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Masel R, Roche ME, Martinez-Outschoorn U. Hodgkin Lymphoma: A disease shaped by the tumor micro- and macroenvironment. Best Pract Res Clin Haematol 2023; 36:101514. [PMID: 38092473 DOI: 10.1016/j.beha.2023.101514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 12/18/2023]
Abstract
The tumor microenvironment (TMicroE) and tumor macroenvironment (TMacroE) are defining features of classical Hodgkin lymphoma (cHL). They are of critical importance to clinicians since they explain the common signs and symptoms, allow us to classify these neoplasms, develop prognostic and predictive biomarkers, bioimaging and novel treatments. The TMicroE is defined by effects of cancer cells to their immediate surrounding and within the tumor. Effects of cancer cells at a distance or outside of the tumor define the TMacroE. Paraneoplastic syndromes are signs and symptoms due to effects of cancer at a distance or the TMacroE, which are not due to direct cancer cell infiltration. The most common paraneoplastic symptoms are B-symptoms, which manifest as fevers, chills, drenching night sweats, and/or weight loss. Less common paraneoplastic syndromes include those that affect the central nervous system, skin, kidney, and hematological autoimmune phenomena including hemophagocytic lymphohistiocytosis (HLH). Paraneoplastic signs such as leukocytosis, lymphopenia, anemia, and hypoalbuminemia are prognostic biomarkers. The neoplastic cells in cHL are the Hodgkin and Reed Sternberg (HRS) cells, which are preapoptotic germinal center B cells with a high mutational burden and almost universal genetic alterations at the 9p24.1 locus primarily through copy gain and amplification with strong activation of signaling via PD-L1, JAK-STAT, NFkB, and c-MYC. In the majority of cases of cHL over 95% of the tumor cells are non-neoplastic. In the TMicroE, HRS cells recruit and mold non-neoplastic cells vigorously via extracellular vesicles, chemokines, cytokines and growth factors such as CCL5, CCL17, IL6, and TGF-β to promote a feed-forward inflammatory loop, which drives cancer aggressiveness and anti-cancer immune evasion. Novel single cell profiling techniques provide critical information on the role in cHL of monocytes-macrophages, neutrophils, T helper, Tregs, cytotoxic CD8+ T cells, eosinophils, mast cells and fibroblasts. Here, we summarize the effects of EBV on the TMicroE and TMacroE. In addition, how the metabolism of the TMicroE of cHL affects bioimaging and contributes to cancer aggressiveness is reviewed. Finally, we discuss how the TMicroE is being leveraged for risk adapted treatment strategies based on bioimaging results and novel immune therapies. In sum, it is clear that we cannot effectively manage patients with cHL without understanding the TMicroE and TMacroE and its clinical importance is expected to continue to grow rapidly.
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Affiliation(s)
- Rebecca Masel
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University-Philadelphia, USA; Department of Medicine, Cardeza Foundation for Hematological Research, Thomas Jefferson University-Philadelphia, USA
| | - Megan E Roche
- Department of Medicine, Cardeza Foundation for Hematological Research, Thomas Jefferson University-Philadelphia, USA
| | - Ubaldo Martinez-Outschoorn
- Department of Medicine, Cardeza Foundation for Hematological Research, Thomas Jefferson University-Philadelphia, USA.
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2
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Maura F, Adams RM, Aoki T. Scientific techniques in adolescent and young adult classic Hodgkin lymphoma. EJHAEM 2023; 4:902-907. [PMID: 38024640 PMCID: PMC10660113 DOI: 10.1002/jha2.786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 12/01/2023]
Abstract
Understanding the tumor microenvironment and genomic landscape is crucial for better prediction of treatment outcomes and developing novel therapies in Hodgkin lymphoma (HL). Recent advancements in genomics have enabled researchers to gain deeper insights into the genomic characteristics of HL at both single-cell resolution and the whole genome level. The use of noninvasive methods such as liquid biopsies and formalin-fixed paraffin-embedded-based imaging techniques has expanded the possibilities of applying cutting-edge analyses to routine clinically available samples. Collaborative efforts between adult and pediatric group are imperative to translate novel findings into routine patient care.
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Affiliation(s)
- Francesco Maura
- Sylvester Comprehensive Cancer CenterUniversity of MiamiMiamiFloridaUSA
| | - Ragini M. Adams
- Division of Pediatric Hematology, OncologyStanford University School of MedicineStanfordCaliforniaUSA
| | - Tomohiro Aoki
- Princess Margaret Cancer CentreUniversity Health NetworkTorontoOntarioCanada
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3
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Fadda GL, Manca A, Testi F, Itri F, Nicoli P, Moratti G, Cavallo G, Guerrasio A. A Rare Case of Hodgkin Lymphoma of the Maxillary Sinus. EAR, NOSE & THROAT JOURNAL 2021; 102:NP232-NP236. [PMID: 33734885 DOI: 10.1177/0145561321993599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hodgkin lymphoma (HL) is an uncommon B-cell malignant disease. It usually presents with mediastinal and/or laterocervical lymph node localization, while primary extranodal HL is a rare entity giving rise to diagnostic and therapeutic challenges. It rarely presents as just extranodal localization, so its presence within the maxillary sinus without any lymphadenopathy is exceptional. Given the rarity of this localization, there is no standard treatment for maxillary sinus HL. We present a case of a patient with extranodal HL of the right maxillary sinus treated with primary surgery followed by adjuvant sequential chemoradiation therapy.
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Affiliation(s)
- Gian Luca Fadda
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Andrea Manca
- FPO IRCCS, Head & Neck Oncology Unit, Candiolo Cancer Institute, Turin, Italy
| | - Francesca Testi
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Federico Itri
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Paolo Nicoli
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Giuseppe Moratti
- Department of Otorhinolaryngology, Galliera Hospital, Genova, Italy
| | - Giovanni Cavallo
- Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Angelo Guerrasio
- Departement of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
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Gaiolla RD, Moraes MPDT, de Oliveira DE. SNPs in genes encoding for IL-10, TNF-α, and NFκB p105/p50 are associated with clinical prognostic factors for patients with Hodgkin lymphoma. PLoS One 2021; 16:e0248259. [PMID: 33684151 PMCID: PMC7939322 DOI: 10.1371/journal.pone.0248259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 02/23/2021] [Indexed: 12/17/2022] Open
Abstract
Classical Hodgkin lymphoma (cHL) is a B-cell-derived malignant neoplasia that has a unique histological distribution, in which the scarce malignant Hodgkin and Reed-Sternberg cells are surrounded by nonmalignant inflammatory cells. The interactions between the malignant and inflammatory cells are mediated by aberrantly produced cytokines, which play an important role in tumor immunopathogenesis. Single nucleotide polymorphisms (SNPs) in genes encoding cytokines and their regulatory proteins may influence the peripheral levels of these molecules and affect disease’s pathobiology. In this study, we evaluate SNPs in the promoter regions of the genes encoding for two key cytokines in Hodgkin lymphoma: IL-10 (SNP/pIL10–592, rs1800872; and SNP/pIL10–1082, rs1800896) and TNF-α (SNP/pTNF -238, rs361525; and SNP/pTNF -862, rs1800630), as well as an SNP in the intronic region of the NFκB1 gene (SNP/iNFKB1, rs1585215), an important regulator of cytokine gene expression. We then look to their possible association with clinical and laboratory features in cHL patients. Seventy-three patients with cHL are genotyped by qPCR-high resolution melting. The SNPs’ genotypes are analyzed individually for each SNP, and when more than two allelic combinations are identified, the genotypes are also divided into two groups according to proposed biological relevance. By univariate analysis, patients harboring SNP/pTNF -238 AG genotype more frequently have EBV-associated cHL compared to homozygous GG, whereas the presence of mediastinal disease (bulky and nonbulky) is more common in the pIL10–592 AC/CC group compared to the AA homozygous group. Patients with SNP/iNFKB1 AA genotype more frequently have stage IV and extranodal disease at diagnosis. These results indicate that some SNPs’ genotypes for IL-10 and TNF-α genes are associated with prognostic parameters in cHL. For the first time, the SNP/iNFKB1 is described in association with clinical features of the disease.
