) of 48 patients completed six cycles of AVD, and 35 patients (73%) received at least one Bv consolidation. Overall response and complete remission rates after initial Bv lead-in dose were 18 (82%) of 22 and 8 (36%) of 22, respectively, and 40 (95%) of 42 and 34 (90%) of 42, respectively, after six cycles of AVD among 42 response-evaluable patients. Twenty (42%) of 48 patients experienced a grade 3 to 4 adverse event, most commonly neutropenia (44%), febrile neutropenia and pneumonia (8%), or diarrhea (6%); 33% had grade 2 peripheral neuropathy, which was reversible in a majority of patients. By intent-to-treat, the 2-year event-free survival, progression-free survival, and overall survival rates were 80%, 84%, and 93%, respectively. Furthermore, 2-year progression-free survival rates for patients with a Cumulative Illness Rating Scale-Geriatric comorbidity score of ≥ 10 versus < 10 were 45% versus 100%, respectively (P < .001), and with baseline loss versus no loss of instrumental activities of daily living were 25% versus 94% (P < .001), respectively, the latter persisting on multivariable analyses. CONCLUSION Altogether, sequential Bv-AVD was well tolerated and was associated with robust outcomes. Furthermore, geriatric-based measures were strongly associated with patient survival.
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Affiliation(s)
- Andrew M Evens
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ranjana H Advani
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Irene B Helenowski
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michelle Fanale
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sonali M Smith
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Borko D Jovanovic
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gregory R Bociek
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andreas K Klein
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jane N Winter
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leo I Gordon
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul A Hamlin
- Andrew M. Evens, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Ranjana H. Advani, Stanford University, Stanford, CA; Irene B. Helenowski, Borko D. Jovanovic, Jane N. Winter, and Leo I. Gordon, Northwestern University Feinberg School of Medicine; Jane N. Winter and Leo I. Gordon, Robert H. Lurie Comprehensive Cancer Center; Sonali M. Smith, University of Chicago, Chicago, IL; Michelle Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Gregory R. Bociek, University of Nebraska, Omaha, NE; Andreas K. Klein, Tufts Medical Center, Boston, MA; and Paul A. Hamlin, Memorial Sloan Kettering Cancer Center, New York, NY
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Lim SH, Johnson PWM. Optimizing therapy in advanced-stage Hodgkin lymphoma. Blood 2018; 131:1679-1688. [PMID: 29500173 DOI: 10.1182/blood-2017-09-772640] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/25/2017] [Indexed: 02/07/2023] Open
Abstract
The treatment of Hodgkin lymphoma has evolved continuously since the introduction of extended-field radiotherapy in the 1960s to involved-field and then involved-node radiotherapy, multiagent chemotherapy, combined chemoradiotherapy, risk-adapted and response-adapted modulation, and, most recently, introduction of antibody-drug conjugates and immune checkpoint-blocking antibodies. These changes have translated into progressively increasing cure rates, so that 10-year survival figures now exceed 80%, compared with <50% 40 years ago. The challenge now is how to improve upon success while maintaining, or if possible improving, the quality of life for survivors. Steering between undertreatment, with the risk of avoidable recurrences, and overtreatment, with the risk of unnecessary toxicity, remains complex because control of the lymphoma and the probability of survival are no longer closely linked. This requires trials with long follow-up and continuous reappraisal of the interaction between the illness; the method used to define risk, and the type of treatment involved. One important factor in this is age: outcomes in older patients have not improved at the same rate as those in the population under 60 years of age, reflecting the need for different approaches. Recently, treatment has moved from being primarily risk-based, using baseline characteristics such as anatomical stage and severity of the illness, to a more dynamic approach that takes account of the response to therapy, using functional imaging to make an early appraisal, with the option to modulate subsequent treatment. The results of several trials indicate that this has advantages, but a combination of risk- and response-adaptation is probably ideal.
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Affiliation(s)
- Sean H Lim
- Antibody and Vaccine Group and
- Cancer Sciences Unit, Cancer Research UK Centre, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| | - Peter W M Johnson
- Cancer Sciences Unit, Cancer Research UK Centre, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
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Watkins MP, Fanale MA, Bartlett NL. SOHO State of the Art Updates and Next Questions: Hodgkin Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:81-90. [PMID: 29366607 DOI: 10.1016/j.clml.2018.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 01/02/2018] [Indexed: 01/05/2023]
Abstract
Until recently, advances in classic Hodgkin lymphoma (HL) treatment primarily consisted of minor modifications of highly effective decades-old chemotherapy and radiation approaches. In early-stage disease, excellent outcomes have been reported with fewer cycles of chemotherapy, lower doses, smaller radiation fields and in some circumstances, radiation elimination. In advanced-stage disease, maintaining the dose intensity of standard chemotherapy regimens has resulted in modest improvements in outcomes. During the past decade, the use of early interim positron emission tomography (PET) scans to escalate or de-escalate treatment has been the subject of intense investigation with the goal of maximizing efficacy and minimizing toxicity. Important updates from recent PET-directed trials include; elimination of bleomycin in patients with advanced-stage HL and negative interim PET findings, the benefit of therapy escalation in patients with unfavorable early-stage HL and positive interim PET findings, and the minimal benefit of consolidative radiotherapy in patients with unfavorable early-stage HL and negative interim PET findings. A more nuanced approach to consolidative radiotherapy is required for patients with favorable early-stage disease based on age, disease sites, secondary cancer risk, and cardiovascular disease. Brentuximab vedotin and nivolumab/pembrolizumab have provided promising new options with surprisingly high response rates and modest toxicity for patients with relapsed HL whose disease does not respond to standard treatments. Incorporating these agents into earlier therapy is an area of active investigation for all stages of HL. Although the overall prognosis for HL patients has seen incremental improvement, efforts to optimize treatment with more effective and less toxic approaches continue.
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Henderson TO, Parsons SK, Wroblewski K, Chen L, Hong F, Smith S, McNeer J, Advani R, Gascoyne RD, Constine LS, Horning S, Bartlett NL, Shah B, Connors JM, Leonard J, Kahl BS, Kelly K, Schwartz CL, Li H, Friedberg JW, Friedman DL, Gordon LI, Evens AM. Outcomes in adolescents and young adults with Hodgkin lymphoma treated on US cooperative group protocols: An adult intergroup (E2496) and Children's Oncology Group (COG AHOD0031) comparative analysis. Cancer 2018; 124:136-144. [PMID: 28902390 PMCID: PMC5735034 DOI: 10.1002/cncr.30979] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/21/2017] [Accepted: 08/09/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND There is no clear consensus between pediatric and adult providers about the treatment of adolescents and young adults (AYAs) with Hodgkin lymphoma (HL). METHODS Failure-free survival (FFS) and overall survival (OS) were compared between 114 patients ages 17 to 21 years with HL who were treated on the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Intergroup adult E2496 study and 391 similarly patients ages 17 to 21 years with HL who were treated on the pediatric Children's Oncology Group (COG) AHOD0031 study. RESULTS Comparing AYAs from the COG and E2496 studies, there were no significant differences in extralymphatic disease, anemia, or hypoalbuminemia. More AYAs in the E2496 trial had stage III and IV disease (63% vs 29%; P < .001) and B symptoms (63% vs 27%; P < .001), and fewer had bulk disease (33% vs 77%; P < .001). More AYAs on the COG trial received radiotherapy (76% vs 66%; P = .03), although in smaller doses. E2496 AYA The 5-year FFS and OS rates were 68% and 89%, respectively in the E2496 AYAs and 81% and 97%, respectively, in the COG AYAs, indicating a statistically superior compared in the COG AYAs (P = .001). In stratified multivariable analyses, E2496 AYAs had worse FFS than COG AYAs in all strata except patients who had stage I and II HL without anemia. Propensity score analysis (based on stage, anemia, and bulk disease) confirmed inferior FFS for E2496 AYAs compared with COG AYAs (P = .004). On the E2496 study, FFS was significantly divergent across age groups (P = .005), with inferior outcomes for those ages 17 to 21 years versus 22-44 years. There was no difference across age on the COG study. CONCLUSIONS Younger AYA patients with HL appear to have better outcomes when treated on a pediatric trial than patients of similar age on an adult trial. Prospective studies examining these differences are warranted. Cancer 2018;124:136-44. © 2017 American Cancer Society.
