1
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Wang J, Wang Y, Jiang X. Targeting anticancer immunity in melanoma tumour microenvironment: unleashing the potential of adjuvants, drugs, and phytochemicals. J Drug Target 2024:1-21. [PMID: 39041142 DOI: 10.1080/1061186x.2024.2384071] [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: 05/08/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 07/24/2024]
Abstract
Melanoma poses a challenge in oncology because of its aggressive nature and limited treatment modalities. The tumour microenvironment (TME) in melanoma contains unique properties such as an immunosuppressive and high-density environment, unusual vasculature, and a high number of stromal and immunosuppressive cells. In recent years, numerous experiments have focused on boosting the immune system to effectively remove malignant cells. Adjuvants, consisting of phytochemicals, toll-like receptor (TLR) agonists, and cytokines, have shown encouraging results in triggering antitumor immunity and augmenting the therapeutic effectiveness of anticancer therapy. These adjuvants can stimulate the maturation of dendritic cells (DCs) and infiltration of cytotoxic CD8+ T lymphocytes (CTLs). Furthermore, nanocarriers can help to deliver immunomodulators and antigens directly to the tumour stroma, thereby improving their efficacy against malignant cells. The remodelling of melanoma TME utilising phytochemicals, agonists, and other adjuvants can be combined with current modalities for improving therapy outcomes. This review article explores the potential of adjuvants, drugs, and their nanoformulations in enhancing the anticancer potency of macrophages, CTLs, and natural killer (NK) cells. Additionally, the capacity of these agents to repress the function of immunosuppressive components of melanoma TME, such as immunosuppressive subsets of macrophages, stromal and myeloid cells will be discussed.
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Affiliation(s)
- Jingping Wang
- Emergency Department, Zhejiang Provincial General Hospital of the Chinese People's Armed Police Force, Zhejiang, China
| | - Yaping Wang
- Respiratory and Oncology Department, Zhejiang Provincial General Hospital of the Chinese People's Armed Police Force, Zhejiang, China
| | - Xiaofang Jiang
- Respiratory and Oncology Department, Zhejiang Provincial General Hospital of the Chinese People's Armed Police Force, Zhejiang, China
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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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Vassilakopoulos TP, Liaskas A, Pereyra P, Panayiotidis P, Angelopoulou MK, Gallamini A. Incorporating Monoclonal Antibodies into the First-Line Treatment of Classical Hodgkin Lymphoma. Int J Mol Sci 2023; 24:13187. [PMID: 37685994 PMCID: PMC10487754 DOI: 10.3390/ijms241713187] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023] Open
Abstract
The long-term survival of Hodgkin lymphoma (HL) patients treated according to the current standard of care is excellent. Combined-modality schedules (ABVD plus radiotherapy) in early-stage disease, along with treatment intensity adaptation to early metabolic response assessed by PET/CT in advanced stage HL, have been the cornerstones of risk stratification and treatment decision-making, minimizing treatment-related complications while keeping efficacy. Nevertheless, a non-negligible number of patients are primary refractory or relapse after front-line treatment. Novel immunotherapeutic agents, namely Brentuximab Vedotin (BV) and immune checkpoint inhibitors (CPI), have already shown outstanding efficacy in a relapsed/refractory setting in recent landmark studies. Several phase 2 single-arm studies suggest that the addition of these agents in the frontline setting could further improve long-term disease control permitting one to reduce the exposure to cytotoxic drugs. However, a longer follow-up is needed. At the time of this writing, the only randomized phase 3 trial so far published is the ECHELON-1, which compares 1 to 1 BV-AVD (Bleomycin is replaced by BV) with standard ABVD in untreated advanced-stage III and IV HL. The ECHELON-1 trial has proven that BV-AVD is safe and more effective both in terms of long-term disease control and overall survival. Just recently, the results of the S1826 SWOG trial demonstrated that the combination nivolumab-AVD (N-AVD) is better than BV-AVD, while preliminary results of other randomized ongoing phase 3 trials incorporating anti-PD-1 in this setting will be soon available. The aim of this review is to present the recent data regarding these novel agents in first-line treatment of HL and to highlight current and future trends which will hopefully reshape the overall management of this disease.
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Affiliation(s)
- Theodoros P. Vassilakopoulos
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; (A.L.); (P.P.); (M.K.A.)
| | - Athanasios Liaskas
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; (A.L.); (P.P.); (M.K.A.)
| | - Patricio Pereyra
- Department of Hematology, National Hospital Alejandro Posadas, Buenos Aires 1684, Argentina;
| | - Panayiotis Panayiotidis
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; (A.L.); (P.P.); (M.K.A.)
| | - Maria K. Angelopoulou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; (A.L.); (P.P.); (M.K.A.)
| | - Andrea Gallamini
- Research and Clinical Innovation Department, Antoine Lacassagne Cancer Center, 06100 Nice, France;
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4
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Nguyen J, Wellard C, Chung E, Cheah CY, Dickinson M, Doo NW, Keane C, Talaulikar D, Berkahn L, Morgan S, Hamad N, Cochrane T, Johnston AM, Forsyth C, Opat S, Barraclough A, Mutsando H, Ratnasingam S, Giri P, Wood EM, McQuilten ZK, Hawkes EA. Clinical characteristics of Australian treatment-naïve patients with classical Hodgkin lymphoma from the lymphoma and related diseases registry. Eur J Haematol 2023; 110:386-395. [PMID: 36539351 DOI: 10.1111/ejh.13915] [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: 10/13/2022] [Revised: 12/03/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
Comprehensive clinical characteristics of Australian patients with classical Hodgkin Lymphoma (cHL) have not previously been systematically collected and described. We report real-world data of 498 eligible patients from the first 5 years of the Lymphoma and Related Diseases Registry (LaRDR), including baseline characteristics, histologic subtype, and treatment patterns in first-line therapy. Patient demographics and distribution of histopathological subtypes of cHL are similar to reported international cohorts. Doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) was the most common therapy for both early and advanced-stage disease, and 48% of patients with the early-stage disease received radiotherapy. Treatment patterns are consistent with international guidelines. In comorbid patients ≥60 years of age with advanced-stage disease, there is greater variation in treatment. In patients with a recorded response, the objective response rate (ORR) was 96% in early-stage disease, and 88% in advanced-stage disease. Early progression-free survival data suggest Australian patients with cHL have good outcomes, similar to other international studies.
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Affiliation(s)
| | - Cameron Wellard
- Monash University School of Public Health & Preventive Medicine, Melbourne, Victoria, Australia
| | - Eliza Chung
- Monash University School of Public Health & Preventive Medicine, Melbourne, Victoria, Australia
| | - Chan Y Cheah
- Sir Charles Gairdner Hospital and Medical School, University of Western Australia, Western Australia, Australia
| | - Michael Dickinson
- Peter MacCallum Cancer Centre; Royal Melbourne Hospital, and the Sir Peter MacCallum Department of Oncology at the University of Melbourne, Melbourne, Victoria, Australia
| | - Nicole Wong Doo
- Concord Repatriation General Hospital; Concord Clinical School, University of Sydney, Concord, New South Wales, Australia
| | - Colm Keane
- Princess Alexandra Hospital, Queensland, Australia
| | - Dipti Talaulikar
- Canberra Health Services, The Australian National University, Australian Capital Territory, Australia
| | | | | | - Nada Hamad
- St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Tara Cochrane
- Gold Coast University Hospital, Griffith University, Southport, Queensland, Australia
| | | | | | | | | | | | | | | | - Erica M Wood
- Monash University School of Public Health & Preventive Medicine, Melbourne, Victoria, Australia
| | - Zoe K McQuilten
- Monash University School of Public Health & Preventive Medicine, Melbourne, Victoria, Australia
| | - Eliza A Hawkes
- Monash University School of Public Health & Preventive Medicine, Melbourne, Victoria, Australia.,Olivia Newton John Cancer Research Institute at Austin Health, Victoria, Australia
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5
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Jennane S, Ababou M, El Haddad M, Ait Sahel O, Mahtat EM, El Maaroufi H, Doudouh A, Doghmi K. Bleomycin-Induced Lung Toxicity in Hodgkin's Lymphoma: Risk Factors in the Positron Emission Tomography Era. Cureus 2022; 14:e23993. [PMID: 35419251 PMCID: PMC8994685 DOI: 10.7759/cureus.23993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Bleomycin is a major antimitotic agent in the first-line treatment for Hodgkin's lymphoma. The main limitation of its use is its pulmonary toxicity. The objectives of this study are to find out the risk factors for the occurrence of bleomycin-induced lung toxicity in patients with Hodgkin's lymphoma and, on the other hand, to determine if positron emission tomography scan is a reliable means of early detection of this toxicity. Methods This is a retrospective study conducted in the clinical Hematology Department of Mohammed V Military Instruction Hospital, Rabat, Morocco. All patients with Hodgkin's lymphoma and treated with a bleomycin-based chemotherapy were included. The impact of different clinical and biological factors on the risk of bleomycin-induced lung toxicity occurrence was assessed using univariate and multivariate logistic regression. The benefit of positron emission tomography, usually performed as part of the re-assessment of Hodgkin’s lymphoma after two and four cycles, has been evaluated in the detection of bleomycin-induced lung toxicity. Results Among 124 patients included in the study, 18 (14.5%) patients experienced bleomycin-induced lung toxicity. On multivariate analysis, smoking (p = 0.038) and the use of the ABVD regimen (doxorubicin, bleomycin, vinblastine, and dacarbazine) compared to the escalated BEACOPPe regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) (p = 0.018) were statistically significant risk factors. After two and four courses of therapy, the positron emission tomography was able to predict the occurrence of bleomycin-induced lung toxicity before the appearance of clinical symptoms only in 36.4 % and 12.5% of patients, respectively. Conclusion Studies to identify risk factors for the development of bleomycin-induced lung toxicity are crucial to reduce toxicity in the treatment of Hodgkin's lymphoma. However, two- and four-cycle positron emission tomography scans cannot be considered as a reliable means of early detection of this toxicity.
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6
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Arter ZL, Meghpara S, Mignano S, Berenberg J. A Rare Coexistence of Seminoma and Hodgkin's Lymphoma in Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:295-297. [PMID: 34877541 PMCID: PMC8646864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Both Hodgkin's lymphoma and testicular cancers can present in young men; however, concurrent Hodgkin's lymphoma with seminoma is very rare. When they do coexist, careful consideration must be made to avoid missing new cancer by assuming the presence of primary metastatic disease when lymphadenopathy presents. Here we present a rare case of coexistence of seminoma and Hodgkin's lymphoma and the staging and treatment challenges associated with a 2-cancer diagnosis.