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Affiliation(s)
- Rafael Dezen Gaiolla
- Viral Carcinogenesis and Cancer Biology Research Group (ViriCan), Institute of Biotechnology (IBTEC), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.,Hematology, Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | | | - Deilson Elgui de Oliveira
- Viral Carcinogenesis and Cancer Biology Research Group (ViriCan), Institute of Biotechnology (IBTEC), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.,Department of Pathology, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
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5
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Prognostic value of Bcl2 and p53 in Hodgkin lymphoma: A systematic review and meta-analysis. Pathol Res Pract 2021; 219:153370. [PMID: 33618247 DOI: 10.1016/j.prp.2021.153370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/21/2022]
Abstract
AIMS Several studies suggested that high expression of Bcl2 and/or p53 in Hodgkin/Reed-Sternberg cells is an unfavorable prognostic factor in Hodgkin lymphoma (HL). However, results in this field appear contrasting. We aimed to assess the prognostic value of p53 and Bcl2 in HL through a systematic review and meta-analysis. METHODS Electronic databases were searched from January 2000 to December 2020 for all studies assessing the prognostic value of p53 and Bcl2 in HL. The association of high p53 or Bcl2 expression with overall survival (OS), progression-free survival (PFS) and response to treatment was assessed by using hazard ratio (HR) and odds ratio (OR). RESULTS Eighteen studies were included. Bcl2 overexpression was significantly associated with decreased PFS (HR = 2.202; p < 0.0001), while the associations with decreased OS (HR = 1.565; p = 0.257) and refractoriness to treatment (OR = 0.482; p = 0.068) were non-significant. p53 overexpression was not significantly associated with refractoriness to treatment (OR = 0.904; p = 0.155); the analysis of OS and PFS was not feasible, but published data suggested the absence of a significant association. CONCLUSIONS In HL, Bcl2 overexpression is associated with decreased PFS, while a significant prognostic value could not be demonstrated for p53. Defining optimal criteria for interpreting Bcl2 and p53 immunostaining is necessary to draw definitive conclusions.
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Ferrant J, Lhomme F, Le Gallou S, Irish JM, Roussel M. Circulating Myeloid Regulatory Cells: Promising Biomarkers in B-Cell Lymphomas. Front Immunol 2021; 11:623993. [PMID: 33603754 PMCID: PMC7884747 DOI: 10.3389/fimmu.2020.623993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/14/2020] [Indexed: 01/01/2023] Open
Abstract
The monocyte/macrophage lineage has been shown to be involved in the promotion of a protumoral tumor microenvironment and resistance to treatment in B cell lymphomas. However, it is still poorly described at the single cell level, and tissue samples are not easily accessible. Thus, a detailed analysis of the circulating myeloid cell compartment in the different B lymphomas is needed to better understand the mechanisms of resistance to treatment and identify at risk patients. In this Perspective, we review current knowledge on the phenotypic and functional description of the circulating monocytic lineage in B cell lymphomas and provide first insights into the heterogeneity of these cell populations in health and lymphoma, using mass cytometry. Indeed, the monocytic compartment is a continuum more than distinct subpopulations, as demonstrated by our high-resolution approach, explaining the sometimes confusing and contradictory conclusions on the prognostic impact of the different populations, including monocytes and monocytic myeloid derived suppressor cells (M-MDSC). By identifying S100A9high monocytic cells as a potential biomarker in diffuse large B cell lymphoma (DLBCL) in this proof-of-concept preliminary study including a limited number of samples, we underline the potential of circulating myeloid regulatory cells as diagnostic and prognostic biomarkers in B-cell lymphomas.
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Affiliation(s)
| | - Faustine Lhomme
- Centre Hospitalier Universitaire de Rennes, Service Hématologie, Rennes, France
| | - Simon Le Gallou
- UMR_S_1236, Univ Rennes, Inserm, Rennes, France.,Centre Hospitalier Universitaire de Rennes, Laboratoire Hématologie, Pôle Biologie, Rennes, France
| | - Jonathan M Irish
- Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN, United States.,Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Mikael Roussel
- UMR_S_1236, Univ Rennes, Inserm, Rennes, France.,Centre Hospitalier Universitaire de Rennes, Laboratoire Hématologie, Pôle Biologie, Rennes, France
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Defining the Inflammatory Plasma Proteome in Pediatric Hodgkin Lymphoma. Cancers (Basel) 2020; 12:cancers12123603. [PMID: 33276546 PMCID: PMC7761312 DOI: 10.3390/cancers12123603] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 01/08/2023] Open
Abstract
Simple Summary Hodgkin lymphoma (HL) is a common type of cancer that is characterized by rare, malignant cells among an inflammatory microenvironment. Specific systemic, inflammatory plasma proteins have demonstrated prognostic significance in adult HL; however, systemic inflammation has not been well-characterized in childhood HL. The aim of our study was to better define the inflammatory pre-therapy plasma proteome and identify plasma proteins associated with clinical features of childhood HL. We measured plasma concentrations of 135 proteins in 56 pediatric subjects with newly diagnosed HL and 47 healthy pediatric controls. We found that the plasma protein profile was distinct from controls, and unique proteins were associated with high-risk disease (IL-10, TNF-α, IFN-γ, IL-8), slow early therapy response (CCL13, IFN-λ1, IL-8), and relapse (TNFSF10). These proteins could be used to improve risk stratification, and thus optimize outcomes and minimize unnecessary toxic exposures for those with childhood HL. Abstract Hodgkin lymphoma (HL) histopathology is characterized by rare malignant Reed–Sternberg cells among an inflammatory infiltrate. We hypothesized that characteristics of inflammation in pediatric HL lesions would be reflected by the levels of inflammatory cytokines or chemokines in pre-therapy plasma of children with HL. The study objectives were to better define the inflammatory pre-therapy plasma proteome and identify plasma biomarkers associated with extent of disease and clinical outcomes in pediatric HL. Pre-therapy plasma samples were obtained from pediatric subjects with newly diagnosed HL and healthy pediatric controls. Plasma concentrations of 135 cytokines/chemokines were measured with the Luminex platform. Associations between protein concentration and disease characteristics were determined using multivariate permutation tests with false discovery control. Fifty-six subjects with HL (mean age: 13 years, range 3–18) and 47 controls were analyzed. The cytokine/chemokine profiles of subjects with HL were distinct from controls, and unique cytokines/chemokines were associated with high-risk disease (IL-10, TNF-α, IFN-γ, IL-8) and slow early response (CCL13, IFN-λ1, IL-8). TNFSF10 was significantly elevated among those who ultimately relapsed and was significantly associated with worse event-free survival. These biomarkers could be incorporated into biologically based risk stratification to optimize outcomes and minimize toxicities in pediatric HL.
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8
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Zytoon AA, Mohamed HH, Mostafa BAAE, Houseni MM. PET/CT and contrast-enhanced CT: making a difference in assessment and staging of patients with lymphoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020; 51:213. [DOI: 10.1186/s43055-020-00320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/14/2020] [Indexed: 08/30/2023] Open
Abstract
Abstract
Background
The aim of this study is to evaluate the diagnostic performance of contrast-enhanced computed tomography (CECT) and 2-[Fluorine-18] fluoro-2-deoxy-d-glucose positron emission tomography combined to computed tomography (18 F-FDG PET/CT) in assessment of lymphoma.
Methods
Hundred patients, pathologically proven as lymphoma, were evaluated by CECT and 18F-FDG PET/CT for initial assessment and staging of the disease. The number of lesions and the disease stage detected by each modality was calculated and further analyzed to be compared.
Results
18F-FDG PET/CT diagnosed a total number of 545 lymphoma involved regions with sensitivity 96.6%, specificity 98.8%, and accuracy 99% that was higher than CECT which diagnosed a total number of 439 lymphomatous regions with sensitivity 87.5%, specificity 85.7%, and accuracy 88%. Discordant staging by both modalities was found in 23% of the patients. Lymphoma was upstaged by PET/CT in 17% of the patients; with major changes in 12% of them and downstaged in 6% of the patients.
Conclusion
18F-FDG PET/CT scan has a better diagnostic performance, represented by sensitivity, specificity, and accuracy, than CECT scan in the initial assessment of lymphoma regarding its nodal and extra-nodal lesions that could lead to alteration of disease staging which in turn markedly affecting the decision of treatment regimens.