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Affiliation(s)
| | - Susan K. Parsons
- Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - Kristen Wroblewski
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Lu Chen
- Children’s Oncology Group, Acadia, CA
| | - Fangxin Hong
- Department of Biostatistics, Dana-Farber Cancer Institute, Boston, MA
| | - Sonali Smith
- Department of Medicine, University of Chicago, Chicago, IL
| | - Jennifer McNeer
- Department of Pediatrics, University of Chicago, Chicago, IL
| | | | | | - Louis S. Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester, Rochester, NY
| | | | | | | | | | - John Leonard
- Department of Medicine, Cornell Weill School of Medicine, New York, NY
| | - Brad S. Kahl
- Washington University School of Medicine, St. Louis, MO
| | - Kara Kelly
- Department of Pediatrics, Roswell Park Cancer Institute, Buffalo, NY
| | - Cindy L. Schwartz
- Department of Oncology, Children’s Hospital of Wisconsin, Milwaukee, WI
| | - Hongli Li
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jonathan W. Friedberg
- Departments of Radiation Oncology and Pediatrics, University of Rochester, Rochester, NY
| | | | - Leo I. Gordon
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew M. Evens
- Tufts Medical Center, Tufts University School of Medicine, Boston, MA
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18
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Kwan EM, Beck S, Amir E, Jewett MA, Sturgeon JF, Anson-Cartwright L, Chung PW, Warde PR, Moore MJ, Bedard PL, Tran B. Impact of Granulocyte-colony Stimulating Factor on Bleomycin-induced Pneumonitis in Chemotherapy-treated Germ Cell Tumors. Clin Genitourin Cancer 2017; 16:S1558-7673(17)30267-7. [PMID: 28943331 DOI: 10.1016/j.clgc.2017.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the impact of granulocyte-colony stimulating factor (G-CSF) use on the incidence and severity of bleomycin-induced pneumonitis (BIP) in patients with germ cell tumor (GCT) receiving first-line chemotherapy. PATIENTS AND METHODS Clinical data from our institutional GCT database was complemented by review of radiology, pharmacy, and medical records. All patients receiving first line chemotherapy between January 1, 2000 and December 31, 2010 were included. Patients receiving at least 1 dose of G-CSF were identified. BIP was graded using Common Terminology Criteria for Adverse Events criteria. Logistic regression was used to explore predictors for risk and severity of BIP. Statistical significance was defined as P < .05. RESULTS Data on 212 patients with GCT treated with a bleomycin-containing chemotherapy regimen were available. The median age was 31 years. The median follow-up period was 36.7 months. BIP occurred in 73 patients (34%), a majority (n = 55) of which were asymptomatic events (Common Terminology Criteria for Adverse Events, grade 1). G-CSF use was not associated with increased risk of BIP in multivariable analyses (odds ratio, 1.60; P = .13), nor was it associated with increased severity of symptomatic BIP (on average 1.22 grades higher; P = .09). There was a non-statistically significant trend towards greater risk of BIP in patients that developed renal impairment during chemotherapy treatment (odds ratio, 2.56; P = .053). CONCLUSION In patients with GCT receiving first line chemotherapy, G-CSF use is not associated with an increased risk of BIP. Furthermore, the use of G-CSF did not have any significant effect on the severity of BIP events. Clinicians are reminded to be vigilant of patients that develop renal impairment while undergoing chemotherapy treatment, given the greater risk of BIP.
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Affiliation(s)
- Edmond M Kwan
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sophie Beck
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Eitan Amir
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Michael A Jewett
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy F Sturgeon
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Lynn Anson-Cartwright
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Peter W Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Padraig R Warde
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Malcolm J Moore
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Philippe L Bedard
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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19
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Dann EJ, Bairey O, Bar-Shalom R, Mashiach T, Barzilai E, Kornberg A, Akria L, Tadmor T, Filanovsky K, Abadi U, Kagna O, Ruchlemer R, Abdah-Bortnyak R, Goldschmidt N, Epelbaum R, Horowitz NA, Lavie D, Ben-Yehuda D, Shpilberg O, Paltiel O. Modification of initial therapy in early and advanced Hodgkin lymphoma, based on interim PET/CT is beneficial: a prospective multicentre trial of 355 patients. Br J Haematol 2017; 178:709-718. [PMID: 28589704 DOI: 10.1111/bjh.14734] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/20/2017] [Indexed: 11/28/2022]
Abstract
This multicentre study evaluated 5-year progression-free (PFS) and overall survival (OS) in early and advanced Hodgkin lymphoma (HL), where therapy was individualized based on initial prognostic factors and positron emission tomography-computed tomography performed after two cycles (PET-2). Between September 2006 and August 2013, 359 patients aged 18-60 years, were recruited in nine Israeli centres. Early-HL patients initially received ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) ×2. Depending on initial unfavourable prognostic features, PET-2-positive patients received additional ABVD followed by involved-site radiotherapy (ISRT). Patients with negative PET-2 and favourable disease received ISRT or ABVD ×2; those with unfavourable disease received ABVD ×2 with ISRT or, alternatively, ABVD ×4. Advanced-HL patients initially received ABVD ×2 or escalated BEACOPP (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone; EB) ×2 based on their international prognostic score (≤2 or ≥3). PET-2-negative patients further received ABVD ×4; PET-2-positive patients received EB ×4 and ISRT to residual masses. With a median follow-up of 55 (13-119) months, 5-year PFS was 91% and 69% for PET-2-negative and positive early-HL, respectively; 5-year OS was 100% and 95%, respectively. For advanced-HL, the PFS was 81% and 68%, respectively (P = 0·08); 5-year OS was 98% and 91%, respectively. PET-2 positivity is associated with inferior prognosis in early-HL, even with additional ABVD and ISRT. Advanced-HL patients benefit from therapy escalation following positive PET-2. EB can be safely de-escalated to ABVD in PET-2-negative patients.
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Affiliation(s)
- Eldad J Dann
- Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Osnat Bairey
- Rabin Medical Centre, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | - Abraham Kornberg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Assaf Harofeh Medical Centre, Zerifin, Israel
| | | | - Tamar Tadmor
- Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Bnai Zion Medical Centre, Haifa, Israel
| | | | - Uri Abadi
- Meir Medical Centre, Kfar Saba, Israel
| | - Olga Kagna
- Rambam Health Care Campus, Haifa, Israel
| | | | | | | | - Ron Epelbaum
- Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Netanel A Horowitz
- Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - David Lavie
- Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Dina Ben-Yehuda
- Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | | | - Ora Paltiel
- Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
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20
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Sun HL, Atenafu EG, Tsang R, Kukreti V, Marras TK, Crump M, Kuruvilla J. Bleomycin pulmonary toxicity does not adversely affect the outcome of patients with Hodgkin lymphoma. Leuk Lymphoma 2017; 58:2607-2614. [PMID: 28504035 DOI: 10.1080/10428194.2017.1307980] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Bleomycin pulmonary toxicity (BPT) is a well-described complication of bleomycin-containing regimens. Previous data on risk factors and the impact of BPT on survival in Hodgkin lymphoma (HL) were conflicting. We reviewed 253 HL patients treated with adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) at the Princess Margaret Hospital from 1999 to 2009 to examine the incidence and risk factors for BPT, and the effect of BPT on survival. BPT was defined by pulmonary symptoms, bilateral interstitial infiltrates on computed tomography, and the absence of infection. Kaplan-Meier estimates were used to compare overall survival (OS) and progression-free survival (PFS) between groups. The incidence of BPT was low (11%). Age ≥45 (OR = 2.5) and granulocyte colony-stimulating factor use (OR = 3.6) were identified as predictors of BPT on multivariable logistic models. At a follow-up of 5 years, OS and PFS were 88% and 82%, respectively. Neither BPT nor bleomycin discontinuation had significant impact on survival outcomes.