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Affiliation(s)
- Zhaohui Liao Arter
- Tripler Army Medical Center, Medicine Department, Honolulu, HI (ZLA, S.Meghpara, S. Mignano)
| | - Sanket Meghpara
- Tripler Army Medical Center, Medicine Department, Honolulu, HI (ZLA, S.Meghpara, S. Mignano)
| | - Salvatore Mignano
- Tripler Army Medical Center, Medicine Department, Honolulu, HI (ZLA, S.Meghpara, S. Mignano)
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7
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Prakash G, Jain A, Sahu K, Bal A, Singh C, Basher R, Singh H, Mishra K, Jandial A, Lad D, Khadwal A, Srinivasan R, Das A, Varma N, Varma S, Malhotra P. Bendamustine in combination with ifosfamide, etoposide, and vinorelbine (VIBE) is an effective salvage regimen for heavily pre-treated patients with relapsed or refractory Hodgkin lymphoma: a single-center experience. Blood Res 2021; 56:134-140. [PMID: 34400589 PMCID: PMC8478624 DOI: 10.5045/br.2021.2021039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/07/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study evaluated the outcomes of patients with refractory/relapsed Hodgkin lymphoma (RRHL) treated with a bendamustine-based regimen in combination with ifosfamide, etoposide, and vinorelbine (VIBE). Methods Consecutive RRHL patients who were treated with the VIBE regimen were identified and studied for clinicopathologic characteristics, response to VIBE regimen, event-free survival (EFS), and feasibility of an autologous stem-cell transplant (autoSCT). Results In total, 24 patients received the VIBE regimen, and a median of 3 cycles were administered. In this cohort, 80% of the patients had received ≥2 prior lines of therapy. The overall and complete response rates with VIBE were 79% and 42%, respectively. After a median follow-up (following VIBE regimen) of 14 months (range, 3‒76), the 3-year EFS and OS were 46% and 74%, respectively. Of the eligible patients, 92% underwent successful AutoSCT. The mean CD34+ cell count in the autograft was 5.5×106/kg (SD 2.07). Neutropenia was the commonest hematologic toxicity and it was observed in 42% of the patients. However, only 9% of the patients developed grade III/IV febrile neutropenia. Chemotherapy-induced nausea and vomiting were the second most common grade III/IV toxicities in our cohort of patients. Conclusion In this retrospective analysis, the combination regimen, VIBE, has shown good efficacy in heavily pre-treated patients with RRHL without compromising stem cell collection. These encouraging results provide a rationale for further development of this regimen.
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Affiliation(s)
- Gaurav Prakash
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arihant Jain
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamalkant Sahu
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Charanpreet Singh
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajender Basher
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harmandeep Singh
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kundan Mishra
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya Jandial
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepesh Lad
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Varma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Clinical Hematology and BMT Division, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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8
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Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Armand P, Bello CM, Benitez CM, Bierman PJ, Boughan KM, Dabaja B, Gordon LI, Hernandez-Ilizaliturri FJ, Herrera AF, Hochberg EP, Huang J, Johnston PB, Kaminski MS, Kenkre VP, Khan N, Lynch RC, Maddocks K, McConathy J, McKinney M, Metzger M, Morgan D, Mulroney C, Rabinovitch R, Rosenspire KC, Seropian S, Tao R, Winter JN, Yahalom J, Burns JL, Ogba N. Hodgkin Lymphoma, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:755-781. [PMID: 32502987 DOI: 10.6004/jnccn.2020.0026] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The NCCN Clinical Practice Guidelines in Oncology for Hodgkin Lymphoma (HL) provide recommendations for the management of adult patients with HL. The NCCN panel meets at least annually to review comments from reviewers within their institutions, examine relevant data, and reevaluate and update their recommendations. Current management of classic HL involves initial treatment with chemotherapy alone or combined modality therapy followed by restaging with PET/CT to assess treatment response. Overall, the introduction of less toxic and more effective regimens has significantly advanced HL cure rates. This portion of the NCCN Guidelines focuses on the management of classic HL.
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Affiliation(s)
| | | | - Weiyun Z Ai
- 2UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | | | - Kirsten M Boughan
- 7Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Leo I Gordon
- 9Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Jiayi Huang
- 13Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Ryan C Lynch
- 18Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Kami Maddocks
- 19The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Monika Metzger
- 22St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | - Randa Tao
- 28Huntsman Cancer Institute at the University of Utah
| | - Jane N Winter
- 9Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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9
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Driessen J, Visser O, Zijlstra JM, Lugtenburg PJ, Plattel WJ, Kersten MJ, Dinmohamed AG. Primary therapy and relative survival in classical Hodgkin lymphoma: a nationwide population-based study in the Netherlands, 1989-2017. Leukemia 2020; 35:494-505. [PMID: 32461630 DOI: 10.1038/s41375-020-0875-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 01/17/2023]
Abstract
Population-based studies of classical Hodgkin lymphoma (cHL) in contemporary clinical practice are scarce. The aim of this nationwide population-based study is to assess trends in primary therapy and relative survival (RS) during 1989-2017. We included 9,985 patients with cHL. Radiotherapy alone was virtually not applied as from 2000 among patients aged 18-69 years with stage I/II disease, following the broader application of chemotherapy combined with radiotherapy. Chemotherapy only was the preferred treatment for patients with stage III/IV disease. Throughout the entire study period, around 20% of patients aged ≥70 years across all disease stages received no anti-neoplastic therapy. The most considerable improvements in 5-year RS were confined to patients aged 18-59 years. Five-year RS for patients with stage I/II disease diagnosed during 2010-2017 was 99%, 98%, 100%, 93%, 84%, and 61% for patients aged 18-29, 30-39, 40-49, 50-59, 60-69, and ≥70 years, respectively. The corresponding estimates for stage III/IV disease were 96%, 92%, 90%, 80%, 58%, and 46%. Collectively, the improvements in survival likely relate to advances in cHL management. These achievements, however, do not seem to translate into significant benefits for patients ≥60 years. Therefore, novel therapies are urgently needed to reduce excess mortality in elderly cHL patients.
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Affiliation(s)
- Julia Driessen
- Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Josée M Zijlstra
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Wouter J Plattel
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Avinash G Dinmohamed
- Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Public Health, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
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10
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Relecom A, Federico M, Connors JM, Coiffier B, Biasoli I, Moccia A, Salles G, McKee T, Miralbell R, Borchmann P, Kuruvilla J, Johnson P, Cavalli F, Delavy M, Dietrich PY, Flahault A. Resources-Stratified Guidelines for Classical Hodgkin Lymphoma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051783. [PMID: 32182952 PMCID: PMC7084688 DOI: 10.3390/ijerph17051783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/19/2020] [Accepted: 02/28/2020] [Indexed: 01/23/2023]
Abstract
Hodgkin lymphoma is a haematological malignancy predominantly affecting young adults. Hodgkin lymphoma is a highly curable disease by current treatment standards. Latest treatment guidelines for Hodgkin lymphoma however imply access to diagnostic and treatment modalities that may not be available in settings with restricted healthcare resources. Considerable discrepancies in Hodgkin lymphoma patient survival exist, with poorer outcomes reported in resources-constrained settings. Resources-stratified guidelines for diagnosis, staging and treatment of Hodgkin lymphoma were derived in an effort to optimize patient outcome provided a given setting of available resources. These guidelines were derived based on the framework of the Breast Health Global Initiative stratifying resource levels in basic, core, advanced and maximal categories.
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Affiliation(s)
- Allan Relecom
- Department of Oncology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland; (A.R.); (P.-Y.D.)
| | - Massimo Federico
- Medical Oncology, CHIMOMO Department, University of Modena and Reggio Emilia, Via Università 4, 41121 Modena, Italy;
| | - Joseph M. Connors
- BC Cancer Agency, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 1G1, Canada;
| | - Bertrand Coiffier
- Department of Hematology, Hospices Civils de Lyon, 3 Quai des Celestins, 69002 Lyon, France;
| | - Irene Biasoli
- Internal Medicine Department, Federal Univsersity of Rio de Janeiro, Av. Pedro Calmon, 550-Cidade Universitária-Rio de Janeiro, RJ 21941-901, Brazil;
| | - Alden Moccia
- Oncology Institute of Southern Switzerland (IOSI) Ospedale Regionale di Locarno “La Carità”, Via Ospedale 1 CH-6600 Locarno;
| | - Gilles Salles
- Groupe d’étude des lymphomes de l’adulte, CHU de Lyon HCL-GH Sud, 165 Chemin du Grand Revoyet, 69495 Pierre-Benite Cedex, France;
| | - Thomas McKee
- Clinical Pathology Unit, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva Switzerland
- Faculté de Médecine, Geneva University, Rue Michel-Servet 1, 1206 Genève, Switzerland
| | - Raymond Miralbell
- Department of Oncology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland; (A.R.); (P.-Y.D.)
| | - Peter Borchmann
- Department of Internal Medicine, University Hospital of Cologne, Karpener Str 62, 50924 Cologne, Germany;
| | - John Kuruvilla
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, ON M5G 2C1, Canada;
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Peter Johnson
- Faculty of Medicine, University of Southampton, Southampton S017 1BJ, UK;
| | - Franco Cavalli
- Institute of Oncology Research (IOR), Via Vela 6, 6500 Bellinzona, Switzerland;
| | - Martine Delavy
- Institute of Global Health, Faculty of Medicine, University of Geneva, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland;
| | - Pierre-Yves Dietrich
- Department of Oncology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland; (A.R.); (P.-Y.D.)
- Faculté de Médecine, Geneva University, Rue Michel-Servet 1, 1206 Genève, Switzerland
| | - Antoine Flahault
- Institute of Global Health, Faculty of Medicine, University of Geneva, Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland;
- Correspondence:
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11
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Myint ZW, Shrestha R, Siddiqui S, Slone S, Huang B, Ramlal R, Monohan GP, Hildebrandt GC, Saeed H. Ten-year survival outcomes for patients with early stage classical Hodgkin lymphoma: An analysis from Kentucky Cancer Registry. Hematol Oncol Stem Cell Ther 2019; 13:17-22. [PMID: 31629724 DOI: 10.1016/j.hemonc.2019.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE/BACKGROUND Early stage classical Hodgkin lymphoma (cHL) has an excellent outcome. Recent studies focus on decreasing toxicity related to the addition of radiation along with chemotherapy. Real-life reporting of the addition of radiation to chemotherapy is lacking. This study investigates the outcomes obtained from a statewide cancer registry for early stage cHL patients treated with chemotherapy alone (CT) versus patients treated with the combined modality of chemotherapy and radiation (CMT). METHODS A retrospective study of cHL patients diagnosed and treated was identified using a statewide cancer registry from 2005 to 2014. Patients with early stage disease (I, II) were then grouped on the basis of the presence of B symptoms into favorable and unfavorable groups. Baseline characteristics (age, gender, extranodal involvement, and histology) as well as overall survival were compared for both groups depending on whether they received CT or CMT as first line therapy for their cHL. RESULTS A total of 961 patients were identified; of those, 127 were excluded as they received only radiation or another form of treatment. Of the remaining patients, 293 were categorized as early stage favorable cHL (Group 1) and 130 adults were in the unfavorable cHL (Group 2). There were 335 patients with advanced stage cHL (Group 3) and 76 patients in an unknown stage. The 10-year overall survival for Group 1 was 81.3% versus 76.3% for Group 2 and 52.7% for Group 3. For Group 1, 10-year overall survival was 86.7% with CMT versus 75.1% for those receiving CT only (p = .004). For Group 2, there was no difference in 10-year overall survival between the CMT group (80.0%) and CT (72.5%) (p = .73). CONCLUSION While radiation therapy might increase long-term toxicity in cHL, in our large data cohort, radiotherapy consolidation as part of the initial therapy for early stage disease provides superior survival at 10 years, especially in favorable risk cHL.
