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Evens AM. Hodgkin lymphoma treatment for older persons in the modern era. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:483-499. [PMID: 38066840 PMCID: PMC10727079 DOI: 10.1182/hematology.2023000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
There has been a renewed effort globally in the study of older Hodgkin lymphoma (HL) patients, generating a multitude of new data. For prognostication, advancing age, comorbidities, altered functional status, Hispanic ethnicity, and lack of dose intensity (especially without anthracycline) portend inferior survival. Geriatric assessments (GA), including activities of daily living (ADL) and comorbidities, should be objectively measured in all patients. In addition, proactive multidisciplinary medical management is recommended (eg, geriatrics, cardiology, primary care), and pre-phase therapy should be considered for most patients. Treatment for fit older HL patients should be given with curative intent, including anthracyclines, and bleomycin should be minimized (or avoided). Brentuximab vedotin given sequentially before and after doxorubicin, vinblastine, dacarbazine (AVD) chemotherapy for untreated patients is tolerable and effective, and frontline checkpoint inhibitor/AVD platforms are rapidly emerging. Therapy for patients who are unfit or frail, whether due to comorbidities and/or ADL loss, is less clear and should be individualized with consideration of attenuated anthracycline-based therapy versus lower-intensity regimens with inclusion of brentuximab vedotin +/- checkpoint inhibitors. For all patients, there should be clinical vigilance with close monitoring for treatment-related toxicities, including neurotoxicity, cardiopulmonary, and infectious complications. Finally, active surveillance for "postacute" complications 1 to 10 years post therapy, especially cardiac disease, is needed for cured patients. Altogether, therapy for older HL patients should include anthracycline-based therapy in most cases, and novel targeted agents should continue to be integrated into treatment paradigms, with more research needed on how best to utilize GAs for treatment decisions.
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Affiliation(s)
- Andrew M. Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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2
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Wilson MR, Haynes E, Parsons K, Hopkins D, Robertson E, Ferguson G, Quinn D, Murray J, Osborne W, Leach M, McKay P. 'ACOPP' chemotherapy for older and less fit patients with Hodgkin lymphoma-A multicentre, retrospective study. Br J Haematol 2023; 202:796-800. [PMID: 37357380 DOI: 10.1111/bjh.18947] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
Management of classical Hodgkin lymphoma in older patients is challenging due to poor tolerance of the chemotherapy regimens used in younger patients. We modified the BEACOPP regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine and prednisolone), whereby bleomycin and etoposide were removed and cyclophosphamide dose was reduced, for older patients with co-morbidities. Here we present data from the first 41 patients treated with 'ACOPP' across 3 centres, demonstrating that it can be delivered, with a favourable toxicity profile (TRM 2%) and promising efficacy (2-year PFS and OS, 73% (95% CI: 52-94) and 93% (95% CI: 80-100) respectively).
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Affiliation(s)
- Matthew R Wilson
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Euan Haynes
- Department of Haematology, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Katrina Parsons
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - David Hopkins
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Graeme Ferguson
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Daire Quinn
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Jim Murray
- Department of Haematology, Royal United Hospital Bath NHS Trust, Bath, UK
| | - Wendy Osborne
- Department of Haematology, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Mike Leach
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Pam McKay
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
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3
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Barrett A, Collins GP. Older patients with Hodgkin Lymphoma: Walking the tightrope of efficacy and toxicity. Front Oncol 2023; 12:1017787. [PMID: 36713561 PMCID: PMC9880490 DOI: 10.3389/fonc.2022.1017787] [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: 08/12/2022] [Accepted: 11/11/2022] [Indexed: 01/15/2023] Open
Abstract
Since its initial description, classical Hodgkin lymphoma (cHL) portends a greatly improved prognosis and the goal of treatment in most patients is cure with minimisation of toxicity from treatment. Outcomes in older patients (>60 years old) lag behind those of their younger counterparts however, and cure remains achievable mostly for those who can tolerate full doses of conventional chemotherapy. This review addresses the difference in biology between younger and older patients with cHL and examines the impact of frailty and comorbidities on outcomes. The toxicities of conventional chemotherapy in anthracycline-fit and -unfit patients are examined, with a particular focus on pulmonary toxicity associated with bleomycin in older patients. New advances are discussed, including the possibility of using more targeted therapies such as the anti-CD30 antibody brentuximab vedotin (BV) and checkpoint inhibitors as a method of reducing dependency on conventional chemotherapy for those less well able to tolerate it. Treatment of older patients with cHL remains an area of unmet need in hematological research, and efforts to rectify this knowledge gap should continue.
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4
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Clinical Dilemmas in the Treatment of Elderly Patients Suffering from Hodgkin Lymphoma: A Review. Biomedicines 2022; 10:biomedicines10112917. [PMID: 36428485 PMCID: PMC9687245 DOI: 10.3390/biomedicines10112917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/02/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
Elderly patients make up a significant number of cases of newly diagnosed Hodgkin lymphoma. However, unlike in young patients, the outcomes of elderly patients are poor, and they are under-represented in phase III trials. Prior to treatment initiation, geriatric assessment should ideally be performed to address the patient's fitness and decide whether to pursue a curative or palliative approach. The ABVD regimen is poorly tolerated in unfit patients, with high treatment-related mortality. Alternative chemotherapy approaches have been explored, with mixed results obtained concerning their feasibility and toxicity in phase II trials. The introduction of brentuximab vedotin-based regimens led to a paradigm shift in first- and further-line treatment of elderly Hodgkin lymphoma patients, providing adequate disease control within a broader patient population. As far as checkpoint inhibitors are concerned, we are only just beginning to understand the role in the treatment of this population. In relapsed/refractory settings there are few options, ranging from autologous stem cell transplantation in selected patients to pembrolizumab, but unfortunately, palliative care is the most common modality. Importantly, published studies are frequently burdened with numerous biases (such as low numbers of patients, selection bias and lack of geriatric assessment), leading to low level of evidence. Furthermore, there are few ongoing studies on this topic. Thus, elderly Hodgkin lymphoma patients are hard to treat and represent an unmet need in hematologic oncology. In conclusion, treatment needs to be personalized and tailored on a case-by-case basis. In this article, we outline treatment options for elderly Hodgkin lymphoma patients.
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5
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Makiyama J, Imaizumi Y, Watanabe H, Fujioka M, Chiwata M, Kitanosono H, Nakashima J, Miyazaki Y, Yoshida S. Outcomes in Patients with Classic Hodgkin Lymphoma Treated with ABVD: A Single-center Retrospective Study. Intern Med 2021; 60:709-718. [PMID: 33087662 PMCID: PMC7990646 DOI: 10.2169/internalmedicine.5004-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Classic Hodgkin lymphoma (CHL) has been regarded as a curable disease when treated appropriately, especially in younger patients, and ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) has been regarded as the standard regimen. However, a relatively poor prognosis has been reported in older patients with CHL, and the efficacy and tolerability of the ABVD regimen has not been fully elucidated. We retrospectively investigated the outcomes in patients with CHL treated with ABVD at our institute. Methods Twenty-five patients were evaluated; 14 were ≤60 years of age, and 11 were >60 years of age (older group). Results The ABVD doses were reduced in all patients in the older group; the median average relative dose intensity was 0.58. In the older group, the 5-year overall survival (OS) and median OS were 100% and not reached, respectively, for patients with early-stage CHL and 66.7% and not reached, respectively, for those with advanced-stage CHL. No patients died of CHL, and only one treatment-related death was observed in the older group. Conclusion ABVD with dose attenuation may represent a feasible and effective strategy for the treatment of older patients with CHL in clinical practice, particularly in those with early-stage disease, although the optimal degree of attenuation remains unclear.
