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Withofs N, Bonnet C, Hustinx R. 2-deoxy-2-[ 18F]FDG PET Imaging for Therapy Assessment in Hodgkin's and Non-Hodgkin Lymphomas. PET Clin 2024; 19:447-462. [PMID: 38945737 DOI: 10.1016/j.cpet.2024.05.001] [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] [Indexed: 07/02/2024]
Abstract
The 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography combined with computed tomography (PET/CT) has contributed to outcome improvement of patients with lymphoma. The use of [18F]FDG PET/CT for staging and response assessment is successfully applied both in routine clinical practice and in clinical trials. The challenges lie in enhancing the outcomes of lymphoma patients, particularly those with advanced or refractory/relapsed disease, and to minimize the long-term toxicity associated with treatments, including radiation therapy. The objective of this review article is to present contemporary data on the use of [18F]FDG PET/CT for treatment assessment of aggressive lymphomas.
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Affiliation(s)
- Nadia Withofs
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liege, Quartier Hopital, Avenue de l'hopital 1, Liege, Belgium; GIGA-Nuclear Medicine Lab, University of Liege, CHU - B34 Quartier Hôpital, Avenue de l'Hôpital 11, Liège, BELGIQUE.
| | - Christophe Bonnet
- Department of Hematology, CHU of Liege, Quartier Hôpital, Avenue de l'hôpital 1, 4000 Liege 1, Belgium
| | - Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liege, Quartier Hopital, Avenue de l'hopital 1, Liege, Belgium; GIGA-Nuclear Medicine Lab, University of Liege, CHU - B34 Quartier Hôpital, Avenue de l'Hôpital 11, Liège, BELGIQUE
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2
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Bell A, Rangaswami A, Murphy P, Meng M, Raphael R, Wu N, Goldsby R. Subsequent Renal Cancer Among Childhood Cancer Survivors: Analysis of Surveillance, Epidemiology, and End Results. J Pediatr Hematol Oncol 2024; 46:e387-e392. [PMID: 38934569 PMCID: PMC11268548 DOI: 10.1097/mph.0000000000002910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/15/2024] [Indexed: 06/28/2024]
Abstract
Renal cancer, although still rare among individuals under 45 years of age, is on the rise in the general population. The risk and timing of subsequent renal cancer in survivors of childhood cancer is not well established. Using the SEER registry, we reported the incidence of subsequent malignant renal neoplasms after treatment for primary malignancy diagnosed under 20 years of age. We evaluated clinical characteristics, standardized incidence ratio (SIR), and Kaplan-Meier survival estimates. Fifty-three survivors developed subsequent renal cancer (54 total cases). Of these, 54.7% were female, 88.7% were white, and 13.2% were Hispanic. Mean ages at primary malignancy and subsequent renal cancer were 10.1 and 31.1 years, respectively. Forty-seven cases were second cancers, 6 were third, and 1 was fourth. For survivors of childhood cancer, the overall SIR for renal cancer was 4.52 (95% CI: 3.39-5.89). The 5-year overall survival rate after development of subsequent renal cancer was 73% (95% CI: 58%-83%). Renal cancer occurs 4.5 times more frequently in childhood cancer survivors than in the general population, necessitating long-term care considerations.
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Affiliation(s)
| | | | | | - Max Meng
- Urology, UCSF Benioff Children’s Hospitals, San Francisco, CA
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3
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Gallamini A, Filippi A, Camus V, Vassilakopoulos TP. Toward a paradigm shift in prognostication and treatment of early-stage Hodgkin lymphoma. Br J Haematol 2024. [PMID: 39039814 DOI: 10.1111/bjh.19657] [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: 06/06/2024] [Accepted: 07/09/2024] [Indexed: 07/24/2024]
Abstract
Twenty years after the conceptual revolution that occurred in the millennium turnaround upon the introduction of PET/CT in lymphoma staging, restaging, and prognostication, a number of new parameters for PET reading have been proposed: (1) the shift from a qualitative to a semi-quantitative reading for PET reporting, (2) an international consensus on these novel interpretation keys, (3) a standardized and agreed procedure to measure the total metabolic tumour volume (TMTV), and (4) the proposition of new indexes to portray the tumour spread: (D-Max and Total Lesion Surface -TLS). These proved to be very powerful prognosticators, able to revolutionize the traditional Ann Arbor four-stage lymphoma staging. During the 17° Lugano meeting on lymphoma, one main question was asked to experts attending a closed workshop dedicated to new metrics for lymphoma diagnosis, staging, restaging, and prognostication: "Should the traditional 4-stage anatomic staging system be simplified to a more clinically relevant 2-stage system (e.g., limited vs. extensive disease)?" Early-stage HL is an example of how these new metrics could fit with this proposal.