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Affiliation(s)
- Zin W Myint
- Department of Internal Medicine, Division of Medical Oncology, University of Kentucky, USA
| | - Runa Shrestha
- Department of Internal Medicine, Division of Hematology/BMT, USA
| | | | - Stacey Slone
- Biostatistics and Bioinformatics Shared Resources Facility, USA
| | - Bin Huang
- Department of Internal Medicine, Division of Hematology/BMT, USA; Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Reshma Ramlal
- Department of Internal Medicine, Division of Hematology/BMT, USA
| | | | | | - Hayder Saeed
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
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Besse HC, Barten-van Rijbroek AD, van der Wurff-Jacobs KMG, Bos C, Moonen CTW, Deckers R. Tumor Drug Distribution after Local Drug Delivery by Hyperthermia, In Vivo. Cancers (Basel) 2019; 11:cancers11101512. [PMID: 31600958 PMCID: PMC6826934 DOI: 10.3390/cancers11101512] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 02/02/2023] Open
Abstract
Tumor drug distribution and concentration are important factors for effective tumor treatment. A promising method to enhance the distribution and the concentration of the drug in the tumor is to encapsulate the drug in a temperature sensitive liposome. The aim of this study was to investigate the tumor drug distribution after treatment with various injected doses of different liposomal formulations of doxorubicin, ThermoDox (temperature sensitive liposomes) and DOXIL (non-temperature sensitive liposomes), and free doxorubicin at macroscopic and microscopic levels. Only ThermoDox treatment was combined with hyperthermia. Experiments were performed in mice bearing a human fibrosarcoma. At low and intermediate doses, the largest growth delay was obtained with ThermoDox, and at the largest dose, the largest growth delay was obtained with DOXIL. On histology, tumor areas with increased doxorubicin concentration correlated with decreased cell proliferation, and substantial variations in doxorubicin heterogeneity were observed. ThermoDox treatment resulted in higher tissue drug levels than DOXIL and free doxorubicin for the same dose. A relation with the distance to the vasculature was shown, but vessel perfusion was not always sufficient to determine doxorubicin delivery. Our results indicate that tumor drug distribution is an important factor for effective tumor treatment and that its dependence on delivery formulation merits further systemic investigation.
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Affiliation(s)
- Helena C Besse
- Center of Imaging Sciences, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | | | - Kim M G van der Wurff-Jacobs
- Center of Imaging Sciences, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Clemens Bos
- Center of Imaging Sciences, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Chrit T W Moonen
- Center of Imaging Sciences, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Roel Deckers
- Center of Imaging Sciences, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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13
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Taparra K, Liu H, Polley MY, Ristow K, Habermann TM, Ansell SM. Bleomycin use in the treatment of Hodgkin lymphoma (HL): toxicity and outcomes in the modern era. Leuk Lymphoma 2019; 61:298-308. [PMID: 31517559 DOI: 10.1080/10428194.2019.1663419] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
One-in-five Hodgkin Lymphoma (HL) patients treated with bleomycin develop bleomycin pulmonary toxicity (BPT). Given bleomycin-omission data with negative interim-PET, we assessed changes in BPT statistics. We retrospectively evaluated 126 ABVD-treated HL patients for overall survival (OS), progression-free survival (PFS), BPT factors, and management. Forty-seven patients developed BPT with 17% BPT-mortality. In univariable analysis, OS was negatively impacted by BPT (HR = 3.6, 95%CI = 1.2-10.6), but not bleomycin-omission (HR = 1.3, 95%CI = 0.5-3.7). In multivariable analysis, BPT was not associated with OS (HR = 3.0, 95%CI = 0.9-9.9). BPT patients were older (46 y vs 33 years) and received less bleomycin (107 vs 215 units) compared to non-BPT patients. BPT was managed primarily with bleomycin-omission. "Recent Era" patients had lower BPT rates (28% vs 48%), mortality (10% vs 21%), and bleomycin doses (7 vs 12 doses), yet higher bleomycin-omission in the absence of the BPT (59% vs 8%) compared to "Early Era". Our data suggest BPT continually impacts OS in ABVD-treated HL patients, however management is changing.
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Affiliation(s)
- Kekoa Taparra
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Heshan Liu
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mei-Yin Polley
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Kay Ristow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Abstract
Early-stage classic Hodgkin lymphoma has been highly curable using extended-field radiation therapy (RT) alone, combined-modality therapy consisting of chemotherapy and RT, and more recently chemotherapy alone. Radiation therapy either to an extended field (extended-field RT) or to various iterations of an involved field (involved-field RT) is potentially associated with late morbidity and mortality, particularly second primary cancers and cardiovascular complications. Treatment with chemotherapy alone, when possible, can achieve a high cure rate while avoiding these risks. This review describes the evolution of treatment for early-stage classic Hodgkin lymphoma.
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15
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Brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine for nonbulky limited-stage classical Hodgkin lymphoma. Blood 2019; 134:606-613. [PMID: 31186274 DOI: 10.1182/blood.2019001272] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/01/2019] [Indexed: 11/20/2022] Open
Abstract
Doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) with or without radiation is standard therapy for limited-stage Hodgkin lymphoma (HL) but carries risks of bleomycin-induced lung injury and radiation toxicity. Brentuximab vedotin is highly active in relapsed HL and was recently approved with doxorubicin, vinblastine, and dacarbazine (AVD) for previously untreated stage III/IV HL. We evaluated brentuximab-AVD for nonbulky stage I/II HL in a multicenter phase 2 study. Patients received a lead-in cycle of brentuximab vedotin monotherapy on days 1 and 15, followed by an exploratory positron emission tomography/computed tomography scan. Patients then received brentuximab-AVD for 4 to 6 cycles based on interim positron emission tomography/computed tomography scanning after cycle 2. Thirty-four patients were enrolled with a median age of 36 years (range, 20-75 years). Risk was early favorable in 62% and unfavorable in 38%. The best complete response rate was 100%. At a median follow-up of 38 months, the progression-free survival and overall survival were 94% and 97%, respectively. The most common adverse events were peripheral sensory neuropathy (79%), neutropenia (76%), fatigue (74%), and nausea (71%). The most common grade 3/4 toxicities were neutropenia (62%), febrile neutropenia (35%), and peripheral sensory neuropathy (24%). One elderly patient died of neutropenic sepsis in the first brentuximab-AVD cycle. Brentuximab dose reductions were required in 38% of patients, most for peripheral neuropathy. In conclusion, brentuximab-AVD without bleomycin or radiation produced a high complete response rate, with most patients requiring only 4 total cycles of therapy. Because toxicity was higher than would be expected from AVD alone, this method may not be appropriate for early-stage patients with a highly favorable prognosis. This trial was registered at www.clinicaltrials.gov as #NCT01534078.
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Narkhede M, Sarraf Yazdy M, Cheson B. Determining the sequence of novel therapies in the treatment of relapsed Hodgkin's lymphoma. Expert Rev Hematol 2018; 11:773-780. [PMID: 30139285 DOI: 10.1080/17474086.2018.1516135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Hodgkin's lymphoma (HL) accounts for about 10% of all lymphomas in the U.S.A. Exceptional progress has been made in the treatment of HL with complete response (CR) rates up to 94% in limited stage and 88% in advanced stage disease with regimens such as adriamycin, bleomycin, vinblastine, and dacarbazine in the frontline setting. Nevertheless, up to 10% of patients with limited stage disease and 20-30% of those with advanced stage HL relapse. In the last decade, newer agents such as brentuximab vedotin (BV) and checkpoint inhibitors have been approved by the FDA for treatment of patients with relapsed or refractory HL. As these newer agents are increasingly incorporated in both the frontline and relapsed settings, their optimal sequence becomes challenging for clinicians. Areas covered: This review will discuss the evidence behind the approval of BV and checkpoint inhibitors in HL and the appropriate sequence for using them in relapsed HL. Expert commentary: The appropriate sequence of BV and/or checkpoint inhibitors in the relapsed setting depends on the regimen used in the frontline setting.
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Affiliation(s)
- Mayur Narkhede
- a Lombardi Comprehensive Cancer Center , MedStar Georgetown University Hospital , Washington , DC , USA
| | - Maryam Sarraf Yazdy
- a Lombardi Comprehensive Cancer Center , MedStar Georgetown University Hospital , Washington , DC , USA
| | - Bruce Cheson
- a Lombardi Comprehensive Cancer Center , MedStar Georgetown University Hospital , Washington , DC , USA
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17
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CALGB 50604: risk-adapted treatment of nonbulky early-stage Hodgkin lymphoma based on interim PET. Blood 2018; 132:1013-1021. [PMID: 30049811 DOI: 10.1182/blood-2018-01-827246] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/20/2018] [Indexed: 11/20/2022] Open
Abstract
A negative interim positron emission tomography/computerized tomography (PET/CT) after 1 to 3 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) in patients with newly diagnosed, nonbulky stage I or II Hodgkin lymphoma (HL) predicts a low relapse rate. This phase 2 trial was designed to determine if a population of patients with early-stage disease can be treated with short-course ABVD without radiation therapy (RT) on the basis of a negative interim PET/CT, thereby limiting the risks of treatment. Between 15 May 2010 and 21 February 2013, 164 previously untreated patients with nonbulky stage I/II HL were enrolled, and 149 were included in the final analysis. Patients received 2 cycles of ABVD followed by PET. Deauville scores 1 to 3 were negative (≤ liver uptake) based on central review. PET- patients received 2 more cycles of ABVD, and PET+ patients received 2 cycles of dose-intense bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (escalated BEACOPP) plus 3060-cGy involved-field RT. The primary objective was to determine 3-year progression-free survival (PFS) for the PET- group. One hundred thirty-five patients (91%) were interim PET-, and 14 patients (9%) were PET+ With median follow-up time of 3.8 years, the estimated 3-year PFS was 91% for the PET- group and 66% for the PET+ group (hazard ratio, 3.84; 95% confidence interval, 1.50-9.84; P = .011). There was 1 death as a result of suicide. Four cycles of ABVD resulted in durable remissions for a majority of patients with early-stage nonbulky HL and a negative interim PET. This trial was registered at www.clinicaltrials.gov as #NCT01132807.