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9
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Möller MD, Ihorst G, Pahl A, Scheubeck S, Barsch F, Dold SM, Bertz H, Arends J, Wäsch R, Engelhardt M. Physical activity is associated with less comorbidity, better treatment tolerance and improved response in patients with multiple myeloma undergoing stem cell transplantation. J Geriatr Oncol 2020; 12:521-530. [PMID: 33223484 DOI: 10.1016/j.jgo.2020.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/08/2020] [Accepted: 11/13/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Multiple myeloma (MM) is the second most common hematological malignancy. Progression free survival (PFS) and overall survival (OS) have substantially improved, nonetheless MM usually remains incurable. Patients with active disease may be affected by numerous comorbidities, including fatigue, depression and osteolytic lesions, which influence their quality of life (QoL). Albeit, it is known that exercising is beneficial for patients' QoL, few clinical trials are available in patients with MM. We therefore aimed to compare comorbidities and clinical outcome in physically active and inactive patients with MM. MATERIAL AND METHODS We defined physical activity according to WHO criteria (150 min of moderate activity and two sessions of resistance training/week). We matched 53 physically active patients with 53 controls (for age, gender, cytogenetics, disease stage, and therapy) and compared the cohorts for incidence of comorbidities/MM symptoms (osteolytic lesions, anemia, infections, fatigue, depression, Revised-Myeloma Comorbidity Index [R-MCI]) and clinical outcome (treatment tolerance, responses to therapy, PFS and OS) in a retrospective audit. All patients were newly diagnosed with MM and received autologous stem cell transplantations (ASCT) between 2001 and 2017. RESULTS Physically active patients showed superior outcomes in R-MCI (p = 0.0005), fatigue (p = 0.0063), treatment tolerance (p = 0.0258) and hospital stays (p = 0.0072). Furthermore, they showed better treatment responses (p = 0.0366), especially complete remission (CR; p = 0.0018) as well as better OS and PFS. CONCLUSION Physical activity in patients with MM undergoing ASCT seemed associated with better overall clinical outcome. Randomized clinical trials are required to understand the benefits and devise strategies for improving exercising among patients with MM.
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Affiliation(s)
- Mandy-Deborah Möller
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Faculty of Medicine, University of Freiburg, Germany
| | - Antonia Pahl
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sophia Scheubeck
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedrich Barsch
- Institute for Movement and Occupational Medicine, Faculty of Medicine, University of Freiburg, Germany
| | - Sandra Maria Dold
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hartmut Bertz
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jann Arends
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ralph Wäsch
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Monika Engelhardt
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Chaber R, Łasecki M, Kuczyński K, Cebryk R, Kwaśnicka J, Olchowy C, Łach K, Pogodajny Z, Koptiuk O, Olchowy A, Popecki P, Zaleska–Dorobisz U. Hounsfield units and fractal dimension (test HUFRA) for determining PET positive/negative lymph nodes in pediatric Hodgkin's lymphoma patients. PLoS One 2020; 15:e0229859. [PMID: 32191718 PMCID: PMC7082024 DOI: 10.1371/journal.pone.0229859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 02/16/2020] [Indexed: 12/30/2022] Open
Abstract
Objectives We had developed a method that can help detect and identify lymph nodes affected by the neoplastic process. Our group evaluated the fractal dimension (FD) and X-ray attenuation (XRA) of lymph nodes in HL and compared to their metabolic activity as measured by 18F-FDG-PET examination. Methods The training set included 72 lymph nodes from 31 consecutive patients, and the tested set of 71 lymph nodes from next 19 patients. The measurement of FD of each lymph node was performed before the start of therapy using original software. X-ray attenuation (XRA) expressed in HU (Hounsfield Units) from CT scans was compared with the metabolic activity of the lymphatic nodes, measured by 18F-FDG-PET examination. Results Significant differences were observed between XRAmax and FDmax values in assessing the PET(+) and PET(-) nodes. All nodes were scored from 0 to 2. The HUFRA test properly qualified 95% with a score of 2 and 0 points as PET(+) or PET(-). Conclusion The HUFRA test can differentiate about 70–80% of lymph nodes as PET(+) or PET(-) based solely on the CT examination. It can be useful in patients who were not subjected to 18FFDG-PET/CT examination before the treatment, or who had an unreliable result of 18F-FDG-PET/CT with further research requirements.
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Affiliation(s)
- Radosław Chaber
- Clinic of Pediatric Oncology and Hematology; Medical Faculty, University of Rzeszow, Rzeszow, Poland
| | | | - Karol Kuczyński
- The State School of Higher Education in Chełm, Chełm, Poland
| | - Rafał Cebryk
- Institute of Computer Science, Maria Curie-Sklodowska University, Lublin, Poland
| | - Justyna Kwaśnicka
- Department of Pediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Wroclaw, Poland
| | - Cyprian Olchowy
- Department of Oral Surgery, Wrocław Medical University, Wrocław, Poland
| | - Kornelia Łach
- Clinic of Pediatric Oncology and Hematology; Medical Faculty, University of Rzeszow, Rzeszow, Poland
| | - Zbigniew Pogodajny
- Affidea Center of Positron Emission Tomography and Computed Tomography, Wrocław, Poland
| | - Olga Koptiuk
- Radiology Department, Lower Silesian Oncology Center in Wrocław, Wrocław, Poland
| | - Anna Olchowy
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Popecki
- Departament of Dental Surgery, Wroclaw Medical University, Wroclaw, Poland
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11
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Taparra K, Liu H, Polley MY, Ristow K, Habermann TM, Ansell SM. Bleomycin use in the treatment of Hodgkin lymphoma (HL): toxicity and outcomes in the modern era. Leuk Lymphoma 2019; 61:298-308. [PMID: 31517559 DOI: 10.1080/10428194.2019.1663419] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
One-in-five Hodgkin Lymphoma (HL) patients treated with bleomycin develop bleomycin pulmonary toxicity (BPT). Given bleomycin-omission data with negative interim-PET, we assessed changes in BPT statistics. We retrospectively evaluated 126 ABVD-treated HL patients for overall survival (OS), progression-free survival (PFS), BPT factors, and management. Forty-seven patients developed BPT with 17% BPT-mortality. In univariable analysis, OS was negatively impacted by BPT (HR = 3.6, 95%CI = 1.2-10.6), but not bleomycin-omission (HR = 1.3, 95%CI = 0.5-3.7). In multivariable analysis, BPT was not associated with OS (HR = 3.0, 95%CI = 0.9-9.9). BPT patients were older (46 y vs 33 years) and received less bleomycin (107 vs 215 units) compared to non-BPT patients. BPT was managed primarily with bleomycin-omission. "Recent Era" patients had lower BPT rates (28% vs 48%), mortality (10% vs 21%), and bleomycin doses (7 vs 12 doses), yet higher bleomycin-omission in the absence of the BPT (59% vs 8%) compared to "Early Era". Our data suggest BPT continually impacts OS in ABVD-treated HL patients, however management is changing.
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Affiliation(s)
- Kekoa Taparra
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Heshan Liu
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Mei-Yin Polley
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Kay Ristow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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12
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Procházka V, Papajík T, Dýšková T, Dihel M, Brychtová S, Prouzová Z, Kriegová E, Lukášová M, Hanáčková V. The Lymphoma-Associated Macrophage to Hodgkin-Reed-Sternberg Cell Ratio Is a Poor Prognostic Factor in Classic Hodgkin Lymphoma Patients. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e573-e580. [PMID: 31377208 DOI: 10.1016/j.clml.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/16/2019] [Accepted: 07/01/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the relatively high rate of curability, approximately 20% to 30% of patients with classic Hodgkin lymphoma relapse. Hodgkin-Reed-Sternberg (HRS) cells:lymphoma-associated macrophages (LAMs) cross talk promotes tumor growth and resistance to therapy. The aim of the study was to assess the prognostic role of the LAM to HRS ratio (LHR) in lymph node biopsies using a novel automated system for scanning large sample areas. PATIENTS AND METHODS High-quality tissue samples obtained from 71 patients and stained with anti-CD30 and anti-CD68 were analyzed using the TissueFAXS (TissueGnostics). RESULTS A high LHR was associated with inferior 5-year progression-free survival (PFS; 50.0% vs. 79.3%; P = .032) and overall survival (OS; 65.4% vs. 92.3%; P = .012). Multivariate Cox regression identified the high LHR as an unfavorable prognostic factor for PFS (hazard ratio [HR], 3.07; P = .029) and OS (HR, 4.56; P = .025). CONCLUSION A high LHR at diagnosis is associated with a higher risk of lymphoma progression or death. Automated image analysis is a new tool that can overcome technical limitations of by microarray samples in lymphomas with high intratumor heterogeneity.