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Affiliation(s)
- Andrea Gallamini
- Research and Clinical Innovation, Antoine Lacassagne Cancer Centre, Nice, France
| | - Andrea Filippi
- Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology, University of Milan, Milan, Italy
| | - Vincent Camus
- Institute of Oncology Research, Bellinzona, Switzerland
- Department of Haematology, Centre Henri Becquerel, Rouen, France
| | - Theodoros P Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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4
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Guja KE, Behr G, Bedmutha A, Kuhn M, Nadel HR, Pandit-Taskar N. Molecular Imaging with PET-CT and PET-MRI in Pediatric Musculoskeletal Diseases. Semin Nucl Med 2024; 54:438-455. [PMID: 38688770 DOI: 10.1053/j.semnuclmed.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 05/02/2024]
Abstract
Molecular imaging has emerged as an integral part of oncologic imaging. Given the physiologic changes that precede anatomic changes, molecular imaging can enable early detection of disease and monitoring of response. [18F] Fluorodeoxyglucose (FDG) Positron emission tomography (PET) is the predominant molecular imaging modality used in oncologic assessment and can be performed using PET/CT or PET/MR. In pediatric patients, PET/MRI imaging is generally preferred due to low radiation exposure and PET/MRI is particularly advantageous for imaging musculoskeletal (MSK) diseases, as MRI provides superior characterization of tissue changes as compared to CT. In this article, we provide an overview of the typical role of PET CT/MRI in assessment of some common pediatric malignancies and benign MSK diseases with case examples. We also discuss the relative advantages of PET/MRI compared to PET/CT, and review published data with a primary focus on the use of PET/MR.
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Affiliation(s)
- Kip E Guja
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gerald Behr
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; Weil Cornell Medical College, New York, New York
| | - Akshay Bedmutha
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marlena Kuhn
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Helen R Nadel
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Neeta Pandit-Taskar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; Weil Cornell Medical College, New York, New York.
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5
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Cook MR, Williams LS, Dorris CS, Luo Y, Makambi K, Dunleavy K. Improved survival for dose-intensive chemotherapy in primary mediastinal B-cell lymphoma: a systematic review and meta-analysis of 4,068 patients. Haematologica 2024; 109:846-856. [PMID: 37646662 PMCID: PMC10905081 DOI: 10.3324/haematol.2023.283446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023] Open
Abstract
Primary mediastinal B-cell lymphoma (PMBCL) is a distinct clinicopathologic entity. Currently, there is a paucity of randomized prospective data to inform on optimal front-line chemoimmunotherapy (CIT) and use of consolidative mediastinal radiation (RT). To assess if distinct CIT approaches are associated with disparate survival outcomes, we performed a systematic review and meta-analysis comparing dose-intensive (DI-CIT) versus standard CIT for the front-line treatment of PMBCL. Standard approach (S-CIT) was defined as R-CHOP-21/CHOP-21, with or without RT. DI-CIT were defined as regimens with increased frequency, dose, and/or number of systemic agents. We reviewed data on 4,068 patients (2,517 DI-CIT; 1,551 S-CIT) with a new diagnosis of PMBCL. Overall survival for DI-CIT patients was 88% (95% CI: 85-90) compared to 80% for the S-CIT cohort (95% CI: 74-85). Meta-regression revealed an 8% overall survival (OS) benefit for the DI-CIT group (P<0.01). Survival benefit was maintained when analyzing rituximab only regimens; OS was 91% (95% CI: 89-93) for the rituximab-DI-CIT arm compared to 86% (95% CI: 82-89) for the R-CHOP-21 arm (P=0.03). Importantly, 55% (95% CI: 43-65) of the S-CIT group received RT compared to 22% (95% CI: 15-31) of DI-CIT patients (meta-regression P<0.01). To our knowledge, this is the largest meta-analysis reporting efficacy outcomes for the front-line treatment of PMBCL. DI-CIT demonstrates a survival benefit, with significantly less radiation exposure, curtailing long-term toxicities associated with radiotherapy. As we await results of randomized prospective trials, our study supports the use of dose-intensive chemoimmunotherapy for the treatment of PMBCL.