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Spinner MA, Advani RH, Connors JM, Azzi J, Diefenbach C. New Treatment Algorithms in Hodgkin Lymphoma: Too Much or Too Little? Am Soc Clin Oncol Educ Book 2018; 38:626-636. [PMID: 30231319 DOI: 10.1200/edbk_200679] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hodgkin lymphoma treatment continues to evolve as new means of assessing response to treatment, new appreciation of important risk factors, and more effective therapeutic agents become available. Treatment algorithms integrating functional imaging now provide the opportunity to modify therapy during its delivery, allowing adjustment of duration and intensity of chemotherapy and rationale identification of patients who may benefit from the addition of therapeutic irradiation. Novel agents, including the antibody drug conjugate brentuximab vedotin and checkpoint inhibitors such as nivolumab and pembrolizumab can improve the effectiveness of treatment while keeping toxicity within acceptable limits. Carefully designed clinical trials permit the identification of superior approaches in which efficacy is enhanced and toxicity minimized. Clinicians treating patients with Hodgkin lymphoma now have access to novel treatment approaches, which will require detailed assessment of each patient and careful discussion of the goals and risks of treatment at the time of planning primary treatment, again during delivery of that treatment as data indicating ongoing effectiveness become available, at the conclusion of initial intervention, and, when the need arises, at the time of recurrence of disease.
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Affiliation(s)
- Michael A Spinner
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Ranjana H Advani
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Joseph M Connors
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Jacques Azzi
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Catherine Diefenbach
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
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19
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ABVD Without Radiation for Newly Diagnosed Pediatric and Young Adult Patients With Hodgkin Lymphoma: A Single Center Retrospective Analysis of 28 Consecutive Patients. J Pediatr Hematol Oncol 2018; 40:290-294. [PMID: 29432308 DOI: 10.1097/mph.0000000000001094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hodgkin lymphoma (HL) is the most common malignancy affecting adolescents and young adults. Treatment with a combination of chemotherapy and radiation results in cure rates of >90%. However, radiation therapy causes significant late effects and avoiding radiation entirely for patients who respond to chemotherapy is an accepted strategy. Since 2011, 28 consecutive patients diagnosed with classic HL have been treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) for 4 to 6 cycles. Patients who achieved a complete metabolic response (CMR) as assessed by [F] fluorodeoxyglucose positron emission tomography by the end of chemotherapy did not receive radiation. Among the 27 evaluable patients, 26/27 (96.2%) achieved a CMR with ABVD alone with 24/27 (88.9%) having achieved a CMR after 2 cycles. Event-free survival at 5 years is 90.5% and overall survival is 100% with a median follow-up time of 22.4 and 22.1 months, respectively. Treating pediatric and young adult HL patients with ABVD alone results in CMRs in >95% of patients. Patients who were refractory to ABVD or relapsed after treatment eventually achieved remission with a combination of standard and novel salvage therapies. This regimen demonstrates the feasibility of avoiding upfront radiation in newly diagnosed pediatric HL patients.
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20
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Parsons SK, Kelly MJ, Cohen JT, Castellino SM, Henderson TO, Kelly KM, Keller FG, Henzer TJ, Kumar AJ, Johnson P, Meyer RM, Radford J, Raemaekers J, Hodgson DC, Evens AM. Early-stage Hodgkin lymphoma in the modern era: simulation modelling to delineate long-term patient outcomes. Br J Haematol 2018; 182:212-221. [PMID: 29707774 PMCID: PMC6055753 DOI: 10.1111/bjh.15255] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/05/2018] [Indexed: 12/17/2022]
Abstract
We developed a novel simulation model integrating multiple data sets to project long-term outcomes with contemporary therapy for early-stage Hodgkin lymphoma (ESHL), namely combined modality therapy (CMT) versus chemotherapy alone (CA) via 18 F-fluorodeoxyglucose positron emission tomography response-adaption. The model incorporated 3-year progression-free survival (PFS), probability of cure with/without relapse, frequency of severe late effects (LEs), and 35-year probability of LEs. Furthermore, we generated estimates for quality-adjusted life years (QALYs) and unadjusted survival (life years, LY) and used model projections to compare outcomes for CMTversusCA for two index patients. Patient 1: a 25-year-old male with favourable ESHL (stage IA); Patient 2: a 25-year-old female with unfavourable ESHL (stage IIB). Sensitivity analyses assessed the impact of alternative assumptions for LE probabilities. For Patient 1, CMT was superior to CA (CMT incremental gain = 0·11 QALYs, 0·21 LYs). For Patient 2, CA was superior to CMT (CA incremental gain = 0·37 QALYs, 0·92 LYs). For Patient 1, the advantage of CMT changed minimally when the proportion of severe LEs was reduced from 20% to 5% (0·15 QALYs, 0·43 LYs), whereas increasing the severity proportion for Patient 2's LEs from 20% to 80% enhanced the advantage of CA (1·1 QALYs, 6·5 LYs). Collectively, this detailed simulation model quantified the long-term impact that varied host factors and alternative contemporary treatments have in ESHL.
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Affiliation(s)
- Susan K Parsons
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA.,Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.,Institute for Clinical Research and Health Policy Studies, Tufts MC, Boston, MA, USA.,Division of Hematology/Oncology, Tufts MC, Boston, MA, USA
| | - Michael J Kelly
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA.,Division of Pediatric Hematology/Oncology, The Floating Hospital for Children at Tufts Medical Center (MC), Boston, MA, USA
| | - Joshua T Cohen
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.,Institute for Clinical Research and Health Policy Studies, Tufts MC, Boston, MA, USA.,Center for the Evaluation of Value and Risk in Health, Tufts MC, Boston, MA, USA
| | - Sharon M Castellino
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Tara O Henderson
- Department of Pediatrics, Section of Hematology, Oncology and Stem Cell Transplantation, University of Chicago, Chicago, IL, USA
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Cancer Institute, University of Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Frank G Keller
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Tobi J Henzer
- Institute for Clinical Research and Health Policy Studies, Tufts MC, Boston, MA, USA
| | - Anita J Kumar
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.,Institute for Clinical Research and Health Policy Studies, Tufts MC, Boston, MA, USA.,Division of Hematology/Oncology, Tufts MC, Boston, MA, USA
| | | | - Ralph M Meyer
- Department of Oncology, Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, ON, Canada
| | - John Radford
- University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - John Raemaekers
- Department of Haematology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - David C Hodgson
- Radiation Medicine Programme, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
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Thomas J, Fermé C, Noordijk EM, Morschhauser F, Girinsky T, Gaillard I, Lugtenburg PJ, André M, Lybeert ML, Stamatoullas A, Beijert M, Hélias P, Eghbali H, Gabarre J, van der Maazen RW, Jaubert J, Bouabdallah K, Boulat O, Roesink JM, Christian B, Ong F, Bordessoule D, Tertian G, Gonzalez H, Vranovsky A, Quittet P, Tirelli U, de Jong D, Audouin J, Aleman BM, Henry-Amar M. Comparison of 36 Gy, 20 Gy, or No Radiation Therapy After 6 Cycles of EBVP Chemotherapy and Complete Remission in Early-Stage Hodgkin Lymphoma Without Risk Factors: Results of the EORT-GELA H9-F Intergroup Randomized Trial. Int J Radiat Oncol Biol Phys 2018; 100:1133-1145. [DOI: 10.1016/j.ijrobp.2017.10.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/29/2017] [Accepted: 10/06/2017] [Indexed: 11/16/2022]
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Goyal G, Maldonado EB, Fan TJ, Kanmanthareddy A, Silberstein PT, Go RS, Armitage JO. Treatment Patterns and Outcomes in Early-stage Hodgkin Lymphoma in the Elderly: A National Cancer Database Analysis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:812-818. [DOI: 10.1016/j.clml.2017.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/11/2017] [Indexed: 01/03/2023]
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Abstract
This topic addresses the treatment of newly diagnosed patients with favorable prognosis stage I and II Hodgkin lymphoma. In most cases, combined modality therapy (chemotherapy followed by involved site radiation therapy) constitutes the current standard of care. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. By combining the most recent medical literature and expert opinion, this revised guideline can aid clinicians in the appropriate use of combined modality therapy for favorable prognosis stage I and II Hodgkin lymphoma. Increasing information about the late effects of treatment has led to attempts to decrease toxicity by using less chemotherapy (decreased duration and/or intensity or different agents) and less radiation therapy (reduced volume and/or dose) while maintaining excellent efficacy.
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Blank O, von Tresckow B, Monsef I, Specht L, Engert A, Skoetz N. Chemotherapy alone versus chemotherapy plus radiotherapy for adults with early stage Hodgkin lymphoma. Cochrane Database Syst Rev 2017; 4:CD007110. [PMID: 28447341 PMCID: PMC6478261 DOI: 10.1002/14651858.cd007110.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Combined modality treatment consisting of chemotherapy followed by localised radiotherapy is the standard treatment for patients with early stage Hodgkin lymphoma (HL). However, due to long- term adverse effects such as secondary malignancies the role of radiotherapy has been questioned recently and some clinical study groups advocate chemotherapy only for this indication. OBJECTIVES To assess the effects of chemotherapy alone compared to chemotherapy plus radiotherapy in adults with early stage HL . SEARCH METHODS For the or i ginal version of this review, we searched MEDLINE, Embase and CENTRAL as well as conference proceedings (American Society of Hematology, American Society of Clinical Oncology and International Symposium of Hodgkin Lymphoma) from January 1980 to November 2010 for randomised controlled trials (RCTs) comparing chemotherapy alone versus chemotherapy regimens plus radiotherapy. For the updated review we searched MEDLINE, CENTRAL and conference proceedings to December 2016. SELECTION CRITERIA We included RCTs comparing chemotherapy alone with chemotherapy plus radiotherapy in patients with early stage HL. We excluded trials with more than 20% of patients in advanced stage. As the value of radiotherapy in addition to chemotherapy is still not clear, we also compared to more cycles of chemotherapy in the control arm. In this updated review, we also included a second comparison evaluating trials with varying numbers of cycles of chemotherapy between intervention and control arms, same chemotherapy regimen in both arms assumed. We excluded trials evaluating children only, therefore only trials involving adults are included in this updated review. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the quality of trials. We contacted study authors to obtain missing information. As effect measures we used hazard ratios (HR) for overall survival (OS) and progression-free survival (PFS) and risk ratios (RR) for response rates. Since not all trials reported PFS according to our definitions, we evaluated all similar outcomes (e.g. event-free survival) as PFS/tumour control. MAIN RESULTS Our search led to 5518 potentially relevant references. From these, we included seven RCTs in the analyses involving 2564 patients. In contrast to the first version of this review including five trials, we excluded trials randomising children. As a result, we excluded one trial from the former analyses and we identified three new trials.Five trials with 1388 patients compared the combination of chemotherapy alone and chemotherapy plus radiotherapy, with the same number of chemotherapy cycles in both arms. The addition of radiotherapy to chemotherapy has probably little or no difference on OS (HR 0.48; 95% confidence interval (CI) 0.22 to 1.06; P = 0.07, moderate- quality evidence), however two included trials had potential other high risk of bias due to a high number of patients not receiving planned radiotherapy. After excluding these trials in a sensitivity analysis, the results showed that the combination of chemotherapy and radiotherapy improved OS compared to chemotherapy alone (HR 0.31; 95% CI 0.19 to 0.52; P <0.00001, moderate- quality evidence). In contrast to chemotherapy alone the use of chemotherapy and radiotherapy improved PFS (HR 0.42; 95% CI 0.25 to 0.72; P = 0.001; moderate- quality evidence). Regarding infection- related mortality (RR 0.33; 95% CI 0.01 to 8.06; P = 0.5; low- quality evidence), second cancer- related mortality (RR 0.53; 95% CI 0.07 to 4.29; P = 0.55; low- quality evidence) and cardiac disease- related mortality (RR 2.94; 95% CI 0.31 to 27.55; P = 0.35;low- quality evidence), there is no evidence for a difference between the use of chemotherapy alone and chemotherapy plus radiotherapy. For complete response rate (CRR) (RR 1.08; 95% CI 0.93 to 1.25; P = 0.33; low- quality evidence), there is also no evidence for a difference between treatment groups.Two trials with 1176 patients compared the combination of chemotherapy alone and chemotherapy plus radiotherapy, with different numbers of chemotherapy cycles in both arms. OS is reported in one trial only, the use of chemotherapy alone (more chemotherapy cycles) may improve OS compared to chemotherapy plus radiotherapy (HR 2.12; 95% CI 1.03 to 4.37; P = 0.04; low- quality evidence). This trial also had a potential other high risk of bias due to a high number of patients not receiving planned therapy. There is no evidence for a difference between chemotherapy alone and chemotherapy plus radiotherapy regarding PFS (HR 0.42; 95% CI 0.14 to 1.24; P = 0.12; low- quality evidence). After excluding the trial with patients not receiving the planned therapy in a sensitivity analysis, the results showed that the combination of chemotherapy and radiotherapy improved PFS compared to chemotherapy alone (HR 0.24; 95% CI 0.070 to 0.88; P = 0.03, based on one trial). For infection- related mortality (RR 6.90; 95% CI 0.36 to 132.34; P = 0.2; low- quality evidence), second cancer- related mortality (RR 2.22; 95% CI 0.7 to 7.03; P = 0.18; low- quality evidence) and cardiac disease-related mortality (RR 0.99; 95% CI 0.14 to 6.90; P = 0.99; low-quality evidence), there is no evidence for a difference between the use of chemotherapy alone and chemotherapy plus radiotherapy. CRR rate was not reported. AUTHORS' CONCLUSIONS This systematic review compared the effects of chemotherapy alone and chemotherapy plus radiotherapy in adults with early stage HL .For the comparison with same numbers of chemotherapy cycles in both arms, we found moderate- quality evidence that PFS is superior in patients receiving chemotherapy plus radiotherapy than in those receiving chemotherapy alone. The addition of radiotherapy to chemotherapy has probably little or no difference on OS . The sensitivity analysis without the trials with potential other high risk of bias showed that chemotherapy plus radiotherapy improves OS compared to chemotherapy alone.For the comparison with different numbers of chemotherapy cycles between the arms there are no implications for OS and PFS possible, because of the low quality of evidence of the results.