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Affiliation(s)
- Vít Procházka
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic.
| | - Tomáš Papajík
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic
| | - Tereza Dýšková
- Department of Immunology (OLGEN), Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic
| | - Martin Dihel
- Department of Immunology (OLGEN), Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic
| | - Světlana Brychtová
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Zuzana Prouzová
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Eva Kriegová
- Department of Immunology (OLGEN), Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic
| | - Marie Lukášová
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic
| | - Veronika Hanáčková
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic
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Abstract
Classic Hodgkin lymphoma (cHL) is one of the most common lymphomas in the Western world. Advances in the management of cHL have led to high cure rates exceeding 80%. Nevertheless, relapse or refractory disease in a subset of patients and treatment-related toxicity still represents unsolved clinical problems. The introduction of targeted treatments such as PD-1 blockade and the CD30 antibody drug conjugate, brentuximab vedotin, has broadened treatment options in cHL, emphasizing the critical need to identify biomarkers with the goal to provide rationales for treatment selection, increase effective drug utilization, and minimize toxicity. The unique biology of cHL featuring low abundant tumor cells and numerous nonmalignant immune cells in the tumor microenvironment can provide various types of promising biomarkers related to the tumor cells directly, tumor microenvironment cross-talk, and host immune response. Here, we comprehensively review novel biomarkers including circulating tumor DNA and gene expression-based prognostic models that might guide the ideal management of cHL in the future.
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Totadri S, Radhakrishnan V, Ganesan TS, Ganesan P, Kannan K, Lakshmipathy KM, Selvaluxmy G, Sagar TG. Can Radiotherapy Be Omitted in Children With Hodgkin Lymphoma Who Achieve Metabolic Remission on Interim Positron Emission Tomography? Experience of a Tertiary Care Cancer Referral Center. J Glob Oncol 2018; 4:1-7. [PMID: 30241201 PMCID: PMC6180840 DOI: 10.1200/jgo.2017.009340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Treating pediatric Hodgkin lymphoma (HL) involves a delicate balance between cure and reducing late toxicity. Fluorodeoxyglucose positron emission tomography (PET) combined with computed tomography (CT) identifies patients with early response to chemotherapy, for whom radiotherapy may be avoided. The role of PET-CT in upfront risk stratification and response-adapted treatment is evaluated in this study. METHODS Patients with HL, who were younger than 18 years, were included. PET-CT was performed at baseline and after two cycles of chemotherapy. Patients were stratified into three risk groups: group 1 (stage I or II with no unfavorable features); group 2 (stage I or II with bulky disease/B symptoms); and group 3 (stage III/IV). A doxorubicin, bleomycin, vinblastine, dacarbazine-based regimen was used in early disease. A cyclophosphamide, vincristine, prednisolone, procarbazine, doxorubicin, bleomycin, vinblastine-based regimen was used in advanced disease. RESULTS Forty-nine patients were included. Fifteen (31%), seven (14%), and 27 (55%) patients were included in groups 1, 2, and 3, respectively. Among 36 patients who underwent staging by PET-CT at diagnosis, seven (19%) patients were upstaged and one (3%) patient was downstaged by PET compared with CT. On the basis of negative interim PET responses, 39 (80%) patients were treated without radiotherapy. The 3-year event-free survival for the entire cohort was 91% (± 5.2%) and overall survival was 100%. CONCLUSION PET-CT is an excellent stand-alone staging modality in HL. The omission of radiotherapy can be considered in patients who achieve metabolic remission on interim PET.
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Spinner MA, Advani RH, Connors JM, Azzi J, Diefenbach C. New Treatment Algorithms in Hodgkin Lymphoma: Too Much or Too Little? Am Soc Clin Oncol Educ Book 2018; 38:626-636. [PMID: 30231319 DOI: 10.1200/edbk_200679] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hodgkin lymphoma treatment continues to evolve as new means of assessing response to treatment, new appreciation of important risk factors, and more effective therapeutic agents become available. Treatment algorithms integrating functional imaging now provide the opportunity to modify therapy during its delivery, allowing adjustment of duration and intensity of chemotherapy and rationale identification of patients who may benefit from the addition of therapeutic irradiation. Novel agents, including the antibody drug conjugate brentuximab vedotin and checkpoint inhibitors such as nivolumab and pembrolizumab can improve the effectiveness of treatment while keeping toxicity within acceptable limits. Carefully designed clinical trials permit the identification of superior approaches in which efficacy is enhanced and toxicity minimized. Clinicians treating patients with Hodgkin lymphoma now have access to novel treatment approaches, which will require detailed assessment of each patient and careful discussion of the goals and risks of treatment at the time of planning primary treatment, again during delivery of that treatment as data indicating ongoing effectiveness become available, at the conclusion of initial intervention, and, when the need arises, at the time of recurrence of disease.
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Affiliation(s)
- Michael A Spinner
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Ranjana H Advani
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Joseph M Connors
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Jacques Azzi
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Catherine Diefenbach
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
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17
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Li Y, Sun H, Yan Y, Sun T, Wang S, Ma H. Long-Term Survival Rates of Patients with Stage III-IV Hodgkin Lymphoma According to Age, Sex, Race, and Socioeconomic Status, 1984-2013. Oncologist 2018; 23:1328-1336. [PMID: 29739895 DOI: 10.1634/theoncologist.2017-0541] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 03/23/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Long-term survival rates for patients with stage III-IV Hodgkin lymphoma, or advanced Hodgkin lymphoma (aHL), have increased substantially since the 1960s. Because large-scale research of aHL is rare, we aimed to demonstrate the differences in incidence and survival of aHL according to four patient variables in recent decades, with a focus on the outcomes of treatment of aHL and the advancement of public health care. MATERIALS AND METHODS Data on aHL cases diagnosed during 1984-2013 were extracted from the Surveillance, Epidemiology, and End Results Program database. Relative survival, Kaplan-Meier, and Cox proportional hazards regression analyses were performed to identify prognosis indicators for aHL. RESULTS The incidence rates for aHL were 1.1, 0.8, and 1.0 per 100,000 in the first, second, and third decades, respectively, during 1984-2013. The 120-month relative survival rate improved continuously in each decade from 58.5% to 64.6% to 72.1%. In addition, disparities in the 120-month relative survival rate between male and female patients and among patients of different races narrowed over time. The difference in long-term survival rate between the poor (medium and high poverty) and rich (low poverty) groups narrowed across the 3 decades. CONCLUSION The long-term survival rate for patients with aHL increased in each decade, whereas survival rate disparities according to sex, race, and socioeconomic status narrowed, except for older patients aged >60 years and the high-poverty group. IMPLICATIONS FOR PRACTICE Long-term survival rates of patients with advanced Hodgkin lymphoma were elaborated in this article. The disparities according to sex, race, and socioeconomic status of survival condition were analyzed and showed the development of the public health care system and modern medicine technology.
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Affiliation(s)
- Yushi Li
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China
| | - Huanhuan Sun
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China
| | - Yan Yan
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China
| | - Tiantian Sun
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Shuncong Wang
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China
| | - Haiqing Ma
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China
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18
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Cordeiro A, Navarro A, Gaya A, Díaz-Beyá M, Gonzalez-Farré B, Castellano JJ, Fuster D, Martínez C, Martínez A, Monzó M. PiwiRNA-651 as marker of treatment response and survival in classical Hodgkin lymphoma. Oncotarget 2018; 7:46002-46013. [PMID: 27329591 PMCID: PMC5216777 DOI: 10.18632/oncotarget.10015] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/26/2016] [Indexed: 01/31/2023] Open
Abstract
PiwiRNAs, small non-coding RNAs processed by Piwi proteins, are involved in maintaining genome stability in germline cells. Recently, piwiRNA expression has been identified in some tumors. We have examined the potential reactivation of the Piwi/piwiRNA pathway in classical Hodgkin lymphoma (cHL). We found that Piwi proteins and three selected piwiRNAs, including piR-651, were expressed in cHL patients and cell lines, indicating that the Piwi/piwiRNA pathway is active in cHL. Interestingly, low levels of piR-651 were associated with lack of complete response to first-line treatment, as well as shorter disease-free and overall survival in a cohort of 94 cHL patients. At diagnosis, piR-651 was underexpressed in cHL serum samples compared to healthy controls, while after complete remission, piR-651 levels increased to levels similar to healthy controls. This is the first evidence that piwiRNAs are active in tumor and serum samples and impact prognosis in cHL.