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Affiliation(s)
- Michael R Cook
- Perelman School of Medicine, University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA.
| | - Lacey S Williams
- Lombardi Comprehensive Cancer Center and Georgetown University Hospital, Washington, DC
| | | | - Yutong Luo
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University
| | - Kepher Makambi
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University
| | - Kieron Dunleavy
- Lombardi Comprehensive Cancer Center and Georgetown University Hospital, Washington, DC.
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Hill NE, Friedman DL, Godown J, Zarnegar-Lumley S. Cough, Shortness of Breath, and Malaise in a 19-year-old Adolescent. Pediatr Rev 2023; 44:S72-S76. [PMID: 37777228 DOI: 10.1542/pir.2022-005906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Nina E Hill
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Debra L Friedman
- Division of Hematology and Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Justin Godown
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Sara Zarnegar-Lumley
- Division of Hematology and Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
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7
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Shilo K, Kneuertz PJ, Liebner D, Chen W. Case report: Pulmonary synovial sarcoma in a long-term survivor of childhood Hodgkin lymphoma. Front Oncol 2023; 13:1096160. [PMID: 36910640 PMCID: PMC9999020 DOI: 10.3389/fonc.2023.1096160] [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: 11/11/2022] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
Solid organ malignancies have been reported in survivors of Hodgkin lymphoma treated with chemoradiation; however, to the best of our knowledge no cases of pulmonary synovial sarcoma have been documented in the literature in this cohort. We herein provide a detailed description of synovial sarcoma occurring in the lung of a long-term survivor of childhood Hodgkin lymphoma. A 29-year-old female never smoker with past medical history of Hodgkin lymphoma diagnosed at the age of 7 years and treated with chemotherapy and radiation therapy was admitted for management of pneumothorax. Wedge lung resection of an ulcerated subpleural nodule revealed a malignant spindle cell tumor that based on light microscopic and immunohistochemical features was classified as monophasic synovial sarcoma. The diagnosis was further confirmed by identification of SS18 (SYT) rearrangement by fluorescence in situ hybridization and SS18-SSX1 gene fusion by RNA sequencing. The case documents a rare occurrence of synovial sarcoma in a long-term survivor of childhood Hodgkin lymphoma. While comprising a typical genetic profile for synovial sarcoma, the tumor had unusual histological features such as cystic and low-grade morphology. The case suggests that synovial sarcoma falls within an expanding spectrum of secondary malignancies following prior treatment of Hodgkin lymphoma.
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Affiliation(s)
- Konstantin Shilo
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Peter J Kneuertz
- Division of Thoracic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - David Liebner
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Wei Chen
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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8
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Roschewski M, Bollard CM. Are We Too Reliant on Radiation Therapy for Children with Hodgkin's Lymphoma? N Engl J Med 2022; 387:1710-1712. [PMID: 36322850 DOI: 10.1056/nejme2211587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mark Roschewski
- From the Lymphoid Malignancies Branch, Clinical Cancer Research, National Cancer Institute, Bethesda, MD (M.R.); and the Center for Cancer and Immunology Research, Children's National Hospital, and George Washington Cancer Center, George Washington University, Washington, DC (C.M.B.)
| | - Catherine M Bollard
- From the Lymphoid Malignancies Branch, Clinical Cancer Research, National Cancer Institute, Bethesda, MD (M.R.); and the Center for Cancer and Immunology Research, Children's National Hospital, and George Washington Cancer Center, George Washington University, Washington, DC (C.M.B.)