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Affiliation(s)
- Oliver Blank
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50937
| | - Bastian von Tresckow
- University Hospital of CologneDepartment I of Internal MedicineCologneGermany50931
| | - Ina Monsef
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50937
| | - Lena Specht
- Rigshospitalet, University of CopenhagenDepts. of Oncology and HaematologyThe Finsen Centre9 BlegdamsvejCopenhagenDenmarkDK‐2100
| | - Andreas Engert
- University Hospital of CologneDepartment I of Internal MedicineCologneGermany50931
| | - Nicole Skoetz
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50937
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Sunderland KS, Yang M, Mao C. Phage-Enabled Nanomedicine: From Probes to Therapeutics in Precision Medicine. Angew Chem Int Ed Engl 2017; 56:1964-1992. [PMID: 27491926 PMCID: PMC5311110 DOI: 10.1002/anie.201606181] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Indexed: 01/08/2023]
Abstract
Both lytic and temperate bacteriophages (phages) can be applied in nanomedicine, in particular, as nanoprobes for precise disease diagnosis and nanotherapeutics for targeted disease treatment. Since phages are bacteria-specific viruses, they do not naturally infect eukaryotic cells and are not toxic to them. They can be genetically engineered to target nanoparticles, cells, tissues, and organs, and can also be modified with functional abiotic nanomaterials for disease diagnosis and treatment. This Review will summarize the current use of phage structures in many aspects of precision nanomedicine, including ultrasensitive biomarker detection, enhanced bioimaging for disease diagnosis, targeted drug and gene delivery, directed stem cell differentiation, accelerated tissue formation, effective vaccination, and nanotherapeutics for targeted disease treatment. We will also propose future directions in the area of phage-based nanomedicines, and discuss the state of phage-based clinical trials.
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Affiliation(s)
- Kegan S Sunderland
- Department of Chemistry and Biochemistry, Stephenson Life Sciences Research Center, University of Oklahoma, 101 Stephenson Parkway, Norman, Oklahoma, 73019, USA
| | - Mingying Yang
- Institute of Applied Bioresource Research, College of Animal Science, Zhejiang University, Yuhangtang Road 866, Hangzhou, Zhejiang, 310058, China
| | - Chuanbin Mao
- Department of Chemistry and Biochemistry, Stephenson Life Sciences Research Center, University of Oklahoma, 101 Stephenson Parkway, Norman, Oklahoma, 73019, USA
- School of Materials Science and Engineering, Zhejiang University, Hangzhou, Zhejiang, 310027, China
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Sunderland KS, Yang M, Mao C. Nanomedizin auf Phagenbasis: von Sonden zu Therapeutika für eine Präzisionsmedizin. Angew Chem Int Ed Engl 2017. [DOI: 10.1002/ange.201606181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Kegan S. Sunderland
- Department of Chemistry and Biochemistry Stephenson Life Sciences Research Center University of Oklahoma 101 Stephenson Parkway Norman Oklahoma 73019 USA
| | - Mingying Yang
- Institute of Applied Bioresource Research College of Animal Science Zhejiang University Yuhangtang Road 866 Hangzhou Zhejiang 310058 China
| | - Chuanbin Mao
- Department of Chemistry and Biochemistry Stephenson Life Sciences Research Center University of Oklahoma 101 Stephenson Parkway Norman Oklahoma 73019 USA
- School of Materials Science and Engineering Zhejiang University Hangzhou Zhejiang 310027 China
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Ali S, Basit A, Kazmi AS, Sidhu A, Badar F, Hameed A. Chemotherapy alone or combined chemotherapy and involved field radiotherapy in favorable risk early-stage classical Hodgkin lymphoma-a 10 years experience. Pak J Med Sci 2016; 32:1408-1413. [PMID: 28083035 PMCID: PMC5216291 DOI: 10.12669/pjms.326.11080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/15/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the outcome of patients with early-stage (stage I-II) favorable risk classical Hodgkin lymphoma treated with chemotherapy alone or combined modality treatment (CMT) utilizing chemotherapy and involved field radiotherapy. METHODS This retrospective study was done at Department of Medical oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan from January 2004 to December 2013. RESULTS There were 101 patients, with male predominance (71.3%). Mean age was 34 years. Sixty three (62.4%) patients received CMT and 38 (37.6%) patients had chemotherapy alone. Ninety eight percent patients had ABVD chemotherapy. Dose of radiotherapy ranged from 20 to 36 gray. Difference between baseline characteristics and major toxicities among the two groups was insignificant. Patients treated with CMT had better overall survival compared to chemotherapy alone: 100% versus 91% at five years and 96% versus 81% at 10 years, respectively (p=0.03). Progression free survival was also better with CMT against chemotherapy alone at five years (98% versus 81%) and 10 years (82% versus 71%) (p=0.01). CONCLUSION Favorable risk classical Hodgkin lymphoma patients had better overall survival and progression free survival when treated with CMT against chemotherapy alone.
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Affiliation(s)
- Sheeraz Ali
- Dr. Sheeraz Ali, MBBS, FCPS (Medicine), Fellow Medical Oncology, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Abdul Basit
- Dr. Abdul Basit, MBBS, FCPS (Medicine), Fellow Medical Oncology, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Ather S. Kazmi
- Dr. Ather Saeed Kazmi, MBBS, MRCP FRCR. Clinical Oncologist, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Armughan Sidhu
- Dr. Farhana Badar, Sr. Biostatistician & Cancer Epidemiologist Cancer Registry, & Clinical Data Management, Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Farhana Badar
- Dr. Armughan Sidhu, MBBS. Resident Medical Oncology, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Abdul Hameed
- Dr. Abdul Hameed MBBS, MD, FRCP (Edin). Consultant Hematologist, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
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ACR Appropriateness Criteria® Hodgkin Lymphoma—Unfavorable Clinical Stage I and II. Am J Clin Oncol 2016; 39:384-95. [DOI: 10.1097/coc.0000000000000294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kumar A, Burger IA, Zhang Z, Drill EN, Migliacci JC, Ng A, LaCasce A, Wall D, Witzig TE, Ristow K, Yahalom J, Moskowitz CH, Zelenetz AD. Definition of bulky disease in early stage Hodgkin lymphoma in computed tomography era: prognostic significance of measurements in the coronal and transverse planes. Haematologica 2016; 101:1237-1243. [PMID: 27390360 DOI: 10.3324/haematol.2016.141846] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 07/05/2016] [Indexed: 11/09/2022] Open
Abstract
Disease bulk is an important prognostic factor in early stage Hodgkin lymphoma, but its definition is unclear in the computed tomography era. This retrospective analysis investigated the prognostic significance of bulky disease measured in transverse and coronal planes on computed tomography imaging. Early stage Hodgkin lymphoma patients (n=185) treated with chemotherapy with or without radiotherapy from 2000-2010 were included. The longest diameter of the largest lymph node mass was measured in transverse and coronal axes on pre-treatment imaging. The optimal cut off for disease bulk was maximal diameter greater than 7 cm measured in either the transverse or coronal plane. Thirty patients with maximal transverse diameter of 7 cm or under were found to have bulk in coronal axis. The 4-year overall survival was 96.5% (CI: 93.3%, 100%) and 4-year relapse-free survival was 86.8% (CI: 81.9%, 92.1%) for all patients. Relapse-free survival at four years for bulky patients was 80.5% (CI: 73%, 88.9%) compared to 94.4% (CI: 89.1%, 100%) for non-bulky; Cox HR 4.21 (CI: 1.43, 12.38) (P=0.004). In bulky patients, relapse-free survival was not impacted in patients treated with chemoradiotherapy; however, it was significantly lower in patients treated with chemotherapy alone. In an independent validation cohort of 38 patients treated with chemotherapy alone, patients with bulky disease had an inferior relapse-free survival [at 4 years, 71.1% (CI: 52.1%, 97%) vs 94.1% (CI: 83.6%, 100%), Cox HR 5.27 (CI: 0.62, 45.16); P=0.09]. Presence of bulky disease on multidimensional computed tomography imaging is a significant prognostic factor in early stage Hodgkin lymphoma. Coronal reformations may be included for routine Hodgkin lymphoma staging evaluation. In future, our definition of disease bulk may be useful in identifying patients who are most appropriate for chemotherapy alone.