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Affiliation(s)
- Junya Makiyama
- Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Japan
- Department of Hematology, National Hospital Organization Nagasaki Medical Center, Japan
| | | | - Haruka Watanabe
- Department of Hematology, National Hospital Organization Nagasaki Medical Center, Japan
| | - Machiko Fujioka
- Department of Hematology, National Hospital Organization Nagasaki Medical Center, Japan
- Department of Hematology, Nagasaki University Hospital, Japan
| | - Masahiko Chiwata
- Department of Hematology, National Hospital Organization Nagasaki Medical Center, Japan
- Department of Hematology, Nagasaki University Hospital, Japan
| | - Hideaki Kitanosono
- Department of Hematology, National Hospital Organization Nagasaki Medical Center, Japan
| | - Jun Nakashima
- Department of Hematology, National Hospital Organization Nagasaki Medical Center, Japan
| | - Yasushi Miyazaki
- Department of Hematology, Nagasaki University Hospital, Japan
- Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Japan
| | - Shinichiro Yoshida
- Department of Hematology, National Hospital Organization Nagasaki Medical Center, Japan
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6
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Moccia AA, Aeppli S, Güsewell S, Bargetzi M, Caspar C, Brülisauer D, Ebnöther M, Fehr M, Fischer N, Ghilardi G, Krasniqi F, Lang N, Mey U, Mingrone W, Novak U, Pfleger C, Richter P, Rütti M, Schmidt A, Stenner F, Voegeli M, Zander T, Zucca E, Hitz F. Clinical characteristics and outcome of patients over 60 years with Hodgkin lymphoma treated in Switzerland. Hematol Oncol 2020; 39:196-204. [PMID: 33300135 DOI: 10.1002/hon.2830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/06/2020] [Indexed: 11/09/2022]
Abstract
Hodgkin lymphoma (HL) in older patients appears to be a different disease compared with younger patients with historically lower survival rates. This is related to a variety of factors, including increased treatment-related toxicity, the presence of comorbidities, and biologic differences. In order to better assess the clinical characteristics, treatment strategies, and outcome of this particular population, we conducted a population-based, retrospective analysis including 269 patients with HL older than 60 years (median age 71 years, range 60-94), treated between 2000 and 2017 in 15 referral centers across Switzerland. Primary endpoints were overall survival (OS), progression-free survival (PFS), and cause-specific survival (CSS). The vast majority of patients were treated with curative intent, either with a combined modality approach (chemotherapy followed by radiation therapy) or with systemic therapy. At a median follow-up of 6.6 years (95% confidence interval [CI], 6.0-7.6), 5-year PFS was 52.2% (95% CI, 46.0-59.2), 5-year OS was 62.5% (95% CI, 56.4-69.2), and 5-year CSS was 85.1.8% (95% CI, 80.3-90.1) for the entire cohort. A significant difference in terms of CSS was observed for patients older than 71 years in comparison to patients aged 60-70 years (hazard ratio 2.6, 1.3-5.0, p = 0.005). Bleomycin-induced lung toxicity (BLT) was documented in 26 patients (17.7%) out of the 147 patients exposed to this compound and was more frequent in patients older than 71 years (15/60, 25%). Outcome of HL pts older than 71 years appeared to decrease substantially in comparison to the younger counterpart. Treatment-related toxicities appeared to be relevant, in particular, BLT. New, potentially less toxic strategies need to be investigated in prospective clinical trials in this particular frail population.
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Affiliation(s)
- A A Moccia
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - S Aeppli
- Medical Oncology and Hematology Clinic, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - S Güsewell
- Clinical Trials Unit, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - M Bargetzi
- Hematology, Kantonsspital Aarau, Aarau, Switzerland
| | - C Caspar
- Medical Oncology and Hematology, Kantonsspital Baden, Baden, Switzerland
| | - D Brülisauer
- Medical Oncology Clinic, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - M Ebnöther
- Medical Oncology and Hematology, Claraspital, Basel, Switzerland
| | - M Fehr
- Medical Oncology and Hematology Clinic, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - N Fischer
- Medical Oncology and Hematology Clinic, Kantonsspital Winterthur, Winterthur, Switzerland
| | - G Ghilardi
- Hematology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - F Krasniqi
- Medical Oncology Clinic, University Hospital of Basel, Basel, Switzerland
| | - N Lang
- Medical Oncology Clinic, University Hospital of Geneva, Genève, Switzerland
| | - U Mey
- Medical Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - W Mingrone
- Medical Oncology Clinic, Kantonsspital Olten, Olten, Switzerland
| | - U Novak
- Medical Oncology Clinic, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - C Pfleger
- Medical Oncology and Hematology, Claraspital, Basel, Switzerland
| | - P Richter
- Medical Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - M Rütti
- Internal Medicine Clinic, Spital Wil, Wil, Switzerland
| | - A Schmidt
- Medical Oncology and Hematology Clinic, Stadtspital Triemli, Zürich, Switzerland
| | - F Stenner
- Medical Oncology Clinic, University Hospital of Basel, Basel, Switzerland
| | - M Voegeli
- Medical Oncology and Hematology Clinic, Kantonsspital Baselland, Liestal, Switzerland
| | - T Zander
- Medical Oncology, Luzerner Kantonsspital, Luzern, Switzerland
| | - E Zucca
- Medical Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - F Hitz
- Medical Oncology and Hematology Clinic, Kantonsspital St. Gallen, St. Gallen, Switzerland
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7
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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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Carter J, David KA, Kritharis A, Evens AM. Current Treatment Options for Older Patients with Hodgkin Lymphoma. Curr Treat Options Oncol 2020; 21:42. [PMID: 32328822 DOI: 10.1007/s11864-020-00745-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OPINION STATEMENT Older adults with Hodgkin lymphoma (HL), commonly defined as age ≥ 60 years, represent approximately 20% of the total HL population. Historically, they have significantly inferior outcomes compared with younger patients. The cause of this is multifactorial, including biologic differences (e.g., mixed cellularity and EBV-related disease); high incidence of advanced stage disease; and frequency of comorbidities and decreased organ reserve leading to poorer tolerability of therapy with increased toxicity, including treatment-related mortality. Pretreatment evaluation for older HL patients should entail a geriatric assessment (GA), with evaluation of functional status and comorbidities (e.g., geriatric cumulative illness rating scale, CIRS-G) to determine fitness. Furthermore, treatment selection should be based in part on GA, with fit older patients receiving curative chemotherapy-based regimens and unfit or frail patients considering less intensive or non-chemotherapy-based platforms. Additionally, there may be consideration for pre-phase of therapy (e.g., pulse steroids) in order to improve performance status. The inclusion of anthracycline therapy appears important, while bleomycin-containing regimens (e.g., ABVD) may be associated with prohibitive pulmonary toxicity, and intensive therapies such as BEACOPP are too toxic. benefit ratio/benefit ratio, a priori omission of bleomycin may also be considered (i.e., AVD), especially for patients older than 70 years of age. In addition, newer regimens for older HL patients integrating novel therapeutic agents into frontline treatment have emerged as effective and tolerable options. Data incorporating brentuximab vedotin sequentially before and after AVD chemotherapy represent the best-reported outcomes in older HL patients to date. In the relapsed/refractory setting, salvage chemotherapy regimens followed by autologous stem cell transplantation should be considered for fit patients, while less intensive treatment, including the use of novel targeted agents, is an option for unfit or frail patients. In this review, we examine the epidemiology, importance of GA, and current treatment options for older HL patients.
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Affiliation(s)
- Jordan Carter
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
| | - Kevin A David
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
| | - Athena Kritharis
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA.
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9
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Sykorova A, Mocikova H, Lukasova M, Koren J, Stepankova P, Prochazka V, Belada D, Klaskova K, Gaherova L, Chroust K, Buresova L, Markova J. Outcome of elderly patients with classical Hodgkin’s lymphoma. Leuk Res 2020; 90:106311. [DOI: 10.1016/j.leukres.2020.106311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 01/18/2020] [Accepted: 01/22/2020] [Indexed: 11/27/2022]
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10
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Allen PB, Ayers A, Behera M, Evens AM, Flowers C. A systematic review of therapeutic regimens for older patients with newly diagnosed Hodgkin lymphoma. Leuk Lymphoma 2020; 61:1555-1564. [PMID: 32102579 DOI: 10.1080/10428194.2020.1731497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Classical Hodgkin lymphoma (cHL) in older adults is associated with inferior outcomes and increased toxicity compared to younger patients. Novel therapies like brentuximab vedotin (BV) have yielded promising results, yet their optimal use in older cHL remains unclear. We performed a systematic review to assess outcomes and toxicity associated with frontline regimens in older cHL. We screened 196 references involving chemotherapy without BV and 662 references containing BV and included 9 studies (12 arms) without BV and 6 studies (7 arms) with BV. Progression-free survival (PFS) ranged from 47 to 84% at 2 years in BV-containing arms and 42-79% at 5 years in non-BV containing trials. Pulmonary toxicity was more common in arms receiving >2 cycles of bleomycin, whereas peripheral neuropathy was associated with cumulative BV dose. This review summarizes available treatment outcomes in newly diagnosed older cHL patients and may aid clinicians in decision-making regarding available frontline approaches.Key PointsThis systematic review suggests that >2 cycles of bleomycin is associated with excess pulmonary toxicity in cHL patients older than 60 years of age.Peripheral neuropathy was more frequent in patients receiving BV-containing regimens and was associated with cumulative BV dose.BV-containing regimens are associated with high response rates in advanced-stage patients, but follow-up is limited.