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9
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Palayullakandi A, Trehan A, Jain R, Kumar R, Mittal BR, Kapoor R, Srinivasan R, Kakkar N, Bansal D. Retrospective single-center experience with OEPA/COPDAC and PET-CT based strategy for pediatric Hodgkin lymphoma in a LMIC setting. Pediatr Hematol Oncol 2022; 39:587-599. [PMID: 35271413 DOI: 10.1080/08880018.2022.2044418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ABVD regimen for Hodgkin lymphoma (HL) is frequently used in children and young adults in low-middle income countries (LMIC). The feasibility and safety data for 'non-ABVD' protocols from LMIC is limited. The retrospective study was conducted in a single center in India. The Euronet PHL-C1 based protocol was administered during 2010-19. A PET-CT was performed at diagnosis and following two OEPA cycles. Radiotherapy was administered for inadequate PET response. During the 10-year period, 143 patients with HL were treated. The mean age was 7.8 ± 2.5 years. Bulky disease was observed in 82 (59%). Treatment abandonment was recorded in 13 (9.1%). The median follow-up duration was 46.4 months. An inadequate PET response was observed in 41/119 (34.4%), of which 56.1% received radiotherapy. Twelve (29.3%) patients who were supposed to receive radiotherapy received 2-cycles of COPDAC instead. Sixty-nine episodes of febrile neutropenia were observed in 54 patients. Treatment-related mortality (TRM) was observed in 7 (5.3%). The majority of episodes of febrile neutropenia (61%) and TRM (86%) occurred in the first cycle of OEPA. The 4-year event-free survival (EFS) and overall survival (OS) were 86.2 ± 3.4% and 93.5 ± 2.2%, respectively. Nine (6.3%) patients relapsed. Bulky disease lacked association with inadequate PET response (p = .800) or relapse (p = 1.000). OEPA/COPDAC regimen and response assessment by PET-CT permitted therapy reduction, including radiotherapy. Febrile neutropenia and resultant TRM (5.3%) are concerning and occurred frequently in the first cycle of OEPA. The support system for managing febrile neutropenia should be optimized for administering OEPA in LMIC.
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Affiliation(s)
- Achanya Palayullakandi
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Chandigarh, India
| | - Amita Trehan
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Chandigarh, India
| | - Richa Jain
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatrics Center, Chandigarh, India
| | - Rajender Kumar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Kakkar
- Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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10
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de Armas S, Huertas-Ayala C, Chan RY, Chi YY, Huh WW, Termuhlen A, Gaynon PS, Kovach AE, Doan A. Survival of pediatric Hodgkin lymphoma patients treated with doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (ABVE-PC) versus doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) at a single institution. Pediatr Blood Cancer 2022; 69:e29601. [PMID: 35187850 DOI: 10.1002/pbc.29601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adriamycin, bleomycin, vinblastine, dacarbazine (ABVD), the de facto standard of care in adult-onset Hodgkin lymphoma (HL), has not been directly compared to doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (ABVE-PC), a pediatric-aimed regimen designed to reduce late effects. We aimed to describe the single-institution experience of using both regimens in patients with pediatric HL. METHODS This retrospective cohort study evaluated a total of 224 patients diagnosed with HL between 1999 and 2018 at Children's Hospital Los Angeles (CHLA), of which 93 patients were eligible having received ABVD (n = 46) or ABVE-PC (n = 47) chemotherapy as their initial treatment. Descriptive analyses were performed using the Student's t-test or Fisher's exact test. Survival analysis used the Kaplan-Meier method. Events included death, relapse, and secondary malignancy. We also describe the use of radiation therapy, pulmonary toxicity, and cardiomyopathy determined by shortening fraction <29%. Analyses followed an intention-to-treat principle. RESULTS There was no difference in baseline characteristics between the patients receiving ABVE-PC or ABVD in regard for stage, risk group, or prognostic variables, such as the presence or absence of "B" symptoms, bulky disease, and extra-nodal involvement. A greater proportion of patients treated with ABVE-PC received consolidating external beam radiation treatment (XRT) either by randomization or by response compared to ABVD (59.6% vs. 32.6%, respectively, p = .01). While not statistically significant, response to therapy, assessed by positron emission tomography/computerized tomography (PET/CT) where available, mirrored the use for radiation (rapid response 58.3% vs. 90.0%, n = 34, p = .11). The median dose of anthracycline (doxorubicin) was the same in patients receiving ABVE-PC versus ABVD (200 vs. 200 mg/m2 , interquartile range 200-250 vs. 200-300 mg/m2 , p = .002). There was no difference in event-free survival (p = .63) or overall survival (p = .37) with a median follow-up length of 3.9 years. CONCLUSIONS ABVD and ABVE-PC achieved similar survival outcomes in our single-institution cohort.