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Affiliation(s)
- Anita Kumar
- Lymphoma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Irene A Burger
- Department Medical Radiology, University Hospital Zurich, Switzerland
| | - Zhigang Zhang
- Biostatistics and Epidemiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Esther N Drill
- Biostatistics and Epidemiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jocelyn C Migliacci
- Lymphoma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andrea Ng
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ann LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Darci Wall
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Kay Ristow
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Craig H Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andrew D Zelenetz
- Lymphoma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Bhatt VR, Giri S, Verma V, Dahal S, Shah BK, Pathak R, Bociek RG, Vose JM, Armitage JO. Secondary acute myeloid leukemia in survivors of Hodgkin lymphoma. Future Oncol 2016; 12:1565-75. [DOI: 10.2217/fon-2016-0048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Hodgkin Lymphoma: the Changing Role of Radiation Therapy in Early-Stage Disease—the Role of Functional Imaging. Curr Treat Options Oncol 2016; 16:45. [PMID: 26187795 DOI: 10.1007/s11864-015-0360-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Early-stage classical Hodgkin lymphoma (CHL) is a highly curable malignancy. Historically, extended-field radiotherapy (EFRT) alone showed excellent cure rates, but the risk of radiotherapy (RT)-associated toxicities led to combined modality therapy (CMT) replacing RT alone. RT has subsequently evolved further with significant reductions of dose and field size, and is currently restricted to involved sites only (ISRT). Contemporary CMT yields cure rates in excess of 85%, and most studies do not have adequate follow-up required to evaluate the risk reduction in late effects. In an effort to avoid RT altogether, response-adapted treatment approaches utilizing results of interim [(18)F]fluorodeoxyglucose (FDG) positron emission tomography with fused computed tomography (PET/CT) imaging have been studied. Results from two studies in favorable-risk (UK RAPID and EORTC H10F) and one in unfavorable-risk patients (EORTC H10U) suggest that omission of RT in patients with a negative interim PET/CT response (Deauville score ≤2) yields slightly inferior progression-free survival (PFS) compared to conventional CMT, but with no difference in overall survival (OS) albeit with short-term follow-up. In order to extrapolate results to daily practice, it is critical to understand the selection of patients entered on trials since definitions of favorable and unfavorable disease vary between study groups. Currently, CMT continues to be the standard of care for the vast majority of patients with early-stage CHL and RT is an integral part of therapy in patients with bulky disease. However, for selected patients with favorable characteristics, emerging data suggest that a chemotherapy-alone approach is reasonable.
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Makita S, Maruyama D, Maeshima AM, Taniguchi H, Miyamoto KI, Kitahara H, Fukuhara S, Munakata W, Kobayashi Y, Itami J, Tobinai K. Clinical features and outcomes of 139 Japanese patients with Hodgkin lymphoma. Int J Hematol 2016; 104:236-44. [PMID: 27086350 DOI: 10.1007/s12185-016-2007-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/05/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
Abstract
Hodgkin lymphoma (HL) is a rare subtype of malignant lymphoma in Japan, and there are few reports of HL in Japan in recent years. We retrospectively analyzed the clinical features of 139 patients with HL who were diagnosed and treated at our institution between 1997 and 2011. The median age at diagnosis was 34 years with 83 male. Of these patients, 83 (60 %) were early stage and 56 (40 %) were advanced-stage. Seventy-three patients (88 %) with early stage disease received ABVd followed by irradiation. All of the 56 advanced-stage patients received chemotherapy, mainly ABVd. The 5-year progression-free survival (PFS) rates and overall survival rates were 90 and 94 % in patients with early stage disease, and 71 and 90 % in those with advanced-stage disease. The PFS of patients with advanced-stage disease was significantly lower than those with early stage (p = 0.014). In conclusion, the outcomes of Japanese patients with HL in recent years were not improved as compared with the results of previous reports. We confirmed that patients with advanced-stage disease have lower PFS than those with early stage disease. Prospective studies are needed to establish novel treatment strategies to improve the outcome of HL patients, especially those with advanced disease.
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Affiliation(s)
- Shinichi Makita
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Dai Maruyama
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | | | - Hirokazu Taniguchi
- Pathology and Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan
| | - Ken-Ichi Miyamoto
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hideaki Kitahara
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Suguru Fukuhara
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Wataru Munakata
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yukio Kobayashi
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Jun Itami
- Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Coyle M, Kostakoglu L, Evens AM. The evolving role of response-adapted PET imaging in Hodgkin lymphoma. Ther Adv Hematol 2016; 7:108-25. [PMID: 27054026 DOI: 10.1177/2040620715625615] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
(18)F-fluorodeoxyglucose positron emission tomography with (FDG-PET) has a well-established role in the pre- and post-treatment staging of Hodgkin lymphoma (HL), however its use as a predictive therapeutic tool via responded-adapted therapy continues to evolve. There have been a multitude of retrospective and noncontrolled clinical studies showing that early (or interim) FDG-PET is highly prognostic in HL, particularly in the advanced-stage setting. Response-adapted treatment approaches in HL are attempting to diminish toxicity for low-risk patients by minimizing therapy, and conversely, intensify treatment for high-risk patients. Results from phase III noninferiority studies in early-stage HL with negative interim FDG-PET that randomized patients to chemotherapy alone versus combined modality therapy showed a continued small improvement in progression-free survival for patients who did not receive radiation. Preliminary reports of data escalating therapy for positive interim FDG-PET in early-stage HL and for de-escalation of therapy [i.e. bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisone (BEACOPP)] for negative interim FDG-PET in advanced stage HL (i.e. deletion of bleomycin) have demonstrated improved outcomes. Maturation of these studies and continued follow up of all response-adapted studies are needed. Altogether, the treatment of HL remains an individualized clinical management choice for physicians and patients. Continued refinement and optimization of FDG-PET is needed, including within the context of targeted therapeutic agents. In addition, a number of new and novel techniques of functional imaging, including metabolic tumor volume and tumor proliferation, are being explored in order to enhance staging, characterization, prognostication and ultimately patient outcome.
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Affiliation(s)
| | - Lale Kostakoglu
- Icahn School of Medicine at Mount Sinai in New York, New York, USA
| | - Andrew M Evens
- Division of Hematology-Oncology, Director, Tufts Cancer Center, Tufts Medical Center, 800 Washington Street, Box #245, Boston, MA 02111, USA
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Algiraigri AH, Essa MF. Management of Adolescent Low-Risk Classical Hodgkin Lymphoma: Which Chemotherapy Backbone Gives the Best Chance of Omitting Radiotherapy Safely. J Adolesc Young Adult Oncol 2016; 5:2-7. [PMID: 26812449 DOI: 10.1089/jayao.2015.0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Even though more than 90% of adolescents with low-risk classical Hodgkin lymphoma (LRcHL) will be cured with first-line therapy, many will suffer serious late toxic effects from radiotherapy (RT). The goals for care have shifted toward minimizing late toxic effects without compromising the outstanding cure rates by adapting a risk and response-based therapy. Recent published and ongoing randomized clinical trials, using functional imaging, may allow for better identification of those patients for whom RT may be safely omitted while maintaining excellent cure rates. To evaluate the best chemotherapy regimens with a reasonable toxicity profile and that are expected to have a high chance of omitting RT based on a response-directed therapy while maintaining high cure rates, a mini review was conducted of the recent clinical trials in pediatric and adult LRcHL. The UK RAPID trial chemotherapy backbone (3 × ABVD) followed by a response-based positron emission tomography scan offers up to a 75% chance of safely omitting RT without compromising the cure rate, which remained well above 90%.
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Affiliation(s)
- Ali H Algiraigri
- 1 Department of Community Health Science, University of Calgary , Calgary, Canada .,2 Department of Hematology, King Abdulaziz University Hospital , Jeddah, Saudi Arabia
| | - Mohammed F Essa
- 3 Department of Pediatric Hematology/Oncology, King Saud bin Abdulaziz University for Health Sciences , King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia
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Maraldo MV, Ng AK. Minimizing Cardiac Risks With Contemporary Radiation Therapy for Hodgkin Lymphoma. J Clin Oncol 2016; 34:208-10. [DOI: 10.1200/jco.2015.64.6588] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Andrea K. Ng
- Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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36
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Trends in Use of Radiation Therapy for Hodgkin Lymphoma From 2000 to 2012 on the Basis of the National Cancer Data Base. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:12-7. [DOI: 10.1016/j.clml.2015.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/12/2015] [Indexed: 11/21/2022]
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Parikh RR, Grossbard ML, Harrison LB, Yahalom J. Early-Stage Classic Hodgkin Lymphoma: The Utilization of Radiation Therapy and Its Impact on Overall Survival. Int J Radiat Oncol Biol Phys 2015; 93:684-93. [DOI: 10.1016/j.ijrobp.2015.06.039] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/16/2015] [Accepted: 06/29/2015] [Indexed: 11/29/2022]
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Rueda Domínguez A, Alfaro Lizaso J, de la Cruz Merino L, Gumá I Padró J, Quero Blanco C, Gómez Codina J, Llanos Muñoz M, Martinez Banaclocha N, Rodriguez Abreu D, Provencio Pulla M. SEOM clinical guidelines for the treatment of Hodgkin's lymphoma. Clin Transl Oncol 2015; 17:1005-13. [PMID: 26497354 PMCID: PMC4689754 DOI: 10.1007/s12094-015-1429-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 10/09/2015] [Indexed: 11/27/2022]
Abstract
Hodgkin lymphoma (HL) is an uncommon B cell lymphoid malignancy representing approximately 10-15 % of all lymphomas. HL is composed of two distinct disease entities; the more commonly diagnosed classical HL and the rare nodular lymphocyte-predominant HL. An accurate assessment of the stage of disease and prognostic factors that identify patients at low or high risk for recurrence are used to optimize therapy. Patients with early stage disease are treated with combined modality strategies using abbreviated courses of combination chemotherapy followed by involved-field radiation therapy, while those with advanced stage disease receive a longer course of chemotherapy often without radiation therapy. High-dose chemotherapy (HDCT) followed by an autologous stem cell transplant (ASCT) is the standard of care for most patients who relapse following initial therapy. Brentuximab vedotin should be considered for patients who fail HDCT with ASCT.