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Affiliation(s)
- Haowei Linda Sun
- a Division of Hematology, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - Eshetu G Atenafu
- b Department of Biostatistics , Princess Margaret Cancer Centre , Toronto , Canada
| | - Richard Tsang
- c Radiation Oncology , Princess Margaret Cancer Centre , Toronto , Canada
| | - Vishal Kukreti
- d Medical Oncology and Hematology , Princess Margaret Cancer Centre , Toronto , Canada
| | - Theodore K Marras
- e Division of Respirology , University Health Network , Toronto , Canada
| | - Michael Crump
- d Medical Oncology and Hematology , Princess Margaret Cancer Centre , Toronto , Canada
| | - John Kuruvilla
- d Medical Oncology and Hematology , Princess Margaret Cancer Centre , Toronto , Canada
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21
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Johnson P, Federico M, Kirkwood A, Fosså A, Berkahn L, Carella A, d'Amore F, Enblad G, Franceschetto A, Fulham M, Luminari S, O'Doherty M, Patrick P, Roberts T, Sidra G, Stevens L, Smith P, Trotman J, Viney Z, Radford J, Barrington S. Adapted Treatment Guided by Interim PET-CT Scan in Advanced Hodgkin's Lymphoma. N Engl J Med 2016; 374:2419-29. [PMID: 27332902 PMCID: PMC4961236 DOI: 10.1056/nejmoa1510093] [Citation(s) in RCA: 546] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND We tested interim positron-emission tomography-computed tomography (PET-CT) as a measure of early response to chemotherapy in order to guide treatment for patients with advanced Hodgkin's lymphoma. METHODS Patients with newly diagnosed advanced classic Hodgkin's lymphoma underwent a baseline PET-CT scan, received two cycles of ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy, and then underwent an interim PET-CT scan. Images were centrally reviewed with the use of a 5-point scale for PET findings. Patients with negative PET findings after two cycles were randomly assigned to continue ABVD (ABVD group) or omit bleomycin (AVD group) in cycles 3 through 6. Those with positive PET findings after two cycles received BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone). Radiotherapy was not recommended for patients with negative findings on interim scans. The primary outcome was the difference in the 3-year progression-free survival rate between randomized groups, a noninferiority comparison to exclude a difference of 5 or more percentage points. RESULTS A total of 1214 patients were registered; 937 of the 1119 patients (83.7%) who underwent an interim PET-CT scan according to protocol had negative findings. With a median follow-up of 41 months, the 3-year progression-free survival rate and overall survival rate in the ABVD group were 85.7% (95% confidence interval [CI], 82.1 to 88.6) and 97.2% (95% CI, 95.1 to 98.4), respectively; the corresponding rates in the AVD group were 84.4% (95% CI, 80.7 to 87.5) and 97.6% (95% CI, 95.6 to 98.7). The absolute difference in the 3-year progression-free survival rate (ABVD minus AVD) was 1.6 percentage points (95% CI, -3.2 to 5.3). Respiratory adverse events were more severe in the ABVD group than in the AVD group. BEACOPP was given to the 172 patients with positive findings on the interim scan, and 74.4% had negative findings on a third PET-CT scan; the 3-year progression-free survival rate was 67.5% and the overall survival rate 87.8%. A total of 62 patients died during the trial (24 from Hodgkin's lymphoma), for a 3-year progression-free survival rate of 82.6% and an overall survival rate of 95.8%. CONCLUSIONS Although the results fall just short of the specified noninferiority margin, the omission of bleomycin from the ABVD regimen after negative findings on interim PET resulted in a lower incidence of pulmonary toxic effects than with continued ABVD but not significantly lower efficacy. (Funded by Cancer Research UK and Others; ClinicalTrials.gov number, NCT00678327.).
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Affiliation(s)
- Peter Johnson
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Massimo Federico
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Amy Kirkwood
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Alexander Fosså
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Leanne Berkahn
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Angelo Carella
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Francesco d'Amore
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Gunilla Enblad
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Antonella Franceschetto
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Michael Fulham
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Stefano Luminari
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Michael O'Doherty
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Pip Patrick
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Thomas Roberts
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Gamal Sidra
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Lindsey Stevens
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Paul Smith
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Judith Trotman
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Zaid Viney
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - John Radford
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
| | - Sally Barrington
- From the Cancer Research UK Centre, University of Southampton, Southampton (P.J.), Cancer Research UK and University College London Cancer Trials Centre (A.K., P.P., T.R., L.S., P.S.) and the PET Imaging Centre, King's College London, King's Health Partners, St. Thomas' Hospital (M.O., Z.V., S.B.), London, the Department of Haematology, Lincoln County Hospital, Lincoln (G.S.), and the Department of Medical Oncology, Christie Hospital, Manchester (J.R.) - all in the United Kingdom; the Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena (M. Federico, A. Franceschetto, S.L.), the Department of Hematology, San Martino University Hospital, Genoa (A.C.), and Arcispedale Santa Maria Nuova-Istituti di Ricovero e Cura a Carattere Scientifico, Reggio Emilia (S.L.) - all in Italy; the Department of Medical Oncology, Oslo University Hospital, Oslo (A. Fosså); the Department of Haematology, Auckland City Hospital, Auckland, New Zealand (L.B.); the Department of Hematology, Aarhus University Hospital, Aarhus, Denmark (F.A.); the Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden (G.E.); and the Department of Molecular Imaging, Royal Prince Alfred Hospital (M. Fulham), and Concord Repatriation General Hospital, University of Sydney (J.T.), Sydney
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Press OW, Li H, Schöder H, Straus DJ, Moskowitz CH, LeBlanc M, Rimsza LM, Bartlett NL, Evens AM, Mittra ES, LaCasce AS, Sweetenham JW, Barr PM, Fanale MA, Knopp MV, Noy A, Hsi ED, Cook JR, Lechowicz MJ, Gascoyne RD, Leonard JP, Kahl BS, Cheson BD, Fisher RI, Friedberg JW. US Intergroup Trial of Response-Adapted Therapy for Stage III to IV Hodgkin Lymphoma Using Early Interim Fluorodeoxyglucose-Positron Emission Tomography Imaging: Southwest Oncology Group S0816. J Clin Oncol 2016; 34:2020-7. [PMID: 27069074 DOI: 10.1200/jco.2015.63.1119] [Citation(s) in RCA: 191] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Four US National Clinical Trials Network components (Southwest Oncology Group, Cancer and Leukemia Group B/Alliance, Eastern Cooperative Oncology Group, and the AIDS Malignancy Consortium) conducted a phase II Intergroup clinical trial that used early interim fluorodeoxyglucose positron emission tomography (FDG-PET) imaging to determine the utility of response-adapted therapy for stage III to IV classic Hodgkin lymphoma. PATIENTS AND METHODS The Southwest Oncology Group S0816 (Fludeoxyglucose F 18-PET/CT Imaging and Combination Chemotherapy With or Without Additional Chemotherapy and G-CSF in Treating Patients With Stage III or Stage IV Hodgkin Lymphoma) trial enrolled 358 HIV-negative patients between July 1, 2009, and December 2, 2012. A PET scan was performed after two initial cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and was labeled PET2. PET2-negative patients (Deauville score 1 to 3) received an additional four cycles of ABVD, whereas PET2-positive patients (Deauville score 4 to 5) were switched to escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) for six cycles. Among 336 eligible and evaluable patients, the median age was 32 years (range, 18 to 60 years), with 52% stage III, 48% stage IV, 49% International Prognostic Score 0 to 2, and 51% score 3 to 7. RESULTS Three hundred thirty-six of the enrolled patients were evaluable. Central review of the interim PET2 scan was performed in 331 evaluable patients, with 271 (82%) PET2-negative and 60 (18%) PET2-positive. Of 60 eligible PET2-positive patients, 49 switched to eBEACOPP as planned and 11 declined. With a median follow-up of 39.7 months, the Kaplan-Meier estimate for 2-year overall survival was 98% (95% CI, 95% to 99%), and the 2-year estimate for progression-free survival (PFS) was 79% (95% CI, 74% to 83%). The 2-year estimate for PFS in the subset of patients who were PET2-positive after two cycles of ABVD was 64% (95% CI, 50% to 75%). Both nonhematologic and hematologic toxicities were greater in the eBEACOPP arm than in the continued ABVD arm. CONCLUSION Response-adapted therapy based on interim PET imaging after two cycles of ABVD seems promising with a 2-year PFS of 64% for PET2-positive patients, which is much higher than the expected 2-year PFS of 15% to 30%.
