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Flerlage JE, Waters-Banker C, Fanale M, Beckerman R, Castellino SM, Liu N. A systematic literature review of clinical evidence and treatment burden in newly diagnosed high-risk pediatric patients with classical Hodgkin lymphoma. Pediatr Blood Cancer 2024; 71:e31027. [PMID: 38761013 DOI: 10.1002/pbc.31027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/19/2024] [Accepted: 04/07/2024] [Indexed: 05/20/2024]
Abstract
This systematic literature review evaluated frontline treatment burden in pediatric and adolescent/young adult (AYA) patients with high-risk classical Hodgkin lymphoma (cHL) among studies originating from the United States. Data were extracted from 32 publications (screened: total, n = 3115; full-text, n = 98) representing 12 studies (randomized controlled trials [RCTs], n = 2; non-comparative, non-randomized, n = 7; observational, n = 3). High-risk disease definitions varied across studies. Five-year event-free survival (EFS)/progression-free survival (PFS) was 86%-100% and 79%-94%, and complete response rates were 35%-100% and 5%-64% for brentuximab vedotin (BV)-containing and chemotherapy-alone regimens, respectively. In identified RCTs, BV-containing compared with chemotherapy-alone regimens demonstrated significantly longer 3-year EFS/5-year PFS. Hematological and peripheral neuropathy were the most commonly reported adverse events of interest, although safety data were inconsistently reported. Few studies evaluated humanistic and no studies evaluated economic burden. Results from studies with the highest quality of evidence indicate an EFS/PFS benefit for frontline BV-containing versus chemotherapy-alone regimens for pediatric/AYA patients with high-risk cHL.
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Affiliation(s)
- Jamie E Flerlage
- Department of Pediatrics, Hematology and Oncology, University of Rochester Medical Center, Rochester, New York, USA
| | | | | | | | - Sharon M Castellino
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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2
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Davies GA, Orav JE, Brantley KD. Survival Outcomes for US and Canadian Patients Diagnosed with Hodgkin Lymphoma before and after Brentuximab Vedotin Approval for Relapsed/Refractory Disease: A Retrospective Cohort Study. Curr Oncol 2024; 31:3885-3894. [PMID: 39057159 PMCID: PMC11276208 DOI: 10.3390/curroncol31070287] [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: 05/29/2024] [Revised: 06/13/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
Cost-effectiveness analyses are required for therapies within Canada's universal healthcare system, leading to delays relative to U.S. healthcare. Patients with Hodgkin lymphoma (HL) generally have an excellent prognosis, but those who relapse after or are ineligible for transplant benefit from novel therapies, including brentuximab vedotin (BV). BV was FDA-approved in 2011 but not Canadian-funded until 2014. To assess the impact of access delays, we compared changes in survival for U.S. (by insurer) and Canadian patients in periods pre/post-U.S. approval. Patients were 16-64 years, diagnosed with HL in 2007-2010 (Period 1) and 2011-2014 (Period 2) from the U.S. SEER and Canadian Cancer Registries. Approval date (surrogate) was utilized as therapy was unavailable in registries. Kaplan-Meier survival curves and adjusted Cox regression models compared survival between periods by insurance category. Among 12,003 U.S. and 4210 Canadian patients, survival was better in U.S. patients (adjusted hazard ratio (aHR) 0.87 (95%CI 0.77-0.98)) between periods; improvement in Canadian patients (aHR 0.84 (95%CI 0.69-1.03) was similar but non-significant. Comparisons between insurers showed survival was significantly worse for U.S. uninsured and Medicaid vs. U.S. privately insured and Canadian patients. Given the increasingly complex nature of oncologic funding, this merits further investigation to ensure equity in access to therapy developments.
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Affiliation(s)
- Gwynivere A. Davies
- Hamilton Health Sciences, Juravinski Cancer Centre, Hamilton, ON L8V 5C2, Canada
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - John E. Orav
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Kristen D. Brantley
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
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3
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Kishida M, Fujisawa M, Steidl C. Molecular biomarkers in classic Hodgkin lymphoma. Semin Hematol 2024:S0037-1963(24)00069-6. [PMID: 38969539 DOI: 10.1053/j.seminhematol.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/27/2024] [Indexed: 07/07/2024]
Abstract
Classic Hodgkin lymphoma is a unique B-cell derived malignancy featuring rare malignant Hodgkin and Reed Sternberg (HRS) cells that are embedded in a quantitively dominant tumor microenvironment (TME). Treatment of classic Hodgkin lymphoma has significantly evolved in the past decade with improving treatment outcomes for newly diagnosed patients and the minority of patients suffering from disease progression. However, the burden of toxicity and treatment-related long-term sequelae remains high in a typically young patient population. This highlights the need for better molecular biomarkers aiding in risk-adapted treatment strategies and predicting response to an increasing number of available treatments that now prominently involve multiple immunotherapy options. Here, we review modern molecular biomarker approaches that reflect both the biology of the malignant HRS cells and cellular components in the TME, while holding the promise to improve diagnostic frameworks for clinical decision-making and be feasible in clinical trials and routine practice. In particular, technical advances in sequencing and analytic pipelines using liquid biopsies, as well as deep phenotypic characterization of tissue architecture at single-cell resolution, have emerged as the new frontier of biomarker development awaiting further validation and implementation in routine diagnostic procedures.