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Affiliation(s)
- Anna Cordeiro
- Molecular Oncology and Embryology Laboratory, Human Anatomy Unit, School of Medicine, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Alfons Navarro
- Molecular Oncology and Embryology Laboratory, Human Anatomy Unit, School of Medicine, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Anna Gaya
- Hematology Department, Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain
| | - Marina Díaz-Beyá
- Hematology Department, Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain
| | | | - Joan Josep Castellano
- Molecular Oncology and Embryology Laboratory, Human Anatomy Unit, School of Medicine, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Dolors Fuster
- Molecular Oncology and Embryology Laboratory, Human Anatomy Unit, School of Medicine, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Carmen Martínez
- Hematology Department, Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain
| | - Antonio Martínez
- Hematopathology Section, Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain
| | - Mariano Monzó
- Molecular Oncology and Embryology Laboratory, Human Anatomy Unit, School of Medicine, University of Barcelona, IDIBAPS, Barcelona, Spain
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Michot JM, Lazarovici J, Ghez D, Danu A, Fermé C, Bigorgne A, Ribrag V, Marabelle A, Aspeslagh S. Challenges and perspectives in the immunotherapy of Hodgkin lymphoma. Eur J Cancer 2017; 85:67-77. [PMID: 28892775 DOI: 10.1016/j.ejca.2017.08.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/04/2017] [Indexed: 01/04/2023]
Abstract
Hodgkin lymphoma (HL) was one of the first few cancers to be cured first with radiotherapy alone and then with a combination of chemotherapy and radiotherapy. Around 80% of the patients with HL will be cured by first-line therapy. However, the ionising radiation not only produces cytotoxicity but also induces alterations in the microenvironment, and patients often struggle with the long-term consequences of these treatments, such as cardiovascular disorders, lung diseases and secondary malignancies. Hence, it is essential to improve treatments while avoiding delayed side-effects. Immunotherapy is a promising new treatment option for Hodgkin lymphoma, and anti- programmed death-1 (PD1) agents have produced striking results in patients with relapsed or refractory disease. The microenvironment of Hodgkin lymphoma appears to be unique in the field of human disease: the malignant Reed-Sternberg cells only constitute 1% of the cells in the lymphoma, but they are surrounded by an extensive immune infiltrate. Reed-Sternberg cells exhibit 9p24.1/PD-L1/PD-L2 copy number alterations and genetic rearrangements associated with programmed cell death ligand 1/ ligand 2 (PD-L1/2) overexpression, together with major histocompatibility complex-I (MHC-I) and major histocompatibility complex-II (MHC-II) downregulation (which may facilitate the tumour's immune evasion). Although HL may be a situation in which defective immune surveillance is restored by anti-PD1 therapy, it challenges our current explanation of how anti-PD1 agents work because MHC-I expression is required for CD8-T-cell-mediated tumour antigen recognition. Here, we review recent attempts to understand the defects in immune recognition in HL and to design an optimal evidence-based treatment for combination with anti-PD1.
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Affiliation(s)
- Jean-Marie Michot
- Département des Innovations Thérapeutiques et des Essais Précoces, Gustave Roussy, 114 Rue Edouard-Vaillant, F-94805 Villejuif, France; Département d'Hématologie, Gustave Roussy, 114 Rue Edouard-Vaillant, F-94805 Villejuif, France.
| | - Julien Lazarovici
- Département d'Hématologie, Gustave Roussy, 114 Rue Edouard-Vaillant, F-94805 Villejuif, France
| | - David Ghez
- Département d'Hématologie, Gustave Roussy, 114 Rue Edouard-Vaillant, F-94805 Villejuif, France
| | - Alina Danu
- Département d'Hématologie, Gustave Roussy, 114 Rue Edouard-Vaillant, F-94805 Villejuif, France
| | - Christophe Fermé
- Département d'Hématologie, Gustave Roussy, 114 Rue Edouard-Vaillant, F-94805 Villejuif, France
| | - Amélie Bigorgne
- Département des Innovations Thérapeutiques et des Essais Précoces, Gustave Roussy, 114 Rue Edouard-Vaillant, F-94805 Villejuif, France; INSERM U1163, 24 bd de Montparnasse, F-75015 Paris, France
| | - Vincent Ribrag
- Département des Innovations Thérapeutiques et des Essais Précoces, Gustave Roussy, 114 Rue Edouard-Vaillant, F-94805 Villejuif, France; Département d'Hématologie, Gustave Roussy, 114 Rue Edouard-Vaillant, F-94805 Villejuif, France
| | - Aurélien Marabelle
- Département des Innovations Thérapeutiques et des Essais Précoces, Gustave Roussy, 114 Rue Edouard-Vaillant, F-94805 Villejuif, France
| | - Sandrine Aspeslagh
- Département des Innovations Thérapeutiques et des Essais Précoces, Gustave Roussy, 114 Rue Edouard-Vaillant, F-94805 Villejuif, France; Département d'Oncologie Médicale, Institut Jules Bordet, rue Héger Bordet 1, B-1000 Brussels, Belgium
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20
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Jain MD, Kuruvilla J. Anti-PD-1 Antibodies as a Therapeutic Strategy in Classical Hodgkin Lymphoma. Drugs 2017; 77:1645-1655. [DOI: 10.1007/s40265-017-0796-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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21
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Roussel M, Irish JM, Menard C, Lhomme F, Tarte K, Fest T. Regulatory myeloid cells: an underexplored continent in B-cell lymphomas. Cancer Immunol Immunother 2017; 66:1103-1111. [PMID: 28689360 PMCID: PMC11029098 DOI: 10.1007/s00262-017-2036-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/22/2017] [Indexed: 12/14/2022]
Abstract
In lymphomas arising from the germinal center, prognostic factors are linked to the myeloid compartment. In particular, high circulating monocyte or myeloid-derived suppressor cell counts are associated with poor prognosis for patients with high-grade B-cell lymphomas. Macrophages with an M2 phenotype are enriched within lymphoma tumors. However, the M1/M2 nomenclature is now deprecated and the clinical impact of this phenotype remains controversial. Across cancer types, myeloid cells are primarily thought to function as immune suppressors during tumor initiation and maintenance, but the biological mechanisms behind the myeloid signatures are still poorly understood in germinal center B-cell lymphomas. Herein, we describe the role and clinical relevance of myeloid cells in B-cell lymphoma and propose innovative approaches to decipher this complex cellular compartment. Indeed, characterization of this heterogeneous cell ecosystem has been largely accomplished with "low-resolution" approaches like morphological evaluation and immunohistochemistry, where cells are characterized using a few proteins and qualitative metrics. High-resolution, quantitative approaches, such as mass cytometry, are valuable to better understand myeloid cell diversity, functions, and to identify potential targets for novel therapies.
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Affiliation(s)
- Mikael Roussel
- CHU de Rennes, Pole de Biologie, Rennes, France.
- INSERM, UMR U1236, Université Rennes 1, EFS Bretagne, Equipe Labellisée Ligue Contre le Cancer, Rennes, France.