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Affiliation(s)
- Oliver W Press
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA.
| | - Hongli Li
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Heiko Schöder
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - David J Straus
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Craig H Moskowitz
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Michael LeBlanc
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Lisa M Rimsza
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Nancy L Bartlett
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Andrew M Evens
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Erik S Mittra
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Ann S LaCasce
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - John W Sweetenham
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Paul M Barr
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Michelle A Fanale
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Michael V Knopp
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Ariela Noy
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Eric D Hsi
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - James R Cook
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Mary Jo Lechowicz
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Randy D Gascoyne
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - John P Leonard
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Brad S Kahl
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Bruce D Cheson
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Richard I Fisher
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
| | - Jonathan W Friedberg
- Oliver W. Press, Fred Hutchinson Cancer Research Center, and the University of Washington; Hongli Li and Michael LeBlanc, Fred Hutchinson Cancer Research Center, Seattle, WA; Heiko Schöder, David J. Straus, Craig H. Moskowitz, and Ariela Noy, Memorial Sloan Kettering Cancer Center; John P. Leonard, Weill Cornell Medical College and New York Presbyterian Hospital, New York City; Paul M. Barr and Jonathan W. Friedberg, University of Rochester Medical Center, Rochester, NY; Lisa M. Rimsza, University of Arizona, Tucson, AZ; Nancy L. Bartlett and Brad S. Kahl, Washington University School of Medicine, St. Louis, MO; Andrew M. Evens, Tufts Medical Center; Ann S. LaCasce, Dana-Farber Cancer Institute, Boston, MA; Erik S. Mittra, Stanford University Medical Center, Stanford, CA; John W. Sweetenham, Huntsman Cancer Hospital, Salt Lake City, UT; Michelle A. Fanale, University of Texas MD Anderson Cancer Center, Houston, TX; Michael V. Knopp, The Ohio State University, Columbus; Eric D. Hsi, Cleveland Clinic Foundation; James R. Cook, Cleveland Clinic, Cleveland, OH; Mary Jo Lechowicz, Winship Cancer Institute of Emory University, Atlanta, GA; Randy D. Gascoyne, British Columbia Cancer Agency, Vancouver, BC; Bruce D. Cheson, Georgetown University Hospital, Washington DC; and Richard I. Fisher, Fox Chase Cancer Center, Philadelphia, PA
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23
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Cheung MC, Prica A, Graczyk J, Buckstein R, Chan KKW. Granulocyte colony-stimulating factor in secondary prophylaxis for advanced-stage Hodgkin lymphoma treated with ABVD chemotherapy: a cost-effectiveness analysis. Leuk Lymphoma 2016; 57:1865-75. [PMID: 26758765 DOI: 10.3109/10428194.2015.1117609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Granulocyte colony-stimulating factor (G-CSF) is commonly administered to patients with Hodgkin lymphoma (HL) with neutropenia. We constructed a decision-analytic model to compare the cost-effectiveness of secondary prophylaxis with G-CSF to a strategy of 'no G-CSF' in response to severe neutropenia for adults with advanced-stage HL treated with ABVD. A Canadian public health payer's perspective was considered and costs were presented in 2013 Canadian dollars. The quality-adjusted life years (QALYs) attained with the G-CSF and 'no G-CSF' strategies were 1.403 and 1.416, respectively. Costs for the strategies with and without G-CSF were $38,971 and $33,982, respectively. In the base case analysis, the 'no G-CSF' strategy was associated with cost savings and improved QALYs; therefore, 'no G-CSF' was the dominant approach. For patients with severe neutropenia during ABVD chemotherapy for advanced-stage HL, a strategy without G-CSF support is associated with improved quality-adjusted outcomes, cost savings, and is the preferred approach.
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Affiliation(s)
- M C Cheung
- a Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto , Toronto , Canada
| | - A Prica
- b Princess Margaret Hospital and Mt. Sinai Hospital, University of Toronto , Toronto , Canada
| | - J Graczyk
- c Grand River Regional Cancer Centre , Kitchener , Canada
| | - R Buckstein
- a Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto , Toronto , Canada
| | - K K W Chan
- a Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto , Toronto , Canada ;,d Division of Biostatistics , Dalla Lana School of Public Health, University of Toronto , Toronto , Canada
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24
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Al-Jizani WA, Al-Mansour MM, Al-Fayea TM, Shafi RU, Kazkaz GA, Bayer AM, Al-Foheidi ME, Ibrahim EM. Bleomycin pulmonary toxicity in adult Saudi patients with Hodgkin's lymphoma. Future Oncol 2015; 11:2149-57. [DOI: 10.2217/fon.15.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Bleomycin pulmonary toxicity (BPT) has been described in Hodgkin's lymphoma (HL) patients treated with bleomycin-containing chemotherapy regimens. Methodology: We reviewed the records of 164 consecutive HL patients. Results: BPT was observed in 24 of 164 patients (15%). Older age and history of concomitant lung disease were significantly associated with approximately threefold (odds ratio: 3.38; 95% CI: 1.25–9.13; p = 0.02) and sevenfold (odds ratio: 7.19; 95% CI: 2.64–19.54; p < 0.0001) increase in BPT risk, respectively. The actuarial 5-year progression-free and overall survival for BPT and non-BPT groups, were not significantly different. Conclusion: In Saudi Arabian HL patients, the risk of BPT and its effect on survival outcome were comparable to that reported from developed countries.
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Affiliation(s)
- Wafa'a A Al-Jizani
- Princess Noorah Oncology Center, King Abdulaziz Medical City, PO BOX 9515, Jeddah 21423, Kingdom of Saudi Arabia
| | - Mubarak M Al-Mansour
- Princess Noorah Oncology Center, King Abdulaziz Medical City, PO BOX 9515, Jeddah 21423, Kingdom of Saudi Arabia
| | - Turki M Al-Fayea
- Princess Noorah Oncology Center, King Abdulaziz Medical City, PO BOX 9515, Jeddah 21423, Kingdom of Saudi Arabia
| | - Ruaa U Shafi
- Princess Noorah Oncology Center, King Abdulaziz Medical City, PO BOX 9515, Jeddah 21423, Kingdom of Saudi Arabia
| | - Ghieth A Kazkaz
- Oncology Center of Excellence, International Medical Center, PO Box 2172, Jeddah 21451, Kingdom of Saudi Arabia
| | - Ali M Bayer
- Oncology Center of Excellence, International Medical Center, PO Box 2172, Jeddah 21451, Kingdom of Saudi Arabia
| | - Meteb E Al-Foheidi
- Princess Noorah Oncology Center, King Abdulaziz Medical City, PO BOX 9515, Jeddah 21423, Kingdom of Saudi Arabia
| | - Ezzeldin M Ibrahim
- Oncology Center of Excellence, International Medical Center, PO Box 2172, Jeddah 21451, Kingdom of Saudi Arabia
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25
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D'Arco AM, Califano C, Barone L, Belsito Petrizzi V, Iovino V, Langella M, Maglione V, Rivellini F, De Lorenzo S. Feasibility and efficacy of dose-dense and dose-intense ABVD for high-risk patients with advanced Hodgkin lymphoma. Br J Haematol 2015; 171:662-5. [PMID: 25873239 DOI: 10.1111/bjh.13429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Saikia TK. Managing advanced stage Hodgkin lymphoma. J Postgrad Med 2015; 61:75-6. [PMID: 25766336 PMCID: PMC4943447 DOI: 10.4103/0022-3859.153102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- T K Saikia
- Department of Medical Oncology and Research, Prince Aly Khan Hospital, Mumbai, Maharashtra, India
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27
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Abstract
Abstract
Treatment of Hodgkin lymphoma is associated with 2 major types of risk: that the treatment may fail to cure the disease or that the treatment will prove unacceptably toxic. Careful assessment of the amount of the lymphoma (tumor burden), its behavior (extent of invasion or specific organ compromise), and host related factors (age; coincident systemic infection; and organ dysfunction, especially hematopoietic, cardiac, or pulmonary) is essential to optimize outcome. Elaborately assembled prognostic scoring systems, such as the International Prognostic Factors Project score, have lost their accuracy and value as increasingly effective chemotherapy and supportive care have been developed. Identification of specific biomarkers derived from sophisticated exploration of Hodgkin lymphoma biology is bringing promise of further improvement in targeted therapy in which effectiveness is increased at the same time off-target toxicity is diminished. Parallel developments in functional imaging are providing additional potential to evaluate the efficacy of treatment while it is being delivered, allowing dynamic assessment of risk during chemotherapy and adaptation of the therapy in real time. Risk assessment in Hodgkin lymphoma is continuously evolving, promising ever greater precision and clinical relevance. This article explores the past usefulness and the emerging potential of risk assessment for this imminently curable malignancy.