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Affiliation(s)
- A Rueda Domínguez
- Área de Oncología y Hematología, Hospital Costa del Sol, Autovía A-7, km 187, 29603, Marbella, Málaga, Spain.
| | - J Alfaro Lizaso
- Servicio de Oncología Médica, Instituto Oncológico de Guipúzcoa, San Sebastian, Spain
| | - L de la Cruz Merino
- Servicio de Oncología Médica, Complejo Hospitalario Regional Virgen Macarena, Seville, Spain
| | - J Gumá I Padró
- Servicio de Oncología Médica, Hospital Universitari de Sant Joan de Reus, Reus, Spain
| | - C Quero Blanco
- Servicio de Oncología Médica, Complejo Hospitalario Regional y Virgen de la Victoria, Málaga, Spain
| | - J Gómez Codina
- Servicio de Oncología Médica, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - M Llanos Muñoz
- Servicio de Oncología Médica, Hospital Universitario de Canarias (H.U.C), San Cristóbal De La Laguna, Tenerife, Spain
| | - N Martinez Banaclocha
- Servicio de Oncología Médica, Hospital General Universitario de Elche y Vega Baja, Elche, Spain
| | - D Rodriguez Abreu
- Servicio de Oncología Médica, Hospital Universitario Insular de Gran Canaria, Las Palmas De Gran Canarias, Spain
| | - M Provencio Pulla
- Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Dorius TH, Bennion NR, Armitage JO. PET-directed therapy in Hodgkin lymphoma: Ready for prime time? Expert Rev Anticancer Ther 2015; 15:1431-41. [PMID: 26472333 DOI: 10.1586/14737140.2015.1096202] [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: 11/08/2022]
Abstract
Advances in chemotherapy and radiation therapy have allowed the vast majority of patients with Hodgkin lymphoma to be cured, but some of these patients develop treatment-related complications, including second malignancies, cardiovascular disease, and thyroid disease. Efforts to decrease exposure of patients to more chemotherapy or radiation therapy than is necessary to cure their disease have led to a trend toward shortened treatment regimens in patients with low-risk disease. Predicting which patients will relapse, and therefore might benefit from a more intense treatment regimen, has been a clinical challenge. PET has emerged as a useful modality in the diagnosis and management of Hodgkin lymphoma, and has been studied as a potential tool to help the oncologist to utilize the optimal chemotherapy and radiation therapy regimen for each patient.
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Affiliation(s)
- Timothy H Dorius
- a 1 Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, USA
| | - Nathan R Bennion
- b 2 Radiation Oncology Department, University of Nebraska Medical Center, Omaha, USA
| | - James O Armitage
- a 1 Department of Internal Medicine, Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, USA
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Abstract
INTRODUCTION Over the past several decades, Hodgkin lymphoma (HL) has become a highly treatable lymphoid malignancy with excellent response rates and long-term disease-free survival. Late-toxicities, however, continue to be an area of significant concern. Recent studies have evaluated novel approaches to limit long-term toxicity without adversely impacting short-term survival. While early or interim PET scan has been correlated with PFS and OS in HL, the modification of therapy based on interim PET (response-adapted therapy) has been evaluated in retrospective and prospective cohorts. This paper will review evidence for the role of response-adapted therapy in HL. AREAS COVERED Data from completed and ongoing retrospective and prospective cohorts of HL patients were reviewed utilizing pubmed and clinicaltrials.org and pertinent studies culled to compile this review article. EXPERT OPINION While response-adapted therapy represents a promising area of research which may ultimately become standard-of-care, current data does not unequivocally endorse this approach, which should be used with caution outside of a clinical trial.
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Affiliation(s)
- Jesse Keller
- a 1 Washington University, Division of Oncology, Department of Medicine , St Louis, MO 63110, USA.,b 2 Washington University School of Medicine, Division of Oncology, Department of Internal Medicine , 660 S. Euclid Avenue, Campus Box 8056, St. Louis, MO 63110, USA +1 31 43 62 56 54 ; +1 31 44 54 79 41 ;
| | - Kenneth R Carson
- a 1 Washington University, Division of Oncology, Department of Medicine , St Louis, MO 63110, USA.,b 2 Washington University School of Medicine, Division of Oncology, Department of Internal Medicine , 660 S. Euclid Avenue, Campus Box 8056, St. Louis, MO 63110, USA +1 31 43 62 56 54 ; +1 31 44 54 79 41 ; .,c 3 Research Service, St. Louis Veterans Affairs Medical Center , 501 N. Grand Blvd Suite 300, St. Louis, MO 63103, USA
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Diefenbach CS, Li H, Hong F, Gordon LI, Fisher RI, Bartlett NL, Crump M, Gascoyne RD, Wagner H, Stiff PJ, Cheson BD, Stewart DA, Kahl BS, Friedberg JW, Blum KA, Habermann TM, Tuscano JM, Hoppe RT, Horning SJ, Advani RH. Evaluation of the International Prognostic Score (IPS-7) and a Simpler Prognostic Score (IPS-3) for advanced Hodgkin lymphoma in the modern era. Br J Haematol 2015; 171:530-8. [PMID: 26343802 DOI: 10.1111/bjh.13634] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022]
Abstract
The International Prognostic Score (IPS-7) is the most commonly used risk stratification tool for advanced Hodgkin lymphoma (HL), however recent studies suggest the IPS-7 is less discriminating due to improved outcomes with contemporary therapy. We evaluated the seven variables for IPS-7 recorded at study entry for 854 patients enrolled on Eastern Cooperative Oncology Group 2496 trial. Univariate and multivariate Cox models were used to assess their prognostic ability for freedom from progression (FFP) and overall survival (OS). The IPS-7 remained prognostic however its prognostic range has narrowed. On multivariate analysis, two factors (age, stage) remained significant for FFP and three factors (age, stage, haemoglobin level) for OS. An alternative prognostic index, the IPS-3, was constructed using age, stage and haemoglobin level, which provided four distinct risk groups [FFP (P = 0·0001) and OS (P < 0·0001)]. IPS-3 outperformed the IPS-7 on risk prediction for both FFP and OS by model fit and discrimination criteria. Using reclassification calibration, 18% of IPS-7 low risk patients were re-classified as intermediate risk and 13% of IPS-7 intermediate risk patients as low risk. For patients with advanced HL, the IPS-3 may provide a simpler and more accurate framework for risk assessment in the modern era. Validation of these findings in other large data sets is planned.
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Affiliation(s)
| | - Hailun Li
- Dana Farber Cancer Institute, Boston, MA, USA
| | | | - Leo I Gordon
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | | | | | - Michael Crump
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | | | - Joseph M Tuscano
- Davis Cancer Center, University of California, Sacramento, CA, USA
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Gallamini A, Borra A, Zwarthoed C. PET response-adapted clinical trials in Hodgkin lymphoma: a comprehensive review. Clin Transl Imaging 2015. [DOI: 10.1007/s40336-015-0124-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mestre F, Gutiérrez A, Rodriguez J, Ramos R, Garcia JF, Martinez-Serra J, Casasus M, Nicolau C, Bento L, Herraez I, Lopez-Perezagua P, Daumal J, Besalduch J. Radiation Therapy Overcomes Adverse Prognostic Role of Cyclooxygenase-2 Expression on Reed-Sternberg Cells in Early Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2015; 92:84-90. [DOI: 10.1016/j.ijrobp.2014.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 09/07/2014] [Accepted: 10/01/2014] [Indexed: 01/15/2023]
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Singh R, Sheikh S, Pallagatti S, Aggarwal A, Gupta D, Handa R, Goyal G, Kumar R. Lymphocyte Depleted Hodgkin's Lymphoma Presented with Haemolytic Anemia: A Case Report and Literature Review. J Maxillofac Oral Surg 2015; 14:317-22. [PMID: 25861191 DOI: 10.1007/s12663-013-0528-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 04/13/2013] [Indexed: 12/27/2022] Open
Abstract
Hodgkin's lymphoma accounts for ten per cent of all lymphomas. Lymphomas represent the third most frequent neoplasia on a worldwide scale and constitute 3 % of malignant tumors. In the United States, there are about 8,000 new cases every year. This case report describes a case of lymphocyte-depletion Hodgkin's lymphoma (LDHL) manifested by anemia. LDHL is the least common of the types of Hodgkin's disease, comprising less than 1 % of all cases of this cancer. A 19-year-old Indian male presented with complaint of huge asymptomatic swelling in the right lateral part of neck since 8 months. All the lymph nodes of the right side submandibular, submental, cervical and axillary lymph nodes were rubbery in consistency, tender and were palpable. The CBC revealed hemoglobin of 7.4 gm/dL and ESR count was highly raised up to 125 mm/first hour. Direct Coomb's test detected multiple antibodies IgG type, which was consistent with the diagnosis of Haemolytic anemia. Ultrasonography of the neck showed enlarged discrete lymph nodes on the right side of the neck. For further evaluation patient was subject for ultrasonography of the abdomen which revealed there was of enlargement of both spleen and liver. Lymph node FNAC revealed classic LDHL. Anemia and swelling resolved after completion of chemotherapy with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) after 6 cycles. The literature review and our case report discuss the optimal management of this Hodgkin's lymphoma. To our knowledge, this is the first case of LDHL with Haemolytic Anemia treated with only ABVD regime.
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Affiliation(s)
- Ravinder Singh
- Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, 133203 Haryana India
| | - Soheyl Sheikh
- Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, 133203 Haryana India
| | - Shambulingappa Pallagatti
- Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, 133203 Haryana India
| | - Amit Aggarwal
- Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, 133203 Haryana India
| | - Deepak Gupta
- Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, 133203 Haryana India
| | - Roopika Handa
- Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, 133203 Haryana India
| | - Gaurav Goyal
- Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, 133203 Haryana India
| | - Raman Kumar
- Department of Oral Medicine and Radiology, M.M. College of Dental Sciences and Research, Mullana, Ambala, 133203 Haryana India
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Behringer K, Goergen H, Hitz F, Zijlstra JM, Greil R, Markova J, Sasse S, Fuchs M, Topp MS, Soekler M, Mathas S, Meissner J, Wilhelm M, Koch P, Lindemann HW, Schalk E, Semrau R, Kriz J, Vieler T, Bentz M, Lange E, Mahlberg R, Hassler A, Vogelhuber M, Hahn D, Mezger J, Krause SW, Skoetz N, Böll B, von Tresckow B, Diehl V, Hallek M, Borchmann P, Stein H, Eich H, Engert A. Omission of dacarbazine or bleomycin, or both, from the ABVD regimen in treatment of early-stage favourable Hodgkin's lymphoma (GHSG HD13): an open-label, randomised, non-inferiority trial. Lancet 2015; 385:1418-27. [PMID: 25539730 DOI: 10.1016/s0140-6736(14)61469-0] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The role of bleomycin and dacarbazine in the ABVD regimen (ie, doxorubicin, bleomycin, vinblastine, and dacarbazine) has been questioned, especially for treatment of early-stage favourable Hodgkin's lymphoma, because of the drugs' toxicity. We aimed to investigate whether omission of either bleomycin or dacarbazine, or both, from ABVD reduced the efficacy of this regimen in treatment of Hodgkin's lymphoma. METHODS In this open-label, randomised, multicentre trial (HD13) we compared two cycles of ABVD with two cycles of the reduced-intensity regimen variants ABV (doxorubicin, bleomycin, and vinblastine), AVD (doxorubicin, vinblastine, and dacarbazine), and AV (doxorubicin and vinblastine), in patients with newly diagnosed, histologically proven, classic or nodular, lymphocyte predominant Hodgkin's lymphoma. In each treatment group, 30 Gy involved-field radiotherapy (IFRT) was given after both cycles of chemotherapy were completed. From Jan 28, 2003, patients were centrally randomly assigned (1:1:1:1) with a minimisation method to the four groups. Because of high event rates, assignment to the AV and ABV groups stopped early, on Sept 30, 2005, and Feb 10, 2006; assignment to ABVD and AVD continued (1:1) until Sept 30, 2009. Our primary objective was to show non-inferiority of the experimental variants compared with ABVD in terms of freedom from treatment failure (FFTF), by excluding a difference of 6% after 5 years corresponding to a hazard ratio (HR) of 1.72, via a 95% CI. Analyses reported here include qualified patients only, and between-group comparisons include only patients recruited during the same period. The trial was registered, number ISRCTN63474366. FINDINGS Of 1502 qualified patients, 566, 198, 571, and 167 were randomly assigned to receive ABVD, ABV, AVD, or AV, respectively. 5 year FFTF was 93.1%, 81.4%, 89.2%, and 77.1% with ABVD, ABV, AVD, and AV, respectively. Compared with ABVD, inferiority of the dacarbazine-deleted variants was detected with 5 year differences of -11.5% (95% CI -18.3 to -4.7; HR 2.06 [1.21 to 3.52]) for ABV and -15.2% (-23.0 to -7.4; HR 2.57 [1.51 to 4.40]) for AV. Non-inferiority of AVD compared with ABVD could also not be detected (5 year difference -3.9%, -7.7 to -0·1; HR 1.50, 1.00 to 2.26). 178 (33%) of 544 patients given ABVD had WHO grade III or IV toxicity, compared with 53 (28%) of 187 given ABV, 142 (26%) of 539 given AVD, and 40 (26%) of 151 given AV. Leucopenia was the most common event, and highest in the groups given bleomycin. INTERPRETATION Dacarbazine cannot be omitted from ABVD without a substantial loss of efficacy. With respect to our predefined non-inferiority margin, bleomycin cannot be safely omitted either, and the standard of care for patients with early-stage favourable Hodgkin's lymphoma should remain ABVD followed by IFRT. FUNDING Deutsche Krebshilfe and Swiss State Secretariat for Education and Research.