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Affiliation(s)
| | | | - Randall Y Chan
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.,Department of Pediatrics, Los Angeles County+University of Southern California Medical Center, Los Angeles, California, USA
| | - Yueh-Yun Chi
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Winston W Huh
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.,Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Amanda Termuhlen
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Paul S Gaynon
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.,Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Alexandra E Kovach
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.,Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Andrew Doan
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.,Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA
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11
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Xiao H, He J, Liang S, Cai D, Zhou Q, Liu L, Yan X, Chi J, Xiao Q, Wang L. Racial/Ethnic Disparities on the Risk of Second Malignant Neoplasm Among Hodgkin Lymphoma Survivors. Front Oncol 2022; 11:790891. [PMID: 35141149 PMCID: PMC8818723 DOI: 10.3389/fonc.2021.790891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background Hodgkin lymphoma survivors are at risk for second malignant neoplasm (SMN). How race/ethnicity affects the risk remains unclear. Methods This retrospective cohort study included 22,415 patients diagnosed with primary Hodgkin lymphoma from January 1992 to December 2015 in 13 Surveillance, Epidemiology, and End Results-based registries and divided patients into four groups: non-Hispanic whites, non-Hispanic blacks, Hispanics, and Asian/others. Taking non-Hispanic whites as a reference, both the proportional subdistribution hazard (PSH) and the cause-specific hazard (CSH) methods were used to calculate the SMN hazard ratio for other racial/ethnic groups with and without considering the competing mortality risk. Results 1,778 patients developed SMN with a median follow-up of 11.63 years. In the adjusted PSH model, Hispanic, Asian/others, and non-Hispanic black patients had 26% (PSH, 0.74; 95% CI, 0.63–0.87), 20% (PSH, 0.80; 95% CI, 0.64–1.01), and 12% (PSH, 0.88; 95% CI, 0.75–1.03) decreased overall SMN hazard, respectively. Moreover, the PSH method revealed the racial/ethnic difference in the SMN risk in the skin, the respiratory system, and the endocrine system. These hazards were slightly higher and different with the use of the CSH approach. In addition to the aforementioned overall SMN and subtypes, adjusted CSH analysis also revealed the racial/ethnic disparities in the risk of subsequent female breast cancer, digestive cancer, and non-Hodgkin lymphoma. Conclusions The subtype and SMN risk among Hodgkin lymphoma survivors varied by race/ethnicity. The use of CSH and PSH provides a dynamic view of racial/ethnic effects on SMN risk in Hodgkin lymphoma survivors.
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Affiliation(s)
- Han Xiao
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Jianghua He
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS, United States
| | - Simin Liang
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Duo Cai
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Qiao Zhou
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Lanxiang Liu
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Xinyu Yan
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Jianxiang Chi
- The Center for the Study of Hematological Malignancies, Karaiskakio Foundation, Nicosia, Cyprus
| | - Qing Xiao
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Li Wang
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
- *Correspondence: Li Wang,
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12
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Blum KA. Controversies in the management of early-stage Hodgkin lymphoma. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:234-239. [PMID: 34889367 PMCID: PMC8791127 DOI: 10.1182/hematology.2021000255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Positron emission tomography (PET)-adapted chemotherapy and radiotherapy approaches are currently used for the initial treatment of early-stage Hodgkin lymphoma (HL) with progression-free survival and overall survival exceeding 85% and 95%, respectively. However, despite general agreement on the prognostic value of interim PET in HL, frontline treatment approaches vary among institutions with respect to how pretreatment clinical risk factors determine treatment selection, the definition of PET negativity, which chemotherapy regimen to initiate and how many cycles to administer, and when to incorporate radiation. Furthermore, as recent trials have confirmed improved efficacy and manageable toxicity when brentuximab and checkpoint inhibitors are combined with frontline regimens such as doxorubicin, vinblastine, and dacarbazine in advanced-stage HL, these agents are now under evaluation as frontline therapy in early-stage HL. A number of issues will affect the use of these agents in early-stage HL, including the costs, early and late toxicities with these agents, patient population (favorable or unfavorable risk groups), how to incorporate them (concurrently or sequentially), and whether they can ultimately replace cytotoxic therapy with similar efficacy and fewer late effects. Future treatment paradigms for early-stage HL may change significantly once randomized studies are completed incorporating these agents into frontline therapy. Ideally, frontline use of brentuximab and checkpoint inhibitors in early-stage HL will result in improved outcomes compared with current PET-adapted approaches with decreased risks of late toxicities that continue to afflict long-term survivors of HL.