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28
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Follows GA, Ardeshna KM, Barrington SF, Culligan DJ, Hoskin PJ, Linch D, Sadullah S, Williams MV, Wimperis JZ. Guidelines for the first line management of classical Hodgkin lymphoma. Br J Haematol 2014; 166:34-49. [PMID: 24712411 DOI: 10.1111/bjh.12878] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- George A Follows
- Department of Haematology, Addenbrookes Hospital, Cambridge University Teaching Hospitals, Cambridge, UK
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29
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Russo F, Corazzelli G, Frigeri F, Capobianco G, Aloj L, Volzone F, De Chiara A, Bonelli A, Gatani T, Marcacci G, Donnarumma D, Becchimanzi C, de Lutio E, Ionna F, De Filippi R, Lastoria S, Pinto A. A phase II study of dose-dense and dose-intense ABVD (ABVDDD-DI) without consolidation radiotherapy in patients with advanced Hodgkin lymphoma. Br J Haematol 2014; 166:118-29. [DOI: 10.1111/bjh.12862] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 02/24/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Filippo Russo
- Haematology-Oncology and Stem Cell Transplantation Unit; National Cancer Institute; Fondazione ‘G. Pascale’; IRCCS; Naples Italy
| | - Gaetano Corazzelli
- Haematology-Oncology and Stem Cell Transplantation Unit; National Cancer Institute; Fondazione ‘G. Pascale’; IRCCS; Naples Italy
| | - Ferdinando Frigeri
- Haematology-Oncology and Stem Cell Transplantation Unit; National Cancer Institute; Fondazione ‘G. Pascale’; IRCCS; Naples Italy
| | - Gaetana Capobianco
- Haematology-Oncology and Stem Cell Transplantation Unit; National Cancer Institute; Fondazione ‘G. Pascale’; IRCCS; Naples Italy
| | - Luigi Aloj
- Nuclear Medicine; National Cancer Institute; Fondazione ‘G. Pascale’; IRCCS; Naples Italy
| | - Francesco Volzone
- Haematology-Oncology and Stem Cell Transplantation Unit; National Cancer Institute; Fondazione ‘G. Pascale’; IRCCS; Naples Italy
| | | | - Annamaria Bonelli
- Cardiology; National Cancer Institute; Fondazione ‘G. Pascale’; IRCCS; Naples Italy
| | - Tindaro Gatani
- Respiratory Medicine; National Cancer Institute; Fondazione ‘G. Pascale’; IRCCS; Naples Italy
| | - Gianpaolo Marcacci
- Haematology-Oncology and Stem Cell Transplantation Unit; National Cancer Institute; Fondazione ‘G. Pascale’; IRCCS; Naples Italy
| | - Daniela Donnarumma
- Haematology-Oncology and Stem Cell Transplantation Unit; National Cancer Institute; Fondazione ‘G. Pascale’; IRCCS; Naples Italy
| | - Cristina Becchimanzi
- Haematology-Oncology and Stem Cell Transplantation Unit; National Cancer Institute; Fondazione ‘G. Pascale’; IRCCS; Naples Italy
| | - Elisabetta de Lutio
- Radiology; National Cancer Institute; Fondazione ‘G. Pascale’; IRCCS; Naples Italy
| | - Franco Ionna
- Head and Neck Surgery Units; National Cancer Institute; Fondazione ‘G. Pascale’; IRCCS; Naples Italy
| | - Rosaria De Filippi
- Department of Clinical Medicine and Surgery; Federico II University; Naples Italy
| | - Secondo Lastoria
- Nuclear Medicine; National Cancer Institute; Fondazione ‘G. Pascale’; IRCCS; Naples Italy
| | - Antonello Pinto
- Haematology-Oncology and Stem Cell Transplantation Unit; National Cancer Institute; Fondazione ‘G. Pascale’; IRCCS; Naples Italy
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Deutsch YE, Lossos IS, Rosenblatt JD. Brentuximab vedotin for Hodgkin lymphoma and systemic anaplastic large cell lymphoma: a review of clinical experience and future directions. Int J Hematol Oncol 2013. [DOI: 10.2217/ijh.13.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Brentuximab vedotin is a novel agent indicated for the treatment of relapsed and refractory Hodgkin lymphoma and systemic anaplastic large cell lymphoma. Brentuximab vedotin is an antibody–drug conjugate consisting of chimeric anti-CD30 antibody cAC10, linked to four molecules of monomethylauristatin E, a tubulin destabilizer. It was granted US FDA approval in 2011 following two pivotal Phase II studies showing objective responses of 75 and 86% in heavily pretreated relapsed and refractory Hodgkin lymphoma and systemic anaplastic large cell lymphoma, respectively. Brentuximab vedotin can be used as a bridge to more definitive stem cell transplant. There are currently over 30 open clinical studies involving the use of brentuximab vedotin used as single agent or combined with chemotherapy in both front-line and salvage settings. These studies include use in other CD30-positive B- and T-cell lymphomas, as well as in CD30-positive germ cell tumors. In clinical practice brentuximab vedotin has been associated with significant sensory and motor neuropathies and clinicians should be alert to the potential for significant neuropathy and the need for dose reduction. However, the potential for significant neuropathy must be balanced against the remarkable clinical benefit of brentuximab vedotin in patients with heavily pretreated relapsed and refractory lymphomas.
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Affiliation(s)
- Yehuda E Deutsch
- Division of Hematology-Oncology, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, USA
| | - Izidore S Lossos
- Division of Hematology-Oncology, Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave, Miami, FL 33136, USA
- Department of Molecular & Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joseph D Rosenblatt
- Department of Microbiology & Immunology, University of Miami Miller School of Medicine, Miami, FL, USA
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Full-dose chemotherapy in early stage breast cancer regardless of absolute neutrophil count and without G-CSF does not increase chemotherapy-induced febrile neutropenia. Support Care Cancer 2013; 21:2727-31. [PMID: 23708859 DOI: 10.1007/s00520-013-1851-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 05/07/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Does giving full-dose adjuvant chemotherapy to patients with early stage breast cancer (ESBC) regardless of the day-before absolute neutrophil count (ANC) lead to an increased incidence of chemotherapy-induced febrile neutropenia (CIFN)? What factors may predispose patients to CIFN? METHODS This was a retrospective chart review conducted on all patients receiving adjuvant chemotherapy for ESBC at a mid-sized community hospital in Toronto, Ontario, Canada between September 2005 and August 2011. Day-before CBC data were collected along with other patient characteristics. CIFN was confirmed by hospital records. One hundred fifty-four patients met the inclusion criteria. Overall, 830 cycles of chemotherapy were analyzed. Univariate and multivariate logistic regression analyses were used to identify risk factors for CIFN. RESULTS Twenty-two episodes of CIFN were observed. There was no significant difference in day-before ANC between patients who developed CIFN relative to those who did not. The day-before ANC was <1.5 × 10(9)/L for 88 cycles of chemotherapy. ANC analyzed as a continuous variable showed that the odds ratio (OR) for CIFN was 0.97 (95 % CI 0.82-1.13, p = NS). The pseudo R (2) statistic, which is a measure of variability accounted for by a regression model, was only 0.0008, indicating that ANC explained less than 1 % of the variability in the risk of CIFN. The most significant predictor of CIFN was the chemotherapy regimen, with docetaxel (Taxotere)/cyclophosphamide demonstrating the highest risk (OR 7.1, 95 % CI 1.4-34.9, p = 0.016). CONCLUSIONS Full-dose adjuvant chemotherapy may be given to patients with ESBC regardless of the day-before ANC, without significantly increasing the risk of CIFN. The chemotherapy regimen is the most significant predictor for CIFN.