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Affiliation(s)
- Makoto Kishida
- Centre for Lymphoid Cancer department, BC Cancer, Vancouver, British Columbia, Canada
| | - Manabu Fujisawa
- Centre for Lymphoid Cancer department, BC Cancer, Vancouver, British Columbia, Canada; Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Christian Steidl
- Centre for Lymphoid Cancer department, BC Cancer, Vancouver, British Columbia, Canada; Institute of Medicine, University of Tsukuba, Ibaraki, Japan; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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4
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Crosswell HE, LaCasce AS, Bartlett NL, Straus DJ, Savage KJ, Zinzani PL, Collins GP, Fanale M, Fenton K, Dong C, Miao H, Grigg AP. Brentuximab vedotin with chemotherapy in adolescents and young adults with stage III or IV classical Hodgkin lymphoma in ECHELON-1. Haematologica 2024; 109:982-987. [PMID: 37794803 PMCID: PMC10905068 DOI: 10.3324/haematol.2023.283303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Howland E Crosswell
- Bon Secours Hematology and Oncology, Bon Secours, St. Francis Health System, Greenville, SC.
| | - Ann S LaCasce
- Dana-Farber Cancer Institute, Partners Cancer Care, Boston, MA
| | - Nancy L Bartlett
- Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - David J Straus
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Pier Luigi Zinzani
- IRCCS University Hospital of Bologna, Institute of Hematology "Seràgnoli," Bologna, Italy; Department of Specialized Medicine, Diagnostic and Experimental, University of Bologna, Bologna
| | | | | | | | - Cassie Dong
- Takeda Development Center Americas, Inc. (TDCA), Lexington, MA
| | - Harry Miao
- Takeda Development Center Americas, Inc. (TDCA), Lexington, MA
| | - Andrew P Grigg
- Department of Clinical Haematology, Austin Hospital, VIC
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5
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Cao Z, Wang X, Xue X, Feng X. Clinical significance and predictive risk factors for event-free survival at 24 months in patients with PTCL, NOS. Ann Hematol 2024; 103:869-883. [PMID: 38040859 DOI: 10.1007/s00277-023-05559-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023]
Abstract
Peripheral T cell lymphoma, not otherwise specified (PTCL, NOS), is a heterogeneous and aggressive type of non-Hodgkin's lymphoma with a bleak prognosis. This study was designed to assess the value of EFS24 as an alternative clinical endpoint and identify prognosis-related factors in PTCL, NOS. Patients diagnosed with PTCL, NOS were retrospectively collected and slides were reviewed by two hematopathologists. EFS was defined as the time from diagnosis to the occurrence of disease progression after initial treatment, retreatment, or death. Subsequent overall survival (OS) was defined from EFS24 or time of progression, if it occurred within 24 months, to the last follow-up or death. 97 cases with complete follow-up were selected. Approximately 66 patients (68.04%) failed to achieve ES24, with the median OS of 12.17 months, and 5-year OS rate of 15.17%. While patients who reached EFS24 had a median OS of 60.57 months and a 5-year OS rate of 68.77%. Multivariate Cox analysis indicated that bone marrow involvement and elevated β2 Microglobulin (β2-MG) were associated with a poor prognosis. B symptoms, extranodal involvement more than one site, and a high Ki67 index were significant factors in predicting the failure of EFS24. EFS24 can help stratify the subsequent outcomes of PTCL, NOS. Patients who achieve EFS24 have a favorable prognosis, although it does not reach that of the general population. On the other hand, patients who do not achieve EFS24 have an extremely poor prognosis. Therefore, EFS24 can be used for patient risk stratification, patient counseling, and study design.
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Affiliation(s)
- Zheng Cao
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaojun Wang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuemin Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoli Feng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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van Bladel DAG, Stevens WBC, Kroeze LI, de Groen RAL, de Groot FA, van der Last-Kempkes JLM, Berendsen MR, Rijntjes J, Luijks JACW, Bonzheim I, van der Spek E, Plattel WJ, Pruijt JFM, de Jonge-Peeters SDPWM, Velders GA, Lensen C, van Bladel ER, Federmann B, Hoevenaars BM, Pastorczak A, van der Werff ten Bosch J, Vermaat JSP, Nooijen PTGA, Hebeda KM, Fend F, Diepstra A, van Krieken JHJM, Groenen PJTA, van den Brand M, Scheijen B. A significant proportion of classic Hodgkin lymphoma recurrences represents clonally unrelated second primary lymphoma. Blood Adv 2023; 7:5911-5924. [PMID: 37552109 PMCID: PMC10558751 DOI: 10.1182/bloodadvances.2023010412] [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: 04/07/2023] [Revised: 06/26/2023] [Accepted: 07/19/2023] [Indexed: 08/09/2023] Open
Abstract
Despite high cure rates in classic Hodgkin lymphoma (cHL), relapses are observed. Whether relapsed cHL represents second primary lymphoma or an underlying T-cell lymphoma (TCL) mimicking cHL is underinvestigated. To analyze the nature of cHL recurrences, in-depth clonality testing of immunoglobulin (Ig) and T-cell receptor (TCR) rearrangements was performed in paired cHL diagnoses and