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Affiliation(s)
- Pamela B Allen
- Department of Hematology and Oncology, Winship Cancer Institution of Emory University, Atlanta, GA, USA
| | - Amy Ayers
- Department of Hematology and Oncology, Winship Cancer Institution of Emory University, Atlanta, GA, USA
| | - Madhusmita Behera
- Department of Research Informatics, Winship Cancer Institution of Emory University, Atlanta, GA, USA
| | - Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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11
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Kasinathan G, Kori AN, Hassan N. Abdominal Lymphocyte-Depleted Hodgkin Lymphoma: A Rare Presentation. Int J Gen Med 2019; 12:405-409. [PMID: 31807052 PMCID: PMC6842749 DOI: 10.2147/ijgm.s232254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/14/2019] [Indexed: 11/23/2022] Open
Abstract
Background Hodgkin lymphoma (HL) is a type of lymphoma that arises from the B lymphocytes. The four main subtypes of HL are the nodular sclerosing, mixed cellularity, lymphocyte rich and the lymphocyte depleted. Nodular sclerosis subtype accounts for majority of all classical HL, whereas lymphocytic depletion type accounts for less than 1%. The main objective of reporting this case is to share with the medical fraternity a rare presentation of abdominal lymphocyte-depleted classical Hodgkin lymphoma. A 47-year-old gentleman of Malay ethnicity with no known pre-morbidities, presented to the haematology unit with a 2-month history of night fever, loss of weight, malaise, anorexia and abdominal swelling. Abdominal examination revealed a periumbilical and lower epigastric swelling measuring 6x6 cms. The swelling was non-tender, firm in consistency and smooth on palpation. The Contrast Enhanced Computed Tomography (CECT) imaging revealed an enlarged mesenteric mass measuring 5.8x6.9x5.7 cm and multiple enlarged aorta-caval lymph nodes. The mesenteric tumour histology and immunohistochemistry were consistent with lymphocyte depleted HL. He completed six cycles of intravenous ABVD polychemotherapy consisting of doxorubicin (Adriamycin) 25mg/m2, Bleomycin 10mg/m2, Vinblastine 6mg/m2 and Dacarbazine 375mg/m2. The Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET /CT) imaging post 2 cycles and 6 cycles of ABVD polychemotherapy showed complete metabolic response to chemotherapy. Conclusion Lymphocyte-depleted classical Hodgkin lymphoma (LDcHL) is a rare entity and is mostly diagnosed at a later stage rendering it a disease with poor prognostic outcomes. Early detection and prompt institution of therapy is crucial in the management of this disease.
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Affiliation(s)
- Ganesh Kasinathan
- Haematology Unit, Tengku Ampuan Afzan Hospital, Kuantan, Pahang, Malaysia
| | - Ahlam Naila Kori
- Haematology Unit, Tengku Ampuan Afzan Hospital, Kuantan, Pahang, Malaysia
| | - Nurhidayah Hassan
- Histopathology Unit, Department of Pathology, Tengku Ampuan Afzan Hospital, Kuantan, Pahang, Malaysia
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12
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Evens AM, Carter J, Loh KP, David KA. Management of older Hodgkin lymphoma patients. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:233-242. [PMID: 31808898 PMCID: PMC6913478 DOI: 10.1182/hematology.2019000028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Hodgkin lymphoma (HL) in older patients, commonly defined as ≥60 years of age, is a disease for which survival rates have historically been significantly lower compared with younger patients. Older HL patients appear to have different disease biology compared with younger patients, including increased incidence of mixed cellularity histology, Epstein-Barr virus-related, and advanced-stage disease. For prognostication, several studies have documented the significance of comorbidities and functional status in older HL patients, as well as the importance of achieving initial complete remission. Collectively, selection of therapy for older HL patients should be based in part on functional status, including pretreatment assessment of activities of daily living (ADL), comorbidities, and other geriatric measures (eg, cognition, social support). Treatment of fit older HL patients should be given with curative intent, regardless of disease stage. However, attention should be paid to serious treatment-related toxicities, including risk of treatment-related mortality. Although inclusion of anthracycline therapy is important, bleomycin-containing regimens (eg, doxorubicin, bleomycin, vinblastine, dacarbazine) may lead to prohibitive pulmonary toxicity, and intensive therapies (eg, bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) are too toxic. Brentuximab vedotin given sequentially before and after doxorubicin, vinblastine, and dacarbazine to fit, untreated advanced-stage older HL patients was recently shown to be tolerable and highly effective. Therapy for patients who are unfit or frail because of comorbidities and/or ADL loss is less clear and should be individualized with consideration of lower-intensity therapy, such as brentuximab vedotin with or without dacarbazine. Altogether, therapy for older HL patients should be tailored based upon a geriatric assessment, and novel targeted agents should continue to be integrated into treatment paradigms.
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Affiliation(s)
- Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and
| | - Jordan Carter
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and
| | - Kah Poh Loh
- Division of Hematology and Oncology, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Kevin A David
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and
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13
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Salvi F, Luminari S, Tucci A, Massidda S, Liberati AM, Stelitano C, Zanni M, Re A, Centurioni R, Freilone R, Musuraca G, Nassi L, Patti C, Arcari A, Tani M, Pulsoni A, Pavone V, Volpetti S, Peli A, Evangelista A, Spina M, Ladetto M, Merli F. Bleomycin, vinblastine and dacarbazine combined with nonpegylated liposomal doxorubicin (MBVD) in elderly (≥70 years) or cardiopathic patients with Hodgkin lymphoma: a phase-II study from Fondazione Italiana Linfomi (FIL). Leuk Lymphoma 2019; 60:2890-2898. [PMID: 31282794 DOI: 10.1080/10428194.2019.1608529] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This phase-II study assessed activity and toxicity of substituting conventional doxorubicin with nonpegylated liposomal doxorubicin in the conventional ABVD regimen for the treatment of elderly or cardiopathic patients with HL. Stage I-IIA and IIB-IV patients were treated with three courses of MBVD plus radiotherapy, or six courses of MBVD, respectively, plus radiotherapy limited to bulky or residual disease areas. The primary endpoints were CR rate and the rate of cardiac events. Forty-seven patients were enrolled. Median age was 75 years, 13 had stage I-II disease. Overall, CR was achieved by 36 patients (77%, 95% CI: 62-88), 100% and 68% in stage I-II and III-IV, respectively. With a median follow-up of 40 months (IQR: 36-45). Three-year overall survival (OS) and progression-free survival (PFS) were 70% and 43%, respectively. Cardiac events grades 3-5 were reported in two patients. In conclusion, MBVD's activity and safety profile was comparable to historical ABVD data.
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Affiliation(s)
- Flavia Salvi
- Division of Hematology, SS. Antonio e Biagio Hospital, Alessandria, Italy
| | - Stefano Luminari
- Hematology Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy.,Surgical, Medical and Dental Department of Morphological Sciences related to Transplant Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Tucci
- Division of Haematology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Stefania Massidda
- Hematology and Transplant Center, Ospedale Oncologico di Riferimento Regionale Armando Businco, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Anna Marina Liberati
- Oncohematology and autotransplantation Unit, Azienda Ospedaliera Santa Maria, Terni, Italy
| | - Caterina Stelitano
- Division of Hematology, Azienda Ospedaliera "Bianchi Melacrino Morelli", Reggio Calabria, Italy
| | - Manuela Zanni
- Division of Hematology, SS. Antonio e Biagio Hospital, Alessandria, Italy
| | - Alessandro Re
- Division of Haematology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Riccardo Centurioni
- Internal medicine and hematology Unit, Azienda Sanitaria Unica Regionale Marche AV3, Civitanova Marche, Italy
| | | | - Gerardo Musuraca
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Luca Nassi
- Division of Hematology Department of Translational Medicine, Università del Piemonte Orientale and AOU Maggiore della Carità, Novara, Italy
| | - Caterina Patti
- Department of Hematology I, Azienda Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Annalisa Arcari
- Hematology Unit and Transplantion Center, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
| | - Monica Tani
- Hematology, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Alessandro Pulsoni
- Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I "Sapienza" University of Rome, Roma, Italy
| | - Vincenzo Pavone
- Department of Hematology and Bone Marrow Transplant, Hospital Card. G. Panico, Tricase, Italy
| | - Stefano Volpetti
- Department of Haematology, DISM Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Annalisa Peli
- Division of Haematology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Andrea Evangelista
- Clinical and Evaluative Epidemiology Unit, AOU Città della Salute e della Scienza di Torino e CPO Piemonte, Torino, Italy
| | - Michele Spina
- Division of Medical Oncology and Immunorelated Tumors, National Cancer Institute, Aviano, Italy
| | - Marco Ladetto
- Division of Hematology, SS. Antonio e Biagio Hospital, Alessandria, Italy
| | - Francesco Merli
- Hematology Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
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14
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Abstract
PURPOSE OF REVIEW We aim to summarize the current knowledge on the treatment of elderly Hodgkin lymphoma patients with a focus on evidence from clinical trials and novel drugs. RECENT FINDINGS For elderly Hodgkin lymphoma patients above 60 years without precluding comorbidities a curative treatment approach is warranted. Early favorable stage patients should receive two cycles of multiagent chemotherapy followed by 20 Gy localized radiotherapy. Early unfavorable stage patients should receive four cycles of multiagent chemotherapy followed by 30 Gy localized radiotherapy. For advanced stage patients six cycles of multiagent chemotherapy can be recommended and should be followed by localized radiotherapy on residual disease manifestations. Relapsed or refractory patients should be treated in an individually tailored approach that considers both the patient's objectives and comorbidities. The antibody-drug conjugate brentuximab vedotin is a very effective option for elderly patients with a high response rate albeit limited durability. Anti-programed cell death protein 1 antibodies might also be effective in elderly Hodgkin lymphoma patients with a mechanism of action distinct from chemotherapy. SUMMARY In conclusion, the goal of treatment in newly diagnosed elderly Hodgkin lymphoma patients is curative whenever possible and prospective and retrospective evidence has shown that this is feasible for all disease stages with a variety of multiagent chemotherapy regimen. Relapsed and refractory elderly Hodgkin lymphoma patients can mostly only be treated with the goal of palliation. However, it remains to be seen if novel substances and new combination regimen are able to change that.