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Affiliation(s)
- Kristie A. Blum
- Department of Hematology and Medical Oncology, Emory Winship Cancer Institute, Atlanta, GA
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13
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Horton DB, Blum MD, Burcu M. Real-World Evidence for Assessing Treatment Effectiveness and Safety in Pediatric Populations. J Pediatr 2021; 238:312-316. [PMID: 34217767 PMCID: PMC8249672 DOI: 10.1016/j.jpeds.2021.06.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/14/2021] [Accepted: 06/23/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Daniel B. Horton
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ,Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ,Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ,Reprint requests: Daniel B. Horton, MD, MSCE, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, 112 Paterson St, New Brunswick, NJ 08901
| | - Michael D. Blum
- Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | - Mehmet Burcu
- Department of Epidemiology, Merck & Co., Inc., Kenilworth, NJ
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Mascaró-Pol M, Díez-Feijoo R, Rodriguez-Sevilla JJ, Fernández-Rodriguez C, García-Pallarols F, Flores S, Vazquez I, Rodriguez-Lopez S, Roman D, Gimeno E, Colomo L, Maiques J, Sánchez-González B, Salar A. Evaluation of routine CT scans in the follow-up of diffuse large B-cell lymphomas. ACTA ACUST UNITED AC 2021; 26:709-715. [PMID: 34547987 DOI: 10.1080/16078454.2021.1975957] [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: 10/20/2022]
Abstract
OBJECTIVE Our aim was to retrospectively assess the role of routine CT scans within the first year of follow-up with a limited surveillance policy prior to Lugano recommendations in diffuse large B-cell lymphomas (DLBCL) achieving complete metabolic remission (CMR). We also evaluated the type of relapse detection and exposure to CT scans within the first five years. METHODS Patients diagnosed with DLBCL who achieved CMR after first-line immunochemotherapy were included. Imaging studies and medical records were thoroughly reviewed. RESULTS Among 101 DLBCL patients in the first CMR, a total of 19 relapses were identified in the study period (18.8% of DLBCL patients included). Nine patients relapsed within the first year (47.4% of all relapses) but only 3 of them were detected by the 202 surveillance CT scans performed during this first year of follow-up. CONCLUSIONS Our real-world data provide clinically applicable results which are in agreement with the Lugano recommendations based on trial data, highlighting the lack of utility of routine CTs in DLBCL patients achieving CMR.
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Affiliation(s)
| | | | | | - Concepción Fernández-Rodriguez
- Group of Applied Clinical Research in Hematology, Cancer Research Program-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Department of Pathology, Hospital del Mar-IMIM, Barcelona, Spain
| | | | - Solange Flores
- Department of Hematology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Ivonne Vazquez
- Department of Pathology, Hospital del Mar-IMIM, Barcelona, Spain
| | | | - David Roman
- Department of Hematology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Eva Gimeno
- Department of Hematology, Hospital del Mar-IMIM, Barcelona, Spain.,Group of Applied Clinical Research in Hematology, Cancer Research Program-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Luis Colomo
- Department of Pathology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Jose Maiques
- Department of Radiology, Hospital del Mar-IMIM, Barcelona, Spain
| | - Blanca Sánchez-González
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Hematology, Hospital del Mar-IMIM, Barcelona, Spain.,Group of Applied Clinical Research in Hematology, Cancer Research Program-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Antonio Salar
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Hematology, Hospital del Mar-IMIM, Barcelona, Spain.,Group of Applied Clinical Research in Hematology, Cancer Research Program-IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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