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Böll B, Görgen H, Fuchs M, Pluetschow A, Eich HT, Bargetzi MJ, Weidmann E, Junghanß C, Greil R, Scherpe A, Schmalz O, Eichenauer DA, von Tresckow B, Rothe A, Diehl V, Engert A, Borchmann P. ABVD in Older Patients With Early-Stage Hodgkin Lymphoma Treated Within the German Hodgkin Study Group HD10 and HD11 Trials. J Clin Oncol 2013; 31:1522-9. [DOI: 10.1200/jco.2012.45.4181] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Older patients with Hodgkin lymphoma (HL) account for approximately 20% of all HL patients. ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy is regarded as standard of care in these patients. However, little is known on feasibility and efficacy of ABVD in this age group. Patients and Methods We analyzed the feasibility and efficacy of four cycles of ABVD in older patients age 60 to 75 years with early-stage HL who were treated within the German Hodgkin Study Group (GHSG) HD10 and HD11 trials; results were compared with those of younger patients treated within these trials. Results In total, 1,299 patients received four cycles of ABVD, and 117 of those patients were older than age 60 years (median, 65 years). In 14% of older patients, treatment was not administered according to protocol, mainly because of excessive toxicity. The mean delay of treatment was twice as high in the older patients (2.2 v 1.2 weeks). Fifty-nine percent of older patients achieved a relative dose-intensity of at least 80% compared with 85% of younger patients. Major toxicity (WHO grade 3 and 4), including leucopenia, nausea, infection, and others, was documented in 68% of older patients with a treatment-related mortality of 5%. Complete response was achieved in 89% of older patients, 3% had progressive disease, and 11% relapsed. At a median observation time of 92 months, 28% of the patients had died, and the 5-year progression-free survival estimate was 75% (95% CI, 66% to 82%). Conclusion In patients age ≥ 60 years with HL, four cycles of ABVD is associated with substantial dose reduction, treatment delay, toxicity, and treatment-related mortality.
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Affiliation(s)
- Boris Böll
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Helen Görgen
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Michael Fuchs
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Annette Pluetschow
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Hans Theodor Eich
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Mario J. Bargetzi
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Eckhart Weidmann
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Christian Junghanß
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Richard Greil
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Alexander Scherpe
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Oliver Schmalz
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Dennis A. Eichenauer
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Bastian von Tresckow
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Achim Rothe
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Volker Diehl
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Andreas Engert
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Peter Borchmann
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
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Graczyk J, Cheung MC, Buckstein R, Chan K. Granulocyte colony-stimulating factor as secondary prophylaxis of febrile neutropenia in the management of advanced-stage Hodgkin lymphoma treated with adriamycin, bleomycin, vinblastine and dacarbazine chemotherapy: a decision analysis. Leuk Lymphoma 2013; 55:56-62. [PMID: 23597142 DOI: 10.3109/10428194.2013.796046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Current practice guidelines are unclear regarding the role of secondary prophylaxis of febrile neutropenia in advanced-stage Hodgkin lymphoma despite several small retrospective studies that demonstrate the omission of growth factors to be a safe and economic practice. We used a decision-analytic model to compare secondary prophylaxis with granulocyte colony-stimulating factor (G-CSF) to no G-CSF with the onset of severe neutropenia for a hypothetical cohort of patients with advanced-stage Hodgkin lymphoma treated with adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). There was a net benefit of 0.017 years and 0.037 quality-adjusted life years for no G-CSF use in severe neutropenia. On microsimulation (10 000 trials), 96% of the simulations showed that the no G-CSF strategy is preferred to the use of G-CSF. This finding was robust across a wide range of sensitivity analyses. Our analysis suggests that G-CSF not be used as secondary prophylaxis of febrile neutropenia in advanced-stage Hodgkin lymphoma.
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Affiliation(s)
- Joanna Graczyk
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Division of Hematology/Oncology , Toronto , Canada
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Evens AM, Hong F, Gordon LI, Fisher RI, Bartlett NL, Connors JM, Gascoyne RD, Wagner H, Gospodarowicz M, Cheson BD, Stiff PJ, Advani R, Miller TP, Hoppe RT, Kahl BS, Horning SJ. The efficacy and tolerability of adriamycin, bleomycin, vinblastine, dacarbazine and Stanford V in older Hodgkin lymphoma patients: a comprehensive analysis from the North American intergroup trial E2496. Br J Haematol 2013; 161:76-86. [PMID: 23356491 DOI: 10.1111/bjh.12222] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 12/17/2012] [Indexed: 11/29/2022]
Abstract
There is a lack of contemporary prospective data examining the adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) and Stanford V (SV; doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, prednisone) regimens in older Hodgkin lymphoma (HL) patients. Forty-four advanced-stage, older HL patients (aged ≥60 years) were treated on the randomized study, E2496. Toxicities were mostly similar between chemotherapy regimens, although 24% of older patients developed bleomycin lung toxicity (BLT), which occurred mainly with ABVD (91%). Further, the BLT-related mortality rate was 18%. The overall treatment-related mortality for older HL patients was 9% vs. 0·3% for patients aged <60 years (P < 0·001). Among older patients, there were no survival differences between ABVD and SV. According to age, outcomes were significantly inferior for older versus younger patients (5-year failure-free survival: 48% vs. 74%, respectively, P = 0·002; 5-year overall survival: 58% and 90%, respectively, P < 0·0001), although time-to-progression (TTP) was not significantly different (5-year TTP: 68% vs. 78%, respectively, P = 0·37). Furthermore, considering progression and death without progression as competing risks, the risk of progression was not different between older and younger HL patients (5 years: 30% and 23%, respectively, P = 0·30); however, the incidence of death without progression was significantly increased for older HL patients (22% vs. 9%, respectively, P < 0·0001). Altogether, the marked HL age-dependent survival differences appeared attributable primarily to non-HL events.
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Affiliation(s)
- Andrew M Evens
- The University of Massachusetts Medical School, Worcester, MA 01655, USA.
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Abstract
The incidence of aggressive lymphoma in the setting of HIV infection is significantly increased relative to the general population. Combination antiretroviral therapy (cART) for HIV has reduced the incidence of these neoplasms and has significantly improved clinical outcome for those who do develop lymphoma and require chemotherapy. With the possible exception of those individuals with the most severe immunocompromise, patients with HIV-associated lymphoma can be treated with the same standard immuno-chemotherapy regimens used in the immunocompetent population with similar expectations for good clinical outcome. Infusional regimens like dose adjusted EPOCH-R appear to be highly effective first-line therapy and for relapsed patients high-dose chemotherapy with autologous stem cell support is well-tolerated and effective. However, it should be recognized that there are unique risks associated with management of lymphoma in this patient population. While opportunistic infections are no longer a significant cause of death, antiretroviral agents used for management of HIV infection may interact with chemotherapeutic agents and other adjunctive therapies making communication between the treating Oncologist and the patient's primary HIV treatment provider of prime importance.
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MESH Headings
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antiretroviral Therapy, Highly Active
- Burkitt Lymphoma/mortality
- Burkitt Lymphoma/pathology
- Burkitt Lymphoma/therapy
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/therapeutic use
- Doxorubicin/administration & dosage
- Doxorubicin/therapeutic use
- Hodgkin Disease/mortality
- Hodgkin Disease/pathology
- Hodgkin Disease/therapy
- Humans
- Lymphoma, AIDS-Related/mortality
- Lymphoma, AIDS-Related/pathology
- Lymphoma, AIDS-Related/therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Peripheral Blood Stem Cell Transplantation
- Prednisone/administration & dosage
- Prednisone/therapeutic use
- Survival Analysis
- Transplantation, Autologous
- Vincristine/administration & dosage
- Vincristine/therapeutic use
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Affiliation(s)
- Lawrence D Kaplan
- Adult Lymphoma Program, University of California, San Francisco, CA 94143, USA.