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Affiliation(s)
- Karolin Behringer
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Helen Goergen
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Felicitas Hitz
- Cantonal Hospital of St Gallen, St Gallen, Switzerland and SAKK Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | | | - Richard Greil
- Third Medical Department, Paracelcus Medical University, Salzburg, Austria
| | - Jana Markova
- University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Stephanie Sasse
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Michael Fuchs
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Max S Topp
- University Hospital Würzburg, Würzburg, Germany
| | | | - Stephan Mathas
- Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | | | | | - Peter Koch
- University Hospital Münster, Münster, Germany
| | | | - Enrico Schalk
- Department of Haematology and Oncology, Medical Centre, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Robert Semrau
- Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - Jan Kriz
- University Hospital Münster, Münster, Germany
| | - Tom Vieler
- Medizinische Klinik, Universitätsklinik Schleswig-Holstein, Kiel, Germany
| | - Martin Bentz
- Medizinische Klinik, Städtisches Klinikum Karlsruhe, Germany
| | - Elisabeth Lange
- Medizinische Klinik, Hämatologie/Onkologie, Evangelisches Krankenhaus, Hamm, Germany
| | - Rolf Mahlberg
- Medizinische Klinik, Krankenanstalt Mutterhaus d. Borromäerinnen, Trier, Germany
| | - Andre Hassler
- Zentrum für Innere Medizin, Hämatologie/Onkologie, Charité Campus Mitte, Berlin, Germany
| | - Martin Vogelhuber
- Medizinische Klinik, Universitätsklinik Regensburg, Regensburg, Germany
| | - Dennis Hahn
- Klinik für Onkologie, Katharinenhospital, Stuttgart, Germany
| | - Jörg Mezger
- Medizinische Klinik-Hämatologie, Onkologie, Immunologie, Palliativmedizin, St. Vincentius-Kliniken gAG, Karlsruhe, Germany
| | - Stefan W Krause
- Department of Internal Medicine 5, Haematology/Oncology, University of Erlangen, Germany
| | - Nicole Skoetz
- Cochrane Haematological Malignancies Group, Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Boris Böll
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Volker Diehl
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Peter Borchmann
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Harald Stein
- Berlin Reference Center for Lymphoma and Haematopathology, Berlin, Germany
| | - Hans Eich
- University Hospital Münster, Münster, Germany
| | - Andreas Engert
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany.
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Matasar MJ, Ford JS, Riedel ER, Salz T, Oeffinger KC, Straus DJ. Late morbidity and mortality in patients with Hodgkin's lymphoma treated during adulthood. J Natl Cancer Inst 2015; 107:djv018. [PMID: 25717170 DOI: 10.1093/jnci/djv018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Survivors of Hodgkin's lymphoma (HL) treated as adults are at risk for late effects of therapy. However, the burden of late morbidity and mortality among adults treated for HL remains incompletely characterized. METHODS Vital status and, for deceased, cause of death were determined for 746 adults treated on a first-line trial at a single center from 1975 to 2000. Survivors completed a detailed survey describing their physical and mental health. A severity score (grades 1-4, ranging from mild to life-threatening or disabling) was assigned to self-reported conditions. RESULTS At a median follow-up of 22 years, 227 of patients (30.4%) had died, 107 (47.1%) from HL, 120 (52.9%) from other causes, including second primary malignancies (SPMs) (n = 52) and cardiovascular disease (n = 27). Across the duration of follow-up, all-cause and SPM-specific risk of death remained higher than predicted by normative data. Among survivors, late morbidity survey data are available for 238 patients (45.9%). Ninety-four-point-one percent of respondents reported at least one morbidity, and 47.5% reported at least one grade 3 or 4 morbidity; 20.2% reported two or more grade 3 morbidities. Commonly reported morbidities included cardiovascular (54.6%), endocrine (68.5%), pulmonary disease (21.4%), and nonfatal second malignancy (23.1%). Anxiety, depression, and fear of recurrence were frequently reported. CONCLUSIONS Among a large cohort of patients treated for HL with extensive follow-up, risk of late mortality from causes other than HL and prevalence of late medical morbidity are high. Guidelines for prevention, screening, and management of late effects in adult survivors of HL are needed.
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Affiliation(s)
- Matthew J Matasar
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO).
| | - Jennifer S Ford
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO)
| | - Elyn R Riedel
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO)
| | - Talya Salz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO)
| | - Kevin C Oeffinger
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO)
| | - David J Straus
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, DJS); Department of Medicine, Weill Cornell Medical College, New York, NY (MJM, DJS); Adult Survivorship Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (MJM, KCO); Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY (JSF); Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY (ERR, TS); Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY (JSF, KCO)
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Abstract
Although there have been dramatic improvements in the treatment of children with non-hodgkin lymphoma, hodgkin lymphoma and histiocytic disorders over the past 3 decades, many still relapse or are refractory to primary therapy. In addition, late effects such as 2nd malignancies, cardiomyopathy and infertility remain a major concern. Thus, this review focuses on the current state of the science and, in particular, novel treatment strategies that are aimed at improving outcomes for all pediatric patients with lymphoma and histiocytic disorders while reducing treatment related morbidity.
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Affiliation(s)
- Carl E Allen
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, 1102 Bates St, Houston, TX 77030, USA
| | - Kara M Kelly
- Herbert Irving Child and Adolescent Oncology Center, Morgan Stanley Children's Hospital, New York-Presbyterian, Columbia University Medical Center, 161 Fort Washington Ave, New York, NY 10032, USA
| | - Catherine M Bollard
- Program for Cell Enhancement and Technologies for Immunotherapy, BMT Division, Department of Pediatrics, Children's National Health System, The George Washington University, 111 Michigan Avenue, Northwest, Washington, DC 20010, USA.
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49
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Abstract
Abstract
Given the excellent survival rates for early-stage Hodgkin lymphoma (HL), the young age of many patients, and concerns regarding acute and late treatment-related toxicities, there is a desire to have a predictive tool that enables therapy to be tailored toward the individual patient. Early (or interim) 18F-fluorodeoxyglucose positron emission tomography with computerized tomography (FDG-PET/CT), as a test of tumor sensitivity to ongoing/planned therapy, has been shown to be prognostic for survival in HL. Based on results of interim FDG-PET/CT, therapy may be subsequently modified through minimization or via intensification for low- and high-risk patient populations, respectively (ie, response-adapted therapy). Important data have been generated to standardize the interpretability and reproducibility of interim FDG-PET/CT (eg, the Deauville 5-point system), and observational and noncontrolled prospective studies have produced evidence supporting the hypothesis that response-adapted therapy may potentially serve as a predictive tool. Furthermore, results from noninferiority phase 3 clinical trials randomizing early-stage HL patients with negative interim FDG-PET/CT to combined modality therapy versus chemotherapy alone have been reported. The current collective findings from these randomized early-stage HL studies have shown that acute relapse rates are lower with combined modality therapy, even in patients with negative interim FDG-PET/CT. Additional randomized response-adapted studies are ongoing and novel FDG-PET/CT applications involving quantitative techniques and innovative imaging modalities are being investigated to identify more robust imaging biomarkers. Treatment of early-stage HL remains a clinical management choice for physicians and patients to make with consideration of acute and long-term outcomes.
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50
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Evens AM, Kostakoglu L. The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease. Blood 2014; 124:3356-64. [PMID: 25428223 PMCID: PMC4467863 DOI: 10.1182/blood-2014-05-577627] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 07/08/2014] [Indexed: 01/06/2023] Open
Abstract
Given the excellent survival rates for early-stage Hodgkin lymphoma (HL), the young age of many patients, and concerns regarding acute and late treatment-related toxicities, there is a desire to have a predictive tool that enables therapy to be tailored toward the individual patient. Early (or interim) (18)F-fluorodeoxyglucose positron emission tomography with computerized tomography (FDG-PET/CT), as a test of tumor sensitivity to ongoing/planned therapy, has been shown to be prognostic for survival in HL. Based on results of interim FDG-PET/CT, therapy may be subsequently modified through minimization or via intensification for low- and high-risk patient populations, respectively (ie, response-adapted therapy). Important data have been generated to standardize the interpretability and reproducibility of interim FDG-PET/CT (eg, the Deauville 5-point system), and observational and noncontrolled prospective studies have produced evidence supporting the hypothesis that response-adapted therapy may potentially serve as a predictive tool. Furthermore, results from noninferiority phase 3 clinical trials randomizing early-stage HL patients with negative interim FDG-PET/CT to combined modality therapy versus chemotherapy alone have been reported. The current collective findings from these randomized early-stage HL studies have shown that acute relapse rates are lower with combined modality therapy, even in patients with negative interim FDG-PET/CT. Additional randomized response-adapted studies are ongoing and novel FDG-PET/CT applications involving quantitative techniques and innovative imaging modalities are being investigated to identify more robust imaging biomarkers. Treatment of early-stage HL remains a clinical management choice for physicians and patients to make with consideration of acute and long-term outcomes.
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Affiliation(s)
- Andrew M Evens
- Division of Hematology-Oncology, Tufts Medical Center, Boston, MA; and
| | - Lale Kostakoglu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
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