- Laboratoire d'Hématologie, CHU Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes Cedex, France.
| | - Jonathan M Irish
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Pathology, Microbiology and Immunology and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cedric Menard
- CHU de Rennes, Pole de Biologie, Rennes, France
- INSERM, UMR U1236, Université Rennes 1, EFS Bretagne, Equipe Labellisée Ligue Contre le Cancer, Rennes, France
| | | | - Karin Tarte
- CHU de Rennes, Pole de Biologie, Rennes, France
- INSERM, UMR U1236, Université Rennes 1, EFS Bretagne, Equipe Labellisée Ligue Contre le Cancer, Rennes, France
| | - Thierry Fest
- CHU de Rennes, Pole de Biologie, Rennes, France
- INSERM, UMR U1236, Université Rennes 1, EFS Bretagne, Equipe Labellisée Ligue Contre le Cancer, Rennes, France
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22
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Five-year follow-up of brentuximab vedotin combined with ABVD or AVD for advanced-stage classical Hodgkin lymphoma. Blood 2017; 130:1375-1377. [PMID: 28733323 DOI: 10.1182/blood-2017-05-784678] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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23
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Mikkilineni L, Whitaker-Menezes D, Domingo-Vidal M, Sprandio J, Avena P, Cotzia P, Dulau-Florea A, Gong J, Uppal G, Zhan T, Leiby B, Lin Z, Pro B, Sotgia F, Lisanti MP, Martinez-Outschoorn U. Hodgkin lymphoma: A complex metabolic ecosystem with glycolytic reprogramming of the tumor microenvironment. Semin Oncol 2017; 44:218-225. [PMID: 29248133 PMCID: PMC5737784 DOI: 10.1053/j.seminoncol.2017.10.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/05/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Twenty percent of patients with classical Hodgkin Lymphoma (cHL) have aggressive disease defined as relapsed or refractory disease to initial therapy. At present we cannot identify these patients pre-treatment. The microenvironment is very important in cHL because non-cancer cells constitute the majority of the cells in these tumors. Non-cancer intra-tumoral cells, such as tumor-associated macrophages (TAMs) have been shown to promote tumor growth in cHL via crosstalk with the cancer cells. Metabolic heterogeneity is defined as high mitochondrial metabolism in some tumor cells and glycolysis in others. We hypothesized that there are metabolic differences between cancer cells and non-cancer tumor cells, such as TAMs and tumor-infiltrating lymphocytes in cHL and that greater metabolic differences between cancer cells and TAMs are associated with poor outcomes. METHODS A case-control study was conducted with 22 tissue samples of cHL at diagnosis from a single institution. The case samples were from 11 patients with aggressive cHL who had relapsed after standard treatment with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) or were refractory to this treatment. The control samples were from 11 patients with cHL who achieved a remission and never relapsed after ABVD. Reactive non-cancerous lymph nodes from four subjects served as additional controls. Samples were stained by immunohistochemistry for three metabolic markers: translocase of the outer mitochondrial membrane 20 (TOMM20), monocarboxylate transporter 1 (MCT1), and monocarboxylate transporter 4 (MCT4). TOMM20 is a marker of mitochondrial oxidative phosphorylation (OXPHOS) metabolism. Monocarboxylate transporter 1 (MCT1) is the main importer of lactate into cells and is a marker of OXPHOS. Monocarboxylate transporter 4 (MCT4) is the main lactate exporter out of cells and is a marker of glycolysis. The immunoreactivity for TOMM20, MCT1, and MCT4 was scored based on staining intensity and percentage of positive cells, as follows: 0 for no detectable staining in > 50% of cells; 1+ for faint to moderate staining in > 50% of cells, and 2+ for high or strong staining in > 50% of cells. RESULTS TOMM20, MCT1, and MCT4 expression was significantly different in Hodgkin and Reed Sternberg (HRS) cells, which are the cancerous cells in cHL compared with TAMs and tumor-associated lymphocytes. HRS have high expression of TOMM20 and MCT1, while TAMs have absent expression of TOMM20 and MCT1 in all but two cases. Tumor-infiltrating lymphocytes have low TOMM20 expression and absent MCT1 expression. Conversely, high MCT4 expression was found in TAMs, but absent in HRS cells in all but one case. Tumor-infiltrating lymphocytes had absent MCT4 expression. Reactive lymph nodes in contrast to cHL tumors had low TOMM20, MCT1, and MCT4 expression in lymphocytes and macrophages. High TOMM20 and MCT1 expression in cancer cells with high MCT4 expression in TAMs is a signature of high metabolic heterogeneity between cancer cells and the tumor microenvironment. A high metabolic heterogeneity signature was associated with relapsed or refractory cHL with a hazard ratio of 5.87 (1.16-29.71; two-sided P < .05) compared with the low metabolic heterogeneity signature. CONCLUSION Aggressive cHL exhibits features of metabolic heterogeneity with high mitochondrial metabolism in cancer cells and high glycolysis in TAMs, which is not seen in reactive lymph nodes. Future studies will need to confirm the value of these markers as prognostic and predictive biomarkers in clinical practice. Treatment intensity may be tailored in the future to the metabolic profile of the tumor microenvironment and drugs that target metabolic heterogeneity may be valuable in this disease.
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Affiliation(s)
- Lekha Mikkilineni
- Department of Medical Oncology, National Cancer Institute, Bethesda, MD
| | | | | | - John Sprandio
- Department of Medical Oncology, Chester County Memorial Hospital, West Chester, PA
| | - Paola Avena
- Department of Pharmacy and Health and Nutritional Sciences, University of Calabria, Calabria, Italy
| | - Paolo Cotzia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jerald Gong
- Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Guldeep Uppal
- Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Tingting Zhan
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - Benjamin Leiby
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - Zhao Lin
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Barbara Pro
- Division of Medical Oncology, Northwestern University, Evanston, IL
| | - Federica Sotgia
- School of Environment and Life Sciences, University of Salford, Salford, UK
| | - Michael P Lisanti
- School of Environment and Life Sciences, University of Salford, Salford, UK
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Falay O, Öztürk E, Bölükbaşı Y, Gümüş T, Örnek S, Özbalak M, Çetiner M, Demirkol O, Ferhanoğlu B. Use of fluorodeoxyglucose positron emission tomography for diagnosis of bleomycin-induced pneumonitis in Hodgkin lymphoma. Leuk Lymphoma 2016; 58:1114-1122. [DOI: 10.1080/10428194.2016.1236379] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Okan Falay
- Koç University, School of Medicine, Department of Nuclear Medicine and Molecular Imaging, Istanbul, Turkey
| | - Erman Öztürk
- Koç University, School of Medicine, Department of Hematology, Istanbul, Turkey
| | - Yasemin Bölükbaşı
- Koç University, School of Medicine, Department of Radiation Oncology, Istanbul, Turkey
- American Hospital-MD Anderson Radiation Treatment Center, Istanbul, Turkey
- Radiation Oncology at University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Terman Gümüş
- American Hospital, Department of Radiology, Istanbul, Turkey
| | - Serdar Örnek
- American Hospital, Department of Hematology, Istanbul, Turkey
| | - Murat Özbalak
- Kozluk State Hospital, Department of Internal Medicine, Batman, Turkey
| | - Mustafa Çetiner
- Koç University, School of Medicine, Department of Hematology, Istanbul, Turkey
- American Hospital, Department of Hematology, Istanbul, Turkey
| | - Onur Demirkol
- Koç University, School of Medicine, Department of Nuclear Medicine and Molecular Imaging, Istanbul, Turkey
- American Hospital, Department of Nuclear Medicine and Molecular Imag?ng, Istanbul, Turkey
| | - Burhan Ferhanoğlu
- Koç University, School of Medicine, Department of Hematology, Istanbul, Turkey
- American Hospital, Department of Hematology, Istanbul, Turkey
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Growth inhibitory effect of rapamycin in Hodgkin-lymphoma cell lines characterized by constitutive NOTCH1 activation. Tumour Biol 2016; 37:13695-13704. [PMID: 27473087 DOI: 10.1007/s13277-016-5272-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/15/2016] [Indexed: 10/21/2022] Open
Abstract
Growing evidence suggests that deregulation of signalling elements of Notch and mammalian target of rapamycin (mTOR) pathways contribute to tumorigenesis. These signals play important roles in cellular functions and malignancies. Their tumorigenic role in T-cell acute lymphoblastic leukaemia (T-ALL) is well known; however, their potential interactions and functions are poorly characterized in Hodgkin lymphoma (HL). The aim of our study was to characterize mTOR and Notch signalling elements in HL cell lines (DEV, L1236, KMH2) and human biopsies and to investigate their cross-talk in the tumorous process. High mTOR activity and constitutive NOTCH1 activation was confirmed in HL cell lines, without any known oncogenic mutations in key elements, including those common to both pathways. The anti-tumour effect of Notch inhibitors are well known from several preclinical models but resistance and side effects occur in many cases. Here, we tested mTOR and Notch inhibitors and their combinations in gamma-secretase inhibitor (GSI) resistant HL cells in vitro and in vivo. mTOR inhibitor alone or in combination was able to reduce tumour growth; furthermore, it was more effective in xenograft models in vivo. Based on these results, we suggest that constitutively activated NOTCH1 may be a potential target in HL therapy; furthermore, mTOR inhibitors may be effective for decreasing tumour growth if resistance to Notch inhibitors develop.