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Ho P, Sherman P, Grigg A. Intermittent granulocyte colony-stimulating factor maintains dose intensity after ABVD therapy complicated by neutropenia. Eur J Haematol 2012; 88:416-21. [PMID: 22296221 DOI: 10.1111/j.1600-0609.2012.01763.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Granulocyte Colony-Stimulating Factor (G-CSF) is commonly used to maintain dose intensity in patients receiving ABVD chemotherapy (doxorubicin, bleomycin, vinblastine and dacarbazine) for Hodgkin lymphoma. However, the need for growth factor support is unclear, with studies suggesting that dose intensity can be maintained without G-CSF. Moreover, G-CSF is expensive (pegfilgrastim: EUR 1540/cycle; 300 μg filgrastim for 7 days: EUR 700/cycle) and is associated with side effects including bone pain and increased risk of bleomycin lung toxicity. Intermittent G-CSF may be an effective compromise, given that the effect of G-CSF on granulocyte precursors in vitro persists for 4-5 days after administration. After promising results of a pilot study, this schedule has been used subsequently in the majority of our patients receiving G-CSF as secondary prophylaxis for ABVD complicated by neutropenia. METHODS Retrospective analysis of the incidence of febrile neutropenia and treatment delay in a variety of different G-CSF schedules used as secondary prophylaxis in patients receiving ABVD. RESULTS 848 cycles in 85 consecutive patients were evaluated. Most patients (86%) received G-CSF, generally commenced prophylactically for neutropenia when cycle 1B was due. Intermittent G-CSF (typically given on days 4, 8 and 12) was used in 413 cycles compared with daily or pegylated G-CSF in 99 cycles. In patients receiving intermittent G-CSF, the median neutrophil count, across all cycles, was 7.3 × 10(9) /L (range: 1.4-47.1) when the next scheduled chemotherapy was due. There were two cases of febrile neutropenia (0.45%) and no treatment delays. One patient developed possible bleomycin toxicity. CONCLUSIONS Intermittent G-CSF is effective in maintaining dose intensity in patients receiving ABVD.
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Affiliation(s)
- Prahlad Ho
- Department of Clinical Haematology, Austin Health, Heidelberg, Victoria, Australia
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38
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Le point sur la toxicité pulmonaire des G-CSF. Bull Cancer 2012; 99:211-7. [DOI: 10.1684/bdc.2011.1534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
AbstractAdvanced-stage Hodgkin lymphoma (HL) has become a curable disease in the majority of patients. Research during the last decade has challenged chemotherapy with Adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) as the standard of care and debates continue regarding the role of radiation therapy (RT) in this patient population. The incorporation of interim positron emission tomography (PET) imaging and, recently, further characterization of HL on cellular and molecular levels are emerging as tools for treatment stratification and predictors of disease status. Newer targeted therapies have emerged that are very effective in the relapsed setting and are actively being explored as frontline therapy. Lastly, the expanding population of survivors cured of HL outnumbers patients with the disease and needs to be monitored for therapy-related late effects.
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Abstract
Radiation therapy (RT) alone and more recently in combination with chemotherapy (combined modality therapy; CMT) has been the cornerstone of curative treatment for early-stage Hodgkin lymphoma (HL) for over 40 years. Because of increasing awareness of the late morbidity and mortality associated with RT, recent treatment regimens have attempted to limit its use. Chemotherapy only has been demonstrated to be a treatment option for most patients with localized HL. Current clinical trials have targeted subgroups of such patients who may be at an increased risk of recurrence for the addition of limited RT to chemotherapy.
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Affiliation(s)
- D J Straus
- Memorial Sloan-Kettering Cancer Center, Department of Medicine, Weill Medical College of Cornell University, New York, NY 10021, USA.
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Minuk LA, Monkman K, Chin-Yee IH, Lazo-Langner A, Bhagirath V, Chin-Yee BH, Mangel JE. Treatment of Hodgkin lymphoma with adriamycin, bleomycin, vinblastine and dacarbazine without routine granulocyte-colony stimulating factor support does not increase the risk of febrile neutropenia: a prospective cohort study. Leuk Lymphoma 2011; 53:57-63. [DOI: 10.3109/10428194.2011.602771] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Neutropenia and Neutropenic Complications in ABVD Chemotherapy for Hodgkin Lymphoma. Adv Hematol 2011; 2011:656013. [PMID: 21687649 PMCID: PMC3112508 DOI: 10.1155/2011/656013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 02/27/2011] [Indexed: 01/23/2023] Open
Abstract
A combination of Adriamycin (a.k.a. Doxorubicin), Bleomycin, Vinblastine, and Dacarbazine (ABVD) is the most commonly used chemotherapy regime for Hodgkin lymphoma. This highly effective treatment is associated with a significant risk of neutropenia. Various strategies are adopted to counter this commonly encountered problem, including dose modification, use of colony stimulating factors, and prophylactic or therapeutic use of antibiotics. Data to support these approaches is somewhat controversial, and in keeping with the paucity of definitive evidence, there is a wide disparity in the management of neutropenia in patients receiving ABVD chemotherapy. This paper summarizes the evidence for managing ABVD-related neutropenia during the treatment of Hodgkin lymphoma.
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Hodgkin's lymphoma--long-term outcome: an experience from a tertiary care cancer center in North India. Ann Hematol 2011; 90:1153-60. [PMID: 21625999 DOI: 10.1007/s00277-011-1262-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 05/16/2011] [Indexed: 10/18/2022]
Abstract
Limited information is available from developing countries on long-term outcome of patients with Hodgkin's lymphoma (HL). Between January 1998 and December 2005, 262 patients (age ≥15 years) underwent treatment. Patients' median age was 30 years, ranging from 15 to 72 years. Male to female ratio was 2.8:1. B symptoms were present in 64% of patients. Seventy percent of patients had stage III and IV disease. Mixed cellularity (52.3%) was the most common histology followed by nodular sclerosis (38%). ABVD chemotherapy was used in 85% of the patients, and 50% received radiotherapy as consolidation. Following treatment 92% of patients achieved complete response. Five-year freedom from treatment failure (FFTF) and overall survival rate are 78.3% and 86.6% ± 0.02% (95% CI 80.0-93.2%), respectively. Stage at presentation, number of lymph node regions involved (≥3 vs ≤2), presence of B symptoms, and serum albumin (≥40 vs <40 g/L) were important determinants of FFTF. In a subset analysis of stage I and II HL patients, presence of bulky disease and pure infradiaphragmatic disease was associated with inferior outcome. On multivariate analysis involvement of three or more number of lymph node regions was a significant predictor of inferior freedom from treatment failure survival (hazard ratio 2.2, p < 0.01). Our analysis confirms excellent outcome for patients of Hodgkin's lymphoma with results comparable to developed countries.
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Wirth A, Grigg A, Wolf M, Goldstein D, Johnson C, Davis S, Dutu G, Kypreos P, Smith C, Kneebone A, Herzberg M, Joseph D, Catalano J, Roos D, Stone J, Reynolds J. Risk and response adapted therapy for early stage Hodgkin lymphoma: a prospective multicenter study of the Australasian Leukaemia and Lymphoma Group/Trans-Tasman Radiation Oncology Group. Leuk Lymphoma 2011; 52:786-95. [DOI: 10.3109/10428194.2010.547155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Presentation of Hodgkin lymphoma (HL) is distinctive in the infected individual being more advanced, accompanied by B symptoms and the presence of extranodal disease particularly lymphadenopathy of the head and neck. Bone marrow involvement may be found in over 50% of cases. Virtually all co express gamma-herpesvirus. Phenotypically there is prominence of the mixed-cellularity and lymphocyte depleted histopathologic subtypes that define an aggressive clinical course in comparison to other variants. Prior to the induction of cART, median survival was only 1-2 years. Notably the first chemotherapy trial using ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in 21 patients, without treating the viral infection, resulted in a 43% complete remission rate accompanied by severe haematological toxicities but did not extend median survival with this being 1.5 years matching the negative cases. Significant change accompanied concomitant anti-retroviral therapy that could be given safely even with dose intensive regimens exemplified by BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) in 12 patients or the Stanford V regimen (doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin, prednisone) coupled with involved-field radiation for bulky disease studied in 59 patients. BEACOPP extended overall survival (OS) to 83% at 2 years. A similar trend was seen when using the Stanford V regimen with an OS rate of 51% at 3 years, disease-free survival (DFS) of 68% and freedom from progression (FFP) in 60%. Additional benefits accrued from supportive care with stimulatory peptides such as G-CSF and when combined with bacterial prophylaxis results approached that found in the uninfected reference group. Current consensus holds this particular lymphoma as still among the non-AIDS defining cancers being lung, stomach, liver or anal despite these having recently gained more attention as several of these neoplasms may be occurring more commonly in the era of cART. While the relative risk of developing a non-AIDS-defining neoplasm in HIV-infected persons on the average is 2-3 times, the risk for developing HL in HIV-infected cases impressively ranges between 5 and 25 times when compared to the general population. Based on the precedent in which Kaposi sarcoma and the non-Hodgkin lymphomas distinctively alter the course of this retroviral infection in a way indistinguishable from concurrent Hodgkin lymphoma we propose that this entity be similarly regarded and the hypothesis tested in large randomised prospective study.