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15
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Böll B, Plütschow A, Bürkle C, Atta J, Pfreundschuh M, Feuring‐Buske M, Vogelhuber M, Sökler M, Eichenauer DA, Thielen I, Tresckow B, Fuchs M, Engert A, Borchmann P. Doxorubicin, vinblastine, dacarbazine and lenalidomide for older Hodgkin lymphoma patients: final results of a German Hodgkin Study Group (
GHSG
) phase‐I trial. Br J Haematol 2018; 185:42-52. [DOI: 10.1111/bjh.15741] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/26/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Boris Böll
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
| | - Annette Plütschow
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
| | - Carolin Bürkle
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
| | - Johannes Atta
- Haematology Oncology University Hospital Frankfurt FrankfurtGermany
| | | | | | - Martin Vogelhuber
- Haematology Oncology University Hospital Regensburg RegensburgGermany
| | - Martin Sökler
- Haematology Oncology University Hospital Tübingen Tübingen Germany
| | - Dennis A. Eichenauer
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
| | - Indra Thielen
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
| | - Bastian Tresckow
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
| | - Michael Fuchs
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
| | - Andreas Engert
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
| | - Peter Borchmann
- German Hodgkin Study Group (GHSG) Department of Internal Medicine 1 University Hospital Cologne CologneGermany
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16
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Affiliation(s)
- Boris Böll
- German Hodgkin Study Group and Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
| | - Helen Görgen
- German Hodgkin Study Group and Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
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17
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Wróbel T, Biecek P, Rybka J, Szulgo A, Sorbotten N, Giza A, Tyczyńska A, Nowara E, Badora-Rybicka A, Adamowicz K, Kulikowski W, Kroll-Balcerzak R, Balcerzak A, Spychałowicz W, Kalinka-Warzocha E, Kumiega B, Drozd-Sokołowska J, Subocz E, Sałek A, Machaczka M, Hołojda J, Pogrzeba J, Dobrzyńska O, Chmielowska E, Jurczak W, Knopińska-Posłuszny W, Leśniewski-Kmak K, Maciej Zaucha J. Hodgkin lymphoma of the elderly patients: a retrospective multicenter analysis from the Polish Lymphoma Research Group. Leuk Lymphoma 2018; 60:341-348. [DOI: 10.1080/10428194.2018.1482539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Tomasz Wróbel
- Department of Hematology, Wroclaw Medical University, Wrocław, Poland
| | - Przemysław Biecek
- Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland
| | - Justyna Rybka
- Department of Hematology, Wroclaw Medical University, Wrocław, Poland
| | - Anna Szulgo
- Department of Oncology, Center of Oncology of Professor Franciszek Łukaszczyk, Bydgoszcz, Poland
| | - Natalia Sorbotten
- Department of Oncology, Center of Oncology of Professor Franciszek Łukaszczyk, Bydgoszcz, Poland
| | - Agnieszka Giza
- Department of Hematology, Collegium Medicum of the Jagiellonian University, Kraków, Poland
| | - Agata Tyczyńska
- Department of Oncology and Radiotherapy, Gdynia Oncology Center, Gdynia, Poland
| | - Elżbieta Nowara
- Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | | | | | | | | | - Andrzej Balcerzak
- Department of Hematology, University of Medical Sciences, Poznan, Poland
| | - Wojciech Spychałowicz
- Internal Medicine and Oncology Clinic, Silesian Medical University, Katowice, Poland
| | | | - Beata Kumiega
- Department of Hematology, Brzozow Oncology Center, Brzozów, Poland
| | - Joanna Drozd-Sokołowska
- Department of Haematology, Oncology and Internal Medicine, The Medical University of Warsaw, Warsaw, Poland
| | - Edyta Subocz
- Department of Haematology, Military Institute of Medicine in Warsaw, Warsaw, Poland
| | - Agata Sałek
- Department of Hematology KSW No.1 and Medical Faculty, University of Rzeszow, Rzeszow, Poland
| | - Maciej Machaczka
- Department of Hematology KSW No.1 and Medical Faculty, University of Rzeszow, Rzeszow, Poland
| | - Jadwiga Hołojda
- Department of Hematology, Provincial Specialist Hospital, Legnica, Poland
| | - Joanna Pogrzeba
- Department of Hematology, Provincial Specialist Hospital, Opole, Poland
| | - Olga Dobrzyńska
- Department of Hematology, Wroclaw Medical University, Wrocław, Poland
| | - Ewa Chmielowska
- Department of Oncology, Center of Oncology of Professor Franciszek Łukaszczyk, Bydgoszcz, Poland
| | - Wojciech Jurczak
- Department of Hematology, Collegium Medicum of the Jagiellonian University, Kraków, Poland
| | | | - Krzysztof Leśniewski-Kmak
- Department of Oncology and Radiotherapy, Gdynia Oncology Center, Gdynia, Poland
- Department of Oncological Propaedeutics, Medical University of Gdańsk, Gdańsk, Poland
| | - Jan Maciej Zaucha
- Department of Oncology and Radiotherapy, Gdynia Oncology Center, Gdynia, Poland
- Department of Hematology and Transplantology, Medical University of Gdańsk, Gdańsk, Poland
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18
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Abstract
Hodgkin's lymphoma (HL) is a relatively rare disease accounting for 15 % of all lymphoma. This disease has developed from an incurable disease to the adult malignancy with the most favorable prognosis. With current therapeutic approaches consisting of polychemo- and small-field radiotherapy, up to 80 % of all patients can be cured long term. In refractory or relapsed HL, intensified treatment including high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT) is associated with progression-free survival (PFS) of 50 %. Evaluation of novel drugs in multiple relapsed or refractory cases, better treatment options for elderly patients and reducing treatment-related side effects are the main focus of current research. Recent clinical developments and future approaches in the treatment of HL will be discussed in this review.
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19
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Bleomycin in older early-stage favorable Hodgkin lymphoma patients: analysis of the German Hodgkin Study Group (GHSG) HD10 and HD13 trials. Blood 2016; 127:2189-92. [PMID: 26834240 DOI: 10.1182/blood-2015-11-681064] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/20/2016] [Indexed: 11/20/2022] Open
Abstract
Doxorubicin, bleomycin, vinblastine sulfate, and dacarbazine (ABVD) is associated with severe toxicity in older patients, particularly from bleomycin-induced lung toxicity (BLT). Therefore, using bleomycin has been questioned in older Hodgkin lymphoma (HL) patients, especially in early-stage HL. We therefore analyzed feasibility, toxicity, and efficacy of ABVD or AVD in 287 older early-stage favorable HL patients. We included patients ≥60 years of age in the German Hodgkin Study Group HD10 and HD13 trials randomized to either 2 cycles of ABVD (2×ABVD; n = 137) or AVD (2×AVD; n = 82), each followed by involved-field radiotherapy (IF-RT), with patients randomized to 4×ABVD+IF-RT (n = 68). Patients' median age was 65 years (range, 60-75) with comparable patient and disease characteristics. Grade III-IV adverse event rates were similar in patients receiving 2×AVD and 2×ABVD (40% and 39%, respectively), but considerably higher in patients receiving 4×ABVD (65%). Similarly, BLT was rare in patients receiving 2×ABVD/AVD, but occurred in 7/69 (10%) of patients randomized to 4×ABVD, with 3 lethal events. In conclusion, no effects of bleomycin on toxicity rates were detectable in older patients receiving 2 cycles of chemotherapy. However, we found a high risk of severe toxicity of bleomycin in older HL patients receiving more than 2 cycles of ABVD. These trials are registered at www.clinicaltrials.gov and www.isrctn.com as #NCT00265018 (HD10) and #ISRCTN63474366 (HD13).
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20
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Zallio F, Tamiazzo S, Monagheddu C, Merli F, Ilariucci F, Stelitano C, Liberati AM, Mannina D, Vitolo U, Angelucci E, Rota Scalabrini D, Vallisa D, Bellei M, Bari A, Ciccone G, Salvi F, Levis A. Reduced intensity VEPEMB regimen compared with standard ABVD in elderly Hodgkin lymphoma patients: results from a randomized trial on behalf of the Fondazione Italiana Linfomi (FIL). Br J Haematol 2016; 172:879-88. [PMID: 26763986 DOI: 10.1111/bjh.13904] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/22/2015] [Indexed: 01/29/2023]
Abstract
Survival rates for elderly Hodgkin Lymphoma (HL) have not improved substantially in recent years, mainly because of a lack of prospective randomized studies, due to difficulties in enrolling patients. Between 2002 and 2006, 54 untreated HL patients, aged between 65 and 80 years and considered 'non-frail' according to a comprehensive geriatric evaluation, were enrolled into a phase III randomized trial to compare a reduced-intensity regimen (vinblastine, cyclophosphamide, procarbazine, prednisone, etoposide, mitoxantrone, bleomycin; VEPEMB) with standard ABVD (adriamycin, bleomycin, vinblastine, dacarbazine). Primary endpoint was progression-free survival (PFS). Seventeen patients were in early stage (I-IIA), while 37 were advanced stage. Median age was 72 years and median follow-up was 76 months. Five-year PFS rates were 48% vs. 70% [adjusted Hazard ratio (HR) = 2·19, 95% confidence interval (CI) = 0·94-5·10, P = 0·068] and 5-year overall survival (OS) rates were 63% vs. 77% (adjusted HR = 1·67, 95% CI = 0·69-4·03, P = 0·254) for VEPEMB compared to ABVD. Overall treatment-related mortality was 4%. World Health Organization grade 4 cardiac and lung toxicity occurred in four patients treated with ABVD versus no cases in the VEPEMB arm. Standard ABVD regimen resulted in better PFS and OS than the VEPEMB, although the differences were not statistically significant. The low toxicity of both treatments was probably attributable to stringent selection of patients based on a Comprehensive Geriatric Assessment that excluded frail patients.
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Affiliation(s)
- Francesco Zallio
- Haematology Department, SS Antonio & Biagio and C. Arrigo Hospital, Alessandria, Italy
| | - Stefania Tamiazzo
- Haematology Department, SS Antonio & Biagio and C. Arrigo Hospital, Alessandria, Italy
| | - Chiara Monagheddu
- Unity of Clinical Epidemiology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - Francesco Merli
- Haematology, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | | | | | - Anna Marina Liberati
- Department of Surgery and Biomedicine, Division of Onco-haematology with Autologous Transplant, University of Perugia, Perugia, Italy
| | - Donato Mannina
- Division of Haematology, Papardo Hospital, Messina, Italy
| | - Umberto Vitolo
- Haematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Delia Rota Scalabrini
- Division of Candiolo Cancer Institute, IRCCS University of Torino Medical School, Candiolo, Italy
| | - Daniele Vallisa
- Oncology and Haematology Department, Azienda Unità Sanitaria Locale, Piacenza, Italy
| | - Monica Bellei
- Department of Diagnostic Medicine, Clinical and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessia Bari
- Department of Diagnostic Medicine, Clinical and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovannino Ciccone
- Unity of Clinical Epidemiology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - Flavia Salvi
- Haematology Department, SS Antonio & Biagio and C. Arrigo Hospital, Alessandria, Italy
| | - Alessandro Levis
- Haematology Department, SS Antonio & Biagio and C. Arrigo Hospital, Alessandria, Italy
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21
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Stamatoullas A, Brice P, Bouabdallah R, Mareschal S, Camus V, Rahal I, Franchi P, Lanic H, Tilly H. Outcome of patients older than 60 years with classical Hodgkin lymphoma treated with front line ABVD chemotherapy: frequent pulmonary events suggest limiting the use of bleomycin in the elderly. Br J Haematol 2015; 170:179-84. [PMID: 25891777 DOI: 10.1111/bjh.13419] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/16/2015] [Indexed: 11/27/2022]
Abstract
There is no standard of care in elderly classical Hodgkin lymphoma (cHL) patients. ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), the standard chemotherapy for younger patients, is also used in elderly patients but little is known about toxicity and efficacy. We retrospectively analysed 147 patients aged 60 years and over treated with ABVD in three French haematological centres. Treatment regimen modification was applied in 56 patients for toxicity or HL progression. Bleomycin was removed or reduced in 53 patients, mainly for pulmonary toxicity. Neither initial characteristics nor treatment characteristics were found to correlate with lung toxicity. One hundred and seventeen patients achieved a complete remission, 6 a partial remission, 16 had refractory disease and 8 were non-evaluable. Five-year overall survival was estimated at 67%. With a median follow-up of 58 months, 51 patients died and 14% of deaths were related to lung toxicity. Our study confirms the efficacy of ABVD in elderly patients even if results are inferior to those obtained in younger patients with the same regimen. ABVD can be proposed as front-line chemotherapy in selected elderly cHL patients. The frequency of pulmonary events leads us to propose to either reduce the dose of bleomycin or to remove it from the regimen.
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Affiliation(s)
| | | | | | | | - Vincent Camus
- Henri Becquerel Centre, Rouen University, Rouen, France
| | | | | | - Hélène Lanic
- Henri Becquerel Centre, Rouen University, Rouen, France
| | - Hervé Tilly
- Henri Becquerel Centre, Rouen University, Rouen, France
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22
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Abstract
Abstract
The development of curative systemic treatment of Hodgkin lymphoma was recently voted one of the top 5 achievements of oncology in the last 50 years (http://cancerprogress.net/top-5-advances-modern-oncology). The high expectation of cure (above 80%) with initial therapy, even for advanced disease, is tempered by the recognition of some important limitations: not all patients are cured, especially those in older age groups, and patients have suffered debilitating or, in some cases, fatal long-term side effects. The challenge for modern treatment approaches is to improve the cure rate and, at the same time, minimize the long-term damage resulting from treatment. After several decades during which we have tested a variety of different ways to combine conventional cytotoxic treatments with or without radiotherapy but have identified no effective new approaches, the field is once again moving forward. The developments that hold the greatest promise in this respect are the application of functional imaging with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) to make an early judgment of the success of treatment and the introduction of some highly active new agents such as antibody-drug conjugates.
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23
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Thakar K, Novero A, Das A, Lisinschi A, Mehta B, Ahmed T, Liu D. CEPP regimen (cyclophosphamide, etoposide, procarbazine and prednisone) as initial treatment for Hodgkin lymphoma patients presenting with severe abnormal liver function. Biomark Res 2014; 2:12. [PMID: 24991411 PMCID: PMC4078319 DOI: 10.1186/2050-7771-2-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/18/2014] [Indexed: 02/06/2023] Open
Abstract
ABVD regimen (doxorubicin, bleomycin, vinblastine and dacarbazine) remains the most commonly used front-line therapy for Hodgkin lymphoma. However, atypical and extranodal presentations present challenges to initial therapy, especially in the presence of renal and liver failure. We hereby present two cases of young male patients with atypical presentation of Hodgkin lymphoma with severe abnormal liver function. Patients showed excellent response to cyclophosphamide, etoposide, procarbazine and prednisone (CEPP regimen).
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Affiliation(s)
- Keyur Thakar
- Division of Hematology & Oncology, Department of Medicine, Westchester Medical Center, 100 Woods Rd, Valhalla, NY 10595, USA
| | - Aileen Novero
- Division of Hematology & Oncology, Department of Medicine, Westchester Medical Center, 100 Woods Rd, Valhalla, NY 10595, USA
| | - Arundhati Das
- Division of Hematology & Oncology, Department of Medicine, Westchester Medical Center, 100 Woods Rd, Valhalla, NY 10595, USA
| | - Adriana Lisinschi
- Division of Hematology & Oncology, Department of Medicine, Westchester Medical Center, 100 Woods Rd, Valhalla, NY 10595, USA
| | - Bella Mehta
- Division of Hematology & Oncology, Department of Medicine, Westchester Medical Center, 100 Woods Rd, Valhalla, NY 10595, USA
| | - Tauseef Ahmed
- Division of Hematology & Oncology, Department of Medicine, Westchester Medical Center, 100 Woods Rd, Valhalla, NY 10595, USA
| | - Delong Liu
- Henan Tumor Hospital, Zhengzhou University, Zhengzhou 450003, China
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24
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Hodgkin's Lymphoma in Older Patients: an Orphan Disease? Mediterr J Hematol Infect Dis 2014; 6:e2014050. [PMID: 25045458 PMCID: PMC4103506 DOI: 10.4084/mjhid.2014.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/20/2014] [Indexed: 01/04/2023] Open
Abstract
Hodgkin Lymphoma HL can be cured in the large majority of younger patients, but prognosis for older patients, especially those with advanced-stage disease, has not improved substantially. The percentage of HL patients aged over 60 ranges between 15% and 35%. A minority of them is enrolled into clinical trials. HL in the elderly have some specificities: more frequent male sex, B-symptoms, advanced stage, sub diaphragmatic presentation, higher percentage of mixed cellularity, up to 50% of advanced cases associated to EBV. Very old age (>70) and comorbidities are factor of further worsening prognosis. Like in younger patients, ABVD is the most used protocol, but treatment outcome remains much inferior with more frequent, severe and sometimes specific toxicities. Few prospective studies with specific protocols are available. The main data have been published by the Italian Lymphoma Group with the VEPEMB schedule and the German Hodgkin Study Group with the PVAG regimen. Recently, the Scotland and Newcastle Lymphoma Study Group published the SHIELD program associating a prospective phase 2 trial with VEPEMB and a prospective registration of others patients. Patients over 60y with early-stage disease received three cycles plus radiotherapy and had 81% of 3-year overall survival (OS). Those with advanced-stage disease received six cycles, with 3-year OS of 66%. The role of geriatric and comorbidity assessment in the treatment’s choice for HL in the elderly is a major challenge. The combination of loss of activities of daily living combined with the age stratification more or less 70y has been shown as a simple and effective survival model. Hopes come from promising new agents like brentuximab-vedotin (BV) a novel antibody-drug conjugate. The use of TEP to adapt the combination of chemotherapy and radiotherapy according to the metabolic response could also be way for prospective studies.
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25
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Follows GA, Ardeshna KM, Barrington SF, Culligan DJ, Hoskin PJ, Linch D, Sadullah S, Williams MV, Wimperis JZ. Guidelines for the first line management of classical Hodgkin lymphoma. Br J Haematol 2014; 166:34-49. [PMID: 24712411 DOI: 10.1111/bjh.12878] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- George A Follows
- Department of Haematology, Addenbrookes Hospital, Cambridge University Teaching Hospitals, Cambridge, UK
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26
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Lu J, Huang G, Li HP, Feng KY, Chen L, Zheng MY, Cai YD. Prediction of cancer drugs by chemical-chemical interactions. PLoS One 2014; 9:e87791. [PMID: 24498372 PMCID: PMC3912061 DOI: 10.1371/journal.pone.0087791] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/31/2013] [Indexed: 11/19/2022] Open
Abstract
Cancer, which is a leading cause of death worldwide, places a big burden on health-care system. In this study, an order-prediction model was built to predict a series of cancer drug indications based on chemical-chemical interactions. According to the confidence scores of their interactions, the order from the most likely cancer to the least one was obtained for each query drug. The 1(st) order prediction accuracy of the training dataset was 55.93%, evaluated by Jackknife test, while it was 55.56% and 59.09% on a validation test dataset and an independent test dataset, respectively. The proposed method outperformed a popular method based on molecular descriptors. Moreover, it was verified that some drugs were effective to the 'wrong' predicted indications, indicating that some 'wrong' drug indications were actually correct indications. Encouraged by the promising results, the method may become a useful tool to the prediction of drugs indications.
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Affiliation(s)
- Jing Lu
- Department of Medicinal Chemistry, School of Pharmacy, Yantai University, Yantai, Shandong, People’s Republic of China
| | - Guohua Huang
- Institute of Systems Biology, Shanghai University, Shanghai, People’s Republic of China
- Department of Mathematics, Shaoyang University, Shaoyang, Hunan, People’s Republic of China
| | - Hai-Peng Li
- CAS-MPG Partner Institute for Computational Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, People’s Republic of China
| | - Kai-Yan Feng
- Beijing Genomics Institute, Shenzhen Beishan Industrial zone, Shenzhen, People’s Republic of China
| | - Lei Chen
- College of Information Engineering, Shanghai Maritime University, Shanghai, People’s Republic of China
- * E-mail: (LC); (MYZ); (YDC)
| | - Ming-Yue Zheng
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Shanghai, People’s Republic of China
- * E-mail: (LC); (MYZ); (YDC)
| | - Yu-Dong Cai
- Institute of Systems Biology, Shanghai University, Shanghai, People’s Republic of China
- * E-mail: (LC); (MYZ); (YDC)
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Early Intensification Treatment Approach in Advanced-stage Hodgkin Lymphoma. Hematol Oncol Clin North Am 2014; 28:65-74. [DOI: 10.1016/j.hoc.2013.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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28
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Böll B, Goergen H, Arndt N, Meissner J, Krause SW, Schnell R, von Tresckow B, Eichenauer DA, Sasse S, Fuchs M, Behringer K, Klimm BC, Naumann R, Diehl V, Engert A, Borchmann P. Relapsed hodgkin lymphoma in older patients: a comprehensive analysis from the German hodgkin study group. J Clin Oncol 2013; 31:4431-7. [PMID: 24190119 DOI: 10.1200/jco.2013.49.8246] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Progression or relapse of Hodgkin lymphoma (HL) is common among older patients. However, prognosis and effects of second-line treatment are thus far unknown. PATIENTS AND METHODS We investigated second-line treatment and survival in older patients with progressive or relapsed HL. Patients treated within German Hodgkin Study Group first-line studies between 1993 and 2007 were screened for refractory disease or relapse (RR-HL). Patients with RR-HL age ≥ 60 years at first-line treatment were included in this analysis. RESULTS We identified 105 patients (median age, 66 years); 28%, 31%, and 41% had progressive disease, early relapse, or late relapse, respectively. Second-line treatment strategies included intensified salvage regimens (22%), conventional polychemotherapy and/or salvage-radiotherapy with curative intent (42%), and palliative approaches (31%). Median overall survival (OS) for the entire cohort was 12 months; OS at 3 years was 31% (95% CI, 22% to 40%). A prognostic score with risk factors (RFs) of early relapse, clinical stage III/IV, and anemia identified patients with favorable and unfavorable prognosis (≤ one RF: 3-year OS, 59%; 95% CI, 44% to 74%; ≥ two RFs: 3-year OS, 9%; 95% CI, 1% to 18%). In low-risk patients, the impact of therapy on survival was significant in favor of the conventional polychemotherapy/salvage radiotherapy approach. In high-risk patients, OS was low overall and did not differ significantly among treatment strategies. CONCLUSION OS in older patients with RR-HL can be predicted using a simple prognostic score. Poor outcome in high-risk patients cannot be overcome by any of the applied treatment strategies. Our results might help to guide treatment decisions and evaluate new compounds in these patients.