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Hodgkin Lymphoma: the Changing Role of Radiation Therapy in Early-Stage Disease—the Role of Functional Imaging. Curr Treat Options Oncol 2016; 16:45. [PMID: 26187795 DOI: 10.1007/s11864-015-0360-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Early-stage classical Hodgkin lymphoma (CHL) is a highly curable malignancy. Historically, extended-field radiotherapy (EFRT) alone showed excellent cure rates, but the risk of radiotherapy (RT)-associated toxicities led to combined modality therapy (CMT) replacing RT alone. RT has subsequently evolved further with significant reductions of dose and field size, and is currently restricted to involved sites only (ISRT). Contemporary CMT yields cure rates in excess of 85%, and most studies do not have adequate follow-up required to evaluate the risk reduction in late effects. In an effort to avoid RT altogether, response-adapted treatment approaches utilizing results of interim [(18)F]fluorodeoxyglucose (FDG) positron emission tomography with fused computed tomography (PET/CT) imaging have been studied. Results from two studies in favorable-risk (UK RAPID and EORTC H10F) and one in unfavorable-risk patients (EORTC H10U) suggest that omission of RT in patients with a negative interim PET/CT response (Deauville score ≤2) yields slightly inferior progression-free survival (PFS) compared to conventional CMT, but with no difference in overall survival (OS) albeit with short-term follow-up. In order to extrapolate results to daily practice, it is critical to understand the selection of patients entered on trials since definitions of favorable and unfavorable disease vary between study groups. Currently, CMT continues to be the standard of care for the vast majority of patients with early-stage CHL and RT is an integral part of therapy in patients with bulky disease. However, for selected patients with favorable characteristics, emerging data suggest that a chemotherapy-alone approach is reasonable.
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Cheah CY, Chihara D, Horowitz S, Sevin A, Oki Y, Zhou S, Fowler NH, Romaguera JE, Turturro F, Hagemeister FB, Fayad LE, Wang M, Neelapu SS, Nastoupil LJ, Westin JR, Rodriguez MA, Samaniego F, Anderlini P, Nieto Y, Fanale MA. Patients with classical Hodgkin lymphoma experiencing disease progression after treatment with brentuximab vedotin have poor outcomes. Ann Oncol 2016; 27:1317-23. [PMID: 27091808 DOI: 10.1093/annonc/mdw169] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/04/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Brentuximab vedotin (BV) is a key therapeutic agent for patients with relapsed/refractory classical Hodgkin lymphoma (cHL). The outcomes of patients experiencing disease progression after BV are poorly described. PATIENTS AND METHODS We reviewed our institutional database to identify patients with cHL treated with BV who were either refractory to treatment or experienced disease relapse. We collected clinicopathologic features, treatment details at progression and outcome. RESULTS One hundred patients met inclusion criteria, with a median age of 32 years (range 18-84) at progression after BV. The median number of treatments before BV was 3 (range 0-9); 71 had prior autologous stem cell transplant. The overall response rate (ORR) to BV was 57%, and the median duration of BV therapy was 3 months (range 1-25). After disease progression post-BV, the most common treatment strategies were investigational agents (n = 30), gemcitabine (n = 15) and bendamustine (n = 12). The cumulative ORR to therapy was 33% (complete response 15%). After a median follow-up of 25 months (range 1-74), the median progression-free (PFS) and overall survival (OS) were 3.5 and 25.2 months, respectively. In multivariate analysis, no factors analyzed were predictive of PFS; age at progression >45 years and serum albumin <40 g/l at disease progression were associated with increased risk of death. Among patients who achieved response to therapy, allogeneic stem cell transplantation was associated with a non-significant trend toward superior OS (P = 0.11). CONCLUSIONS Patients with BV-resistant cHL have poor outcomes. These data serve as a reference for newer agents active in BV-resistant disease.
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Affiliation(s)
- C Y Cheah
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA Department of Haematology, Pathwest Laboratory Medicine WA and Sir Charles Gairdner Hospital, Nedlands School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Australia
| | - D Chihara
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | | | - Y Oki
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S Zhou
- Department of Biostatistics
| | - N H Fowler
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J E Romaguera
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Turturro
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F B Hagemeister
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - L E Fayad
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M Wang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S S Neelapu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - L J Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J R Westin
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M A Rodriguez
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Samaniego
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - P Anderlini
- Department of Stem Cell Transplant and Cellular Therapies, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Y Nieto
- Department of Stem Cell Transplant and Cellular Therapies, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M A Fanale
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, USA
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Abstract
OBJECTIVES Clinical series suggest favorable outcomes of HIV-associated Hodgkin lymphoma, in conflict with population-based statistics. Our objective was to investigate the proportion of Americans who received curative chemotherapy for this disease, and compare their survival with HIV-negative cases using population data. METHODS We selected cases of HIV-associated Hodgkin lymphoma diagnosed in 2004-2012 from the National Cancer Data Base. Factors associated with receipt of chemotherapy were analyzed by logistic regression. Overall survival was compared in proportional hazard models adjusting for available confounding factors. RESULTS Among 2090 HIV-positive patients, 81% received chemotherapy, but 16% received no treatment. Advanced age, male sex, nonwhite race, poor socioeconomic status, and undetermined histologic subtype were associated with higher risk of nontreatment. In 2012, 49% of HIV-positive patients were black, and 15% were Hispanic. Unadjusted 5-year overall survival was significantly lower for HIV-positive (66%) than for HIV-negative (80%) populations. However, among patients who received chemotherapy, HIV-positive status was not significantly associated with higher mortality in classical histologic subtypes, including nodular sclerosis (hazard ratio, HR, 1.08; 95% confidence interval, CI, 0.88-1.33) and mixed cellularity (HR, 1.06; 95% CI, 0.80-1.40). In contrast, prognosis remained significantly worse for cases with undetermined histology (HR, 1.56; 95% CI, 1.31-1.85), suggesting a more aggressive biology or other high-risk characteristics in this subgroup. CONCLUSION Worse survival statistics for HIV-associated Hodgkin lymphoma are driven by lower rates of chemotherapy administration. The disparity in treatment delivery needs attention because a majority of HIV-positive Americans with Hodgkin lymphoma are now black or Hispanic, and this proportion is increasing.
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Abstract
AbstractHodgkin lymphoma (HL) is a highly curable form of childhood cancer, with estimated 5 year survival rates exceeding 98%. However, the establishment of a “standard of care” approach to its management is complicated by the recognition that long-term overall survival declines in part from delayed effects of therapy and that there continue to be subgroups of patients at risk for relapse for which prognostic criteria cannot adequately define. This challenge has resulted in the development of various strategies aimed at identifying the optimal balance between maintaining overall survival and avoidance of long-term morbidity of therapy, often representing strategies quite different from those used for adults with HL. More precise risk stratification and methods for assessing the chemosensitivity of HL through imaging studies and biomarkers are in evolution. Recent advances in the understanding of the biology of HL have led to the introduction of targeted therapies in both the frontline and relapsed settings. However, significant barriers exist in the development of new combination therapies, necessitating collaborative studies across pediatric HL research consortia and in conjunction with adult groups for the adolescent and young adult (AYA) population with HL.
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30
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Glimelius I, Ekberg S, Jerkeman M, Chang ET, Björkholm M, Andersson TM, Smedby KE, Eloranta S. Long-term survival in young and middle-aged Hodgkin lymphoma patients in Sweden 1992-2009-trends in cure proportions by clinical characteristics. Am J Hematol 2015; 90:1128-34. [PMID: 26349012 DOI: 10.1002/ajh.24184] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/04/2015] [Indexed: 12/16/2022]
Abstract
Trends in Hodgkin lymphoma (HL) survival among patients treated outside of clinical trials provide real-world benchmark estimates of prognosis and help identify patient subgroups for targeted trials. In a Swedish population-based cohort of 1947 HL patients diagnosed in 1992-2009 at ages 18-59 years, we estimated relative survival (RS), cure proportions (CP), and median survival times using flexible parametric cure models. Overall, the CP was 89% (95% CI: 0.87-0.91) and median survival of the uncured was 4.6 years (95% CI: 3.0-6.3). For patients aged 18-50 years diagnosed after the year 2000, CP was high and stable, whereas for patients of 50-59 years, cure was not reached. The survival of relapse-free patients was similar to that of the general population (RS5-year : 0.99; 95% CI: 0.98-0.99, RS15-year : 0.95; 95% CI: 0.92-0.97). The excess mortality of relapsing patients was 19 times (95% CI: 12-31) that of relapse-free patients. Despite modern treatments, patients with adverse prognostic factors (e.g., advanced stage) still had markedly worse outcomes [CP stage: IIIB 0.82 (95% CI: 0.73-0.89); CP stage: IVB 0.72, (95% CI: 0.60-0.81)] and patients with international prognostic score (IPS) ≥3 had 2.7 times higher excess mortality (95% CI: 1.0-7.0, p = 0.04) than patients with IPS <3. High-risk patients selected for 6-8 courses of BEACOPP (bleomycin, etoposide, doxorubicin, cyclofosphamide, vincristine, procarbazine, prednisone)-chemotherapy had a 15-year relative survival of 87%, (95% CI: 0.80-0.92), whereas the corresponding estimate for patients selected for 6-8 courses of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) was 93% (95% CI: 0.88-0.97). These population-based results indicate limited fatal side-effects in the 15-year perspective with contemporary treatments, while the unmet need of effective relapse treatment remains of concern. BEACOPP-chemotherapy was still not sufficient in high-risk HL patients.