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Affiliation(s)
- Gerhard Sissolak
- Division of Clinical Haematology, Department of Internal Medicine, Faculty of Health Sciences, Stellenbosch University, Tygerberg Academic Hospital, South Africa
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Schwenkglenks M, Pettengell R, Szucs TD, Culakova E, Lyman GH. Hodgkin lymphoma treatment with ABVD in the US and the EU: neutropenia occurrence and impaired chemotherapy delivery. J Hematol Oncol 2010; 3:27. [PMID: 20723212 PMCID: PMC2933589 DOI: 10.1186/1756-8722-3-27] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 08/19/2010] [Indexed: 11/22/2022] Open
Abstract
Background In newly diagnosed patients with Hodgkin lymphoma (HL) the effect of doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD)-related neutropenia on chemotherapy delivery is poorly documented. The aim of this analysis was to assess the impact of chemotherapy-induced neutropenia (CIN) on ABVD chemotherapy delivery in HL patients. Study design Data from two similarly designed, prospective, observational studies conducted in the US and the EU were analysed. One hundred and fifteen HL patients who started a new course of ABVD during 2002-2005 were included. The primary objective was to document the effect of neutropenic complications on delivery of ABVD chemotherapy in HL patients. Secondary objectives were to investigate the incidence of CIN and febrile neutropenia (FN) and to compare US and EU practice with ABVD therapy in HL. Pooled data were analysed to explore univariate associations with neutropenic events. Results Chemotherapy delivery was suboptimal (with a relative dose intensity ≤ 85%) in 18-22% of patients. The incidence of grade 4 CIN in cycles 1-4 was lower in US patients (US 24% vs. EU 32%). Patients in both the US and the EU experienced similar rates of FN across cycles 1-4 (US 12% vs. EU 11%). Use of primary colony-stimulating factor (CSF) prophylaxis and of any CSF was more common in the US than the EU (37% vs. 4% and 78% vs. 38%, respectively). The relative risk (RR) of dose delays was 1.54 (95% confidence interval [CI] 1.08-2.23, p = 0.036) for patients with vs. without grade 4 CIN and the RR of grade 4 CIN was 0.35 (95% CI 0.12-1.06, p = 0.046) for patients with vs. without primary CSF prophylaxis. Conclusions In this population of HL patients, CIN was frequent and FN occurrence clinically relevant. Chemotherapy delivery was suboptimal. CSF prophylaxis appeared to reduce CIN rates.
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Tauro S, Cochrane L, Lauritzsen GF, Baker L, Delabie J, Roberts C, Mahendra P, Holte H. Dose-intensified treatment of Burkitt lymphoma and B-cell lymphoma unclassifiable, (with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma) in young adults (<50 years): a comparison of two adapted BFM protocols. Am J Hematol 2010; 85:261-3. [PMID: 20201088 DOI: 10.1002/ajh.21648] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The chemotherapy dose-intensity in two adapted German BFM paediatric protocols (BFM 90 and NHL 86) was compared in contemporaneously treated adults <50 years with Burkitt lymphoma and B-cell lymphoma unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma (collectively referred to as BL). In BFM 90, primary prophylaxis with Granulocyte-colony-stimulating factor was used, postinduction treatment was started at granulocytes > or =0.5 x 10(9)/L (> or =1.0 x 10(9)/L in NHL 86) with a higher mean methotrexate dose (2.9 g/m(2)/cycle, n = 23; 1.6 g/m(2)/cycle in NHL 86, n = 22, P < 0.001). Intervals between consecutive treatment-cycles were shorter in BFM 90 (P < 0.001) with no additional toxicity. However, the two-year failure-free survival with BFM 90 (82%) was similar to that achieved with NHL 86 (72%, P = 0.33). We conclude that BFM 90 enables safe intensification of therapy in young adults with BL compared to NHL 86, but registry-based studies are required to further evaluate the antineoplastic effects and cost-effectiveness of the two therapeutic approaches.
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Affiliation(s)
- Sudhir Tauro
- Department of Haematology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
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Bartlett NL. The present: optimizing therapy--too much or too little? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2010; 2010:108-114. [PMID: 21239779 DOI: 10.1182/asheducation-2010.1.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Despite the use of less toxic chemotherapy and more limited doses and fields of radiation, the prognosis for patients with all stages of classical Hodgkin lymphoma (HL) has continued to improve over the last 20 years. The challenge today is better identification of prognostic markers that will allow even further reduction of therapy in the most favorable subsets and new approaches for those who have a high risk of failure with current approaches. Most ongoing clinical trials for newly diagnosed HL base therapy decisions on the result of an interim restaging PET/CT, de-escalating for early responders and escalating for patients with a suboptimal response. While awaiting the results of these important trials, the debates rage on regarding the use of consolidative radiotherapy in early stage HL and the use of escalated BEACOPP in advanced stage disease. Unfortunately, we still face the very difficult decision with nearly every patient with HL of "too much," risking long-term consequences, or "too little," risking relapse and the need for additional toxic therapy. At present, we need to make these very difficult initial treatment decisions with inadequate data, but reassured by the excellent outcomes for most patients and encouraged by the new agents available for those who fail first-line therapy.
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Affiliation(s)
- Nancy L Bartlett
- Siteman Cancer Center, Washington University, St. Louis, MO 63110, USA.
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Pettengell R, Aapro M, Brusamolino E, Caballero D, Coiffier B, Pfreundschuh M, Trneny M, Walewski J. Implications of the European Organisation for Research And Treatment Of Cancer (EORTC) guidelines on the use of granulocyte colony-stimulating factor (G-CSF) for lymphoma care. Clin Drug Investig 2009; 29:491-513. [PMID: 19591512 DOI: 10.2165/00044011-200929080-00001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Febrile neutropenia (FN) is a potentially life-threatening complication of myelosuppressive chemotherapy. The European Organisation for Research and Treatment of Cancer (EORTC) guidelines recommend use of primary granulocyte colony-stimulating factor (G-CSF) prophylaxis if the overall FN risk to a patient is >or=20%, or if a reduction in chemotherapy dose intensity correlates with a poorer outcome. Many of the regimens used for treatment of lymphoma, including R-CHOP (rituximab combined with cyclophosphamide, doxorubicin, vincristine and prednisolone), are associated with an FN risk of approximately 20% or higher. Individual patient factors that may increase the risk of FN such as advanced age or advanced disease should be taken into account when assessing the need for G-CSF support. Predictive models are being developed to facilitate individual risk assessment. Additional anti-infective prophylaxis may be indicated in some settings. There is now much evidence for the benefits of G-CSF in reducing the incidence of FN and facilitating delivery of chemotherapy, including dose-escalated and dose-dense (interval-reduced) regimens. If given according to guidelines, G-CSF has the potential to reduce FN and related morbidity. Furthermore, by facilitating delivery of planned chemotherapy, use of G-CSF may potentially influence survival in the curative setting. Implementation of the EORTC guidelines will lead to a greater proportion of patients receiving G-CSFs, but the costs involved should be at least partly offset by a reduction in FN and its associated costs, including those of hospitalization.
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Affiliation(s)
- Ruth Pettengell
- Department of Heamatology, St George's University of London, Cranmer Terrace, London, UK.
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