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Affiliation(s)
- Boris Böll
- Boris Böll, Bastian von Tresckow, Dennis A. Eichenauer, Stephanie Sasse, Michael Fuchs, Karolin Behringer, Beate C. Klimm, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Bastian von Tresckow, Dennis A. Eichenauer, Stephanie Sasse, Michael Fuchs, Karolin Behringer, Beate C. Klimm, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Nils Arndt and Ralph Naumann, Stiftungsklinikum Mittelrhein, Koblenz; Julia Meissner, Heidelberg University Hospital, Heidelberg; Stefan W. Krause, Erlangen University Hospital, Erlangen; and Roland Schnell, Pioh Medical Oncology and Hematology, Frechen, Germany
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29
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Böll B, Görgen H, Fuchs M, Pluetschow A, Eich HT, Bargetzi MJ, Weidmann E, Junghanß C, Greil R, Scherpe A, Schmalz O, Eichenauer DA, von Tresckow B, Rothe A, Diehl V, Engert A, Borchmann P. ABVD in Older Patients With Early-Stage Hodgkin Lymphoma Treated Within the German Hodgkin Study Group HD10 and HD11 Trials. J Clin Oncol 2013; 31:1522-9. [DOI: 10.1200/jco.2012.45.4181] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Older patients with Hodgkin lymphoma (HL) account for approximately 20% of all HL patients. ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) chemotherapy is regarded as standard of care in these patients. However, little is known on feasibility and efficacy of ABVD in this age group. Patients and Methods We analyzed the feasibility and efficacy of four cycles of ABVD in older patients age 60 to 75 years with early-stage HL who were treated within the German Hodgkin Study Group (GHSG) HD10 and HD11 trials; results were compared with those of younger patients treated within these trials. Results In total, 1,299 patients received four cycles of ABVD, and 117 of those patients were older than age 60 years (median, 65 years). In 14% of older patients, treatment was not administered according to protocol, mainly because of excessive toxicity. The mean delay of treatment was twice as high in the older patients (2.2 v 1.2 weeks). Fifty-nine percent of older patients achieved a relative dose-intensity of at least 80% compared with 85% of younger patients. Major toxicity (WHO grade 3 and 4), including leucopenia, nausea, infection, and others, was documented in 68% of older patients with a treatment-related mortality of 5%. Complete response was achieved in 89% of older patients, 3% had progressive disease, and 11% relapsed. At a median observation time of 92 months, 28% of the patients had died, and the 5-year progression-free survival estimate was 75% (95% CI, 66% to 82%). Conclusion In patients age ≥ 60 years with HL, four cycles of ABVD is associated with substantial dose reduction, treatment delay, toxicity, and treatment-related mortality.
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Affiliation(s)
- Boris Böll
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Helen Görgen
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Michael Fuchs
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Annette Pluetschow
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Hans Theodor Eich
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Mario J. Bargetzi
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Eckhart Weidmann
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Christian Junghanß
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Richard Greil
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Alexander Scherpe
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Oliver Schmalz
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Dennis A. Eichenauer
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Bastian von Tresckow
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Achim Rothe
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Volker Diehl
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Andreas Engert
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
| | - Peter Borchmann
- Boris Böll, Michael Fuchs, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Andreas Engert, and Peter Borchmann, University Hospital Cologne; Boris Böll, Helen Goergen, Michael Fuchs, Annette Pluetschow, Hans T. Eich, Dennis A. Eichenauer, Bastian von Tresckow, Achim Rothe, Volker Diehl, Andreas Engert, and Peter Borchmann, German Hodgkin Study Group, Cologne; Hans T. Eich, University Hospital Muenster, Muenster; Eckhart Weidmann, Nordwest Hospital Frankfurt, Frankfurt; Christian Junghanß,
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Abstract
Key PointsPU.1 is a potent tumor suppressor in cHL cells and the induction of PU.1 is a possible therapeutic option for patients with cHL.
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31
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Evaluation of treatment outcome in 175 patients with Hodgkin lymphoma aged 60 years or over: the SHIELD study. Blood 2012; 119:6005-15. [DOI: 10.1182/blood-2011-12-396556] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
The SHIELD program for Hodgkin lymphoma in patients 60 years of age or older, prospectively evaluated clinical features and outcome in a large patient cohort (n = 175). The central element was a phase 2 study of VEPEMB chemotherapy (n = 103, median age 73 years) incorporating comorbidity assessment. A total of 72 other patients were treated off-study but registered prospectively and treated concurrently with: ABVD (n = 35); CLVPP (n = 19), or other (n = 18). Of VEPEMB patients, 31 had early-stage disease (stage 1A/2A) and received VEPEMB 3 times plus radiotherapy. Median follow-up was 36 months. Complete remission (CR) rate (intention-to-treat) was 74% and 3-year overall survival (OS) and progression-free survival (PFS) were 81% and 74%, respectively. A total of 72 patients had advanced-stage disease (stage 1B/2B/3 or 4) and received VEPEMB 6 times. CR rate was 61% with 3-year OS and PFS of 66% and 58%, respectively. Of patients achieving CR, 13% with early-stage and 5% with advanced-stage disease progressed. Overall treatment-related mortality was 7%. In patients treated with curative intent with VEPEMB, ABVD, and CLVPP (n = 157), CR linked to several factors in univariate analysis. In a Cox regression model only, obtaining CR remained significant for OS and CR plus comorbidity and age for PFS. RS-EBV status had no significant effect on outcome.
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Phase 2 study of PVAG (prednisone, vinblastine, doxorubicin, gemcitabine) in elderly patients with early unfavorable or advanced stage Hodgkin lymphoma. Blood 2011; 118:6292-8. [DOI: 10.1182/blood-2011-07-368167] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Approximately 20% of all Hodgkin lymphoma (HL) patients are older than 60 years and have a poor prognosis, mainly because of increased treatment-related toxicity resulting in reduced overall dose intensity and more treatment-related mortality. To possibly improve the treatment of elderly HL patients, the German Hodgkin Study Group developed a new regimen, PVAG (prednisone, vinblastine, doxorubicin, and gemcitabine). In this multicenter phase 2 study, elderly HL patients in early unfavorable and advanced stages received 6 to 8 cycles of PVAG and additional radiotherapy if they were not in complete remission (CR) after chemotherapy. Endpoints included feasibility, acute toxicity, and response rate. Fifty-nine patients 60 to 75 years of age (median, 68 years) were eligible for analysis; 93% had advanced stage disease. WHO grade 3/4 toxicities were documented in 43 patients; 46 patients responded with CR/CR uncertain (78%). Within 37 months median observation time, 15 progressions or relapses and 17 deaths were observed, of which 8 were related to HL and 1 was the result of treatment-related toxicity. The 3-year estimates for overall survival and progression-free survival were 66% (95% CI, 50%-78%) and 58% (95% CI, 43%-71%), respectively. We conclude that PVAG is safe and feasible in elderly HL patients. This trial was registered at www.clinicaltrials.gov as #NCT00147875.
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Halbsguth TV, Böll B, Borchmann P, Diehl V. The unique characteristics and management of patients over 60 years of age with classic Hodgkin lymphoma. Curr Hematol Malig Rep 2011; 6:164-71. [PMID: 21553348 DOI: 10.1007/s11899-011-0089-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In recent decades, the prognosis of Hodgkin lymphoma has been substantially improved, but these successes have been restricted to younger patients and could not be translated into a major benefit for older patients, especially those with advanced-stage disease. Major problems in treating older patients include a different biology, frailty, comorbidities, and poorer tolerance of therapy. Additionally, these patients are often excluded from randomized trials, so an evidence-based standard of care is lacking. Importantly, the proportion of older patients with HL will increase over the next 50 years. Currently, ABVD (Adriamycin [doxorubicin], bleomycin, vinblastine, and dacarbazine) is considered to be the gold standard, even though it has some toxicity in older patients and prospective data are not available. Thus, further studies are required, including the assessment of comorbidities and the incorporation of new drugs such as immunomodulatory agents, antibody-drug conjugates, mTOR inhibitors, or histone deacetylase (HDAC) inhibitors.
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Affiliation(s)
- Teresa V Halbsguth
- First Department of Internal Medicine, German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany.
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Borchmann P, Haverkamp H, Diehl V, Cerny T, Markova J, Ho AD, Eich HT, Mueller-Hermelink HK, Kanz L, Greil R, Rank A, Paulus U, Smardova L, Huber C, Dörken B, Nerl C, Krause SW, Mueller RP, Fuchs M, Engert A. Eight Cycles of Escalated-Dose BEACOPP Compared With Four Cycles of Escalated-Dose BEACOPP Followed by Four Cycles of Baseline-Dose BEACOPP With or Without Radiotherapy in Patients With Advanced-Stage Hodgkin's Lymphoma: Final Analysis of the HD12 Trial of the German Hodgkin Study Group. J Clin Oncol 2011; 29:4234-42. [DOI: 10.1200/jco.2010.33.9549] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Eight cycles of BEACOPPescalated (escalated dose of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) followed by radiotherapy (RT) to initial bulk or residual tumor mass is the German Hodgkin Study Group standard of care for advanced-stage Hodgkin's lymphoma (HL). However, treatment-related toxicity is a concern, and the role of RT in this setting is unclear. The HD12 study thus aimed to reduce toxicity while maintaining efficacy. Patients and Methods In this prospectively randomized multicenter trial, eight cycles of BEACOPPescalated was compared with four cycles of BEACOPPescalated followed by four cycles of the baseline dose of BEACOPP (BEACOPPbaseline; 4 + 4), and RT with no RT in the case of initial bulk or residual disease. The study was designed to exclude a difference in 5-year freedom from treatment failure (FFTF) rate of 6%. Results Between January 1999 and January 2003, 1,670 patients age 16 to 65 years were enrolled onto the HD12 study. At 5 years, FFTF was 86.4% in the BEACOPPescalated arm and 84.8% in the 4 + 4 arm (difference, −1.6%; 95% CI, −5.2% to 1.9%), and overall survival was 92% versus 90.3% (difference, −1.7%; 95% CI, −4.6% to 1.1%). Deaths related to acute toxicity of chemotherapy were observed in 2.9% of patients (BEACOPPescalated, n = 19; 4 + 4, n = 27). FFTF was inferior without RT (90.4% v 87%; difference, −3.4%; 95% CI, −6.6% to −0.1%), particularly in patients who had residual disease after chemotherapy (difference, −5.8%; 95% CI, −10.7% to −1.0%), but not in patients with bulk in complete response after chemotherapy (difference, −1.1%; 95% CI, −6.2% to 4%). Conclusion The reduction of BEACOPP to the 4 + 4 regimen did not substantially reduce severe toxicity but might decrease efficacy. Our results do not support the omission of consolidation RT for patients with residual disease. Alternative strategies for improving the risk-to-benefit ratio for patients with advanced HL are needed.
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Affiliation(s)
- Peter Borchmann
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Heinz Haverkamp
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Volker Diehl
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Thomas Cerny
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Jana Markova
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Anthony D. Ho
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Hans-Theodor Eich
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Hans Konrad Mueller-Hermelink
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Lothar Kanz
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Richard Greil
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Andreas Rank
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Ursula Paulus
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Lenka Smardova
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Christoph Huber
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Bernd Dörken
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Christoph Nerl
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Stefan W. Krause
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Rolf-Peter Mueller
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Michael Fuchs
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
| | - Andreas Engert
- Peter Borchmann, Heinz Haverkamp, Volker Diehl, Hans-Theodor Eich, Ursula Paulus, Rolf-Peter Mueller, Michael Fuchs, and Andreas Engert, University Hospital of Cologne, Cologne; Anthony D. Ho, University of Heidelberg, Heidelberg; Hans Konrad Mueller-Hermelink, University of Wuerzburg, Wuerzburg; Lothar Kanz, University of Tübingen, Tübingen; Andreas Rank, University Hospital of Munich; Christoph Nerl, Klinikum Schwabing, Munich; Christoph Huber, University Hospital of Mainz, Mainz; Bernd Dörken, Charité
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Klimm B, Franklin J, Stein H, Eichenauer DA, Haverkamp H, Diehl V, Fuchs M, Borchmann P, Engert A. Lymphocyte-Depleted Classical Hodgkin's Lymphoma: A Comprehensive Analysis From the German Hodgkin Study Group. J Clin Oncol 2011; 29:3914-20. [DOI: 10.1200/jco.2011.36.4703] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To investigate the clinical characteristics and treatment outcome of patients with lymphocyte-depleted classical Hodgkin's lymphoma (LDCHL) compared with other histologic subtypes of Hodgkin's lymphoma (HL). Patients and Methods From a total of 12,155 evaluable patients with biopsy-proven HL treated within the German Hodgkin Study Group trials HD4 to HD15, 10,019 patients underwent central expert pathology review. Eighty-four patients with LDCHL (< 1%) were identified and confirmed. The median follow-up time was 67 months. Results Patients with LDCHL, compared with patients with other histologic subtypes, presented more often with advanced disease (74% v 42%, respectively; P < .001) and “B” symptoms (76% v 41%, respectively; P < .001). Other risk factors were also more frequent in patients with LDCHL. Complete remission or unconfirmed complete remission was achieved in 82% of patients with LDCHL compared with 93% of patients with other HL subtypes (P < .001), and more patients with LDCHL had progressive disease. At 5 years, progression-free survival (PFS) and overall survival (OS) were significantly lower in patients with LDCHL compared with patients with other HL subtypes (PFS, 71% v 85%, respectively; P < .001; OS, 83% v 92%, respectively; P = .0018). However, when analyzing the subgroup of patients who underwent treatment with intensified or dose-dense bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone, patients with LDCHL (n = 39) had similar outcomes when compared with patients with other subtypes of HL (n = 3,564; P = .61). Conclusion LDCHL has a different pattern from other HL subtypes with more clinical risk factors at initial diagnosis and significantly poorer prognosis. Patients with LDCHL should be treated with modern dose-intense treatment strategies.
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Affiliation(s)
- Beate Klimm
- Beate Klimm, Dennis A. Eichenauer, Heinz Haverkamp, Volker Diehl, Michael Fuchs, Peter Borchmann, and Andreas Engert, German Hodgkin Study Group; Jeremy Franklin, University Hospital of Cologne, Cologne; and Harald Stein, Berlin Reference Center for Lymphoma and Hematopathology at the Pathodiagnostik Berlin, Berlin, Germany
| | - Jeremy Franklin
- Beate Klimm, Dennis A. Eichenauer, Heinz Haverkamp, Volker Diehl, Michael Fuchs, Peter Borchmann, and Andreas Engert, German Hodgkin Study Group; Jeremy Franklin, University Hospital of Cologne, Cologne; and Harald Stein, Berlin Reference Center for Lymphoma and Hematopathology at the Pathodiagnostik Berlin, Berlin, Germany
| | - Harald Stein
- Beate Klimm, Dennis A. Eichenauer, Heinz Haverkamp, Volker Diehl, Michael Fuchs, Peter Borchmann, and Andreas Engert, German Hodgkin Study Group; Jeremy Franklin, University Hospital of Cologne, Cologne; and Harald Stein, Berlin Reference Center for Lymphoma and Hematopathology at the Pathodiagnostik Berlin, Berlin, Germany
| | - Dennis A. Eichenauer
- Beate Klimm, Dennis A. Eichenauer, Heinz Haverkamp, Volker Diehl, Michael Fuchs, Peter Borchmann, and Andreas Engert, German Hodgkin Study Group; Jeremy Franklin, University Hospital of Cologne, Cologne; and Harald Stein, Berlin Reference Center for Lymphoma and Hematopathology at the Pathodiagnostik Berlin, Berlin, Germany
| | - Heinz Haverkamp
- Beate Klimm, Dennis A. Eichenauer, Heinz Haverkamp, Volker Diehl, Michael Fuchs, Peter Borchmann, and Andreas Engert, German Hodgkin Study Group; Jeremy Franklin, University Hospital of Cologne, Cologne; and Harald Stein, Berlin Reference Center for Lymphoma and Hematopathology at the Pathodiagnostik Berlin, Berlin, Germany
| | - Volker Diehl
- Beate Klimm, Dennis A. Eichenauer, Heinz Haverkamp, Volker Diehl, Michael Fuchs, Peter Borchmann, and Andreas Engert, German Hodgkin Study Group; Jeremy Franklin, University Hospital of Cologne, Cologne; and Harald Stein, Berlin Reference Center for Lymphoma and Hematopathology at the Pathodiagnostik Berlin, Berlin, Germany
| | - Michael Fuchs
- Beate Klimm, Dennis A. Eichenauer, Heinz Haverkamp, Volker Diehl, Michael Fuchs, Peter Borchmann, and Andreas Engert, German Hodgkin Study Group; Jeremy Franklin, University Hospital of Cologne, Cologne; and Harald Stein, Berlin Reference Center for Lymphoma and Hematopathology at the Pathodiagnostik Berlin, Berlin, Germany
| | - Peter Borchmann
- Beate Klimm, Dennis A. Eichenauer, Heinz Haverkamp, Volker Diehl, Michael Fuchs, Peter Borchmann, and Andreas Engert, German Hodgkin Study Group; Jeremy Franklin, University Hospital of Cologne, Cologne; and Harald Stein, Berlin Reference Center for Lymphoma and Hematopathology at the Pathodiagnostik Berlin, Berlin, Germany
| | - Andreas Engert
- Beate Klimm, Dennis A. Eichenauer, Heinz Haverkamp, Volker Diehl, Michael Fuchs, Peter Borchmann, and Andreas Engert, German Hodgkin Study Group; Jeremy Franklin, University Hospital of Cologne, Cologne; and Harald Stein, Berlin Reference Center for Lymphoma and Hematopathology at the Pathodiagnostik Berlin, Berlin, Germany
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