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Affiliation(s)
- Ingrid Glimelius
- Department of Medicine; Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital; Stockholm Sweden
- Department of Immunology, Genetics and Pathology Clinical and Experimental Oncology; Uppsala University and Uppsala Akademiska Hospital; Sweden
| | - Sara Ekberg
- Department of Medicine; Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital; Stockholm Sweden
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Mats Jerkeman
- Department of Oncology; Skåne University Hospital; Lund Sweden
| | - Ellen T. Chang
- California and Department of Health Research and Policy; Health Sciences Practice, Exponent, Inc., Menlo Park, Stanford University School of Medicine; Stanford California
| | - Magnus Björkholm
- Department of Medicine Division of Hematology; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - Therese M.L. Andersson
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Karin E. Smedby
- Department of Medicine; Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital; Stockholm Sweden
| | - Sandra Eloranta
- Department of Medicine; Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital; Stockholm Sweden
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31
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Hodgkin lymphoma in children and adolescents: improving the therapeutic index. Blood 2015; 126:2452-8. [DOI: 10.1182/blood-2015-07-641035] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/15/2015] [Indexed: 01/06/2023] Open
Abstract
Abstract
Hodgkin lymphoma (HL) is a highly curable form of childhood cancer, with estimated 5 year survival rates exceeding 98%. However, the establishment of a “standard of care” approach to its management is complicated by the recognition that long-term overall survival declines in part from delayed effects of therapy and that there continue to be subgroups of patients at risk for relapse for which prognostic criteria cannot adequately define. This challenge has resulted in the development of various strategies aimed at identifying the optimal balance between maintaining overall survival and avoidance of long-term morbidity of therapy, often representing strategies quite different from those used for adults with HL. More precise risk stratification and methods for assessing the chemosensitivity of HL through imaging studies and biomarkers are in evolution. Recent advances in the understanding of the biology of HL have led to the introduction of targeted therapies in both the frontline and relapsed settings. However, significant barriers exist in the development of new combination therapies, necessitating collaborative studies across pediatric HL research consortia and in conjunction with adult groups for the adolescent and young adult (AYA) population with HL.
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Besson C, Lancar R, Prevot S, Brice P, Meyohas MC, Marchou B, Gabarre J, Bonnet F, Goujard C, Lambotte O, Boué F, Mounier N, Partisani M, Raffi F, Costello R, Hendel-Chavez H, Algarte-Genin M, Trabelsi S, Marchand L, Raphael M, Taoufik Y, Costagliola D. High Risk Features Contrast With Favorable Outcomes in HIV-associated Hodgkin Lymphoma in the Modern cART Era, ANRS CO16 LYMPHOVIR Cohort. Clin Infect Dis 2015. [PMID: 26223997 DOI: 10.1093/cid/civ627] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection is associated with a high risk of classical Hodgkin's lymphoma (cHL) in the combined antiretroviral therapy (cART) era. METHODS We analyzed the characteristics and outcome of HIV-associated cHL diagnosed in the modern cART era. The French ANRS-CO16 Lymphovir cohort enrolled 159 HIV-positive patients with lymphoma, including 68 (43%) with cHL. HIV-HL patients were compared with a series of non-HV-infected patients consecutively diagnosed with HL. RESULTS Most patients (76%) had Ann-Arbor stages III-IV and 96% of patients were treated with ABVD. At diagnosis, median CD4 T-cell count was 387/µL and 94% of patients were treated with cART. All patients received cART after diagnosis. Five patients died from early progression (n = 2), sepsis (1) or after relapse (2). Two additional patients relapsed during follow-up. Two-year overall and progression free survivals (PFS) were 94% [95% CI, 89%, 100%] and 89% [82%, 97%], respectively. The only factor associated with progression or death was age with a relative risk of 8.1 [1.0; 67.0] above 45 years. The PFS of Lymphovir patients appeared similar to PFS of HIV-negative patients, 86% [82%, 90%], but patients with HIV infection displayed higher risk features than HIV-negative patients. CONCLUSIONS Although high-risk features still predominate in HIV-HL, the prognosis of these patients, treated with cART and mainly ABVD, has markedly improved in the modern cART era and is now similar to non-HIV-infected patients.
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Affiliation(s)
- Caroline Besson
- Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre AP-HP, Hôpitaux Paris Sud, Service d'hématologie, Le Kremlin-Bicêtre
| | - Remi Lancar
- Sorbonne Universités, UPMC Univ Paris 06 INSERM, UMR_S 1136, Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris
| | - Sophie Prevot
- Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre AP-HP, Hôpitaux Paris Sud Site Béclère, Service d'anatomo-pathologie, Clamart
| | - Pauline Brice
- Department of Hemato-oncology, Hôpital Saint-Louis, AP-HP
| | | | | | - Jean Gabarre
- AP-HP, CHU Pitié-Salpétrière, Service d'hématologie, Paris
| | - Fabrice Bonnet
- CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, and INSERM U593, Université de Bordeaux
| | - Cécile Goujard
- Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre AP-HP, Hôpitaux Paris Sud, Service d'hématologie, Le Kremlin-Bicêtre
| | - Olivier Lambotte
- Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre AP-HP, Hôpitaux Paris Sud, Service d'hématologie, Le Kremlin-Bicêtre
| | - François Boué
- Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre AP-HP, Hôpitaux Paris Sud Site Béclère, Service d'immunologie clinique, Clamart
| | | | | | | | - Régis Costello
- Department of Hematology, Hôpital La Conception, Marseille
| | | | - Michele Algarte-Genin
- Sorbonne Universités, UPMC Univ Paris 06 INSERM, UMR_S 1136, Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris
| | - Selma Trabelsi
- Sorbonne Universités, UPMC Univ Paris 06 INSERM, UMR_S 1136, Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris
| | | | - Martine Raphael
- Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre
| | - Yassine Taoufik
- Université Paris Sud, Faculté de médecine Paris Sud, Le Kremlin-Bicêtre AP-HP, Hôpitaux Paris Sud, Service d'imunologie biologique, Le Kremlin-Bicêtre, France
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Univ Paris 06 INSERM, UMR_S 1136, Institut Pierre Louis d'épidémiologie et de Santé Publique, Paris
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33
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Kelly KM. Hodgkin lymphoma in children and adolescents: improving the therapeutic index. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2015; 2015:514-521. [PMID: 26637767 DOI: 10.1182/asheducation-2015.1.514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Hodgkin lymphoma (HL) is a highly curable form of childhood cancer, with estimated 5 year survival rates exceeding 98%. However, the establishment of a "standard of care" approach to its management is complicated by the recognition that long-term overall survival declines in part from delayed effects of therapy and that there continue to be subgroups of patients at risk for relapse for which prognostic criteria cannot adequately define. This challenge has resulted in the development of various strategies aimed at identifying the optimal balance between maintaining overall survival and avoidance of long-term morbidity of therapy, often representing strategies quite different from those used for adults with HL. More precise risk stratification and methods for assessing the chemosensitivity of HL through imaging studies and biomarkers are in evolution. Recent advances in the understanding of the biology of HL have led to the introduction of targeted therapies in both the frontline and relapsed settings. However, significant barriers exist in the development of new combination therapies, necessitating collaborative studies across pediatric HL research consortia and in conjunction with adult groups for the adolescent and young adult (AYA) population with HL.
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Affiliation(s)
- Kara M Kelly
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Medical Center, New York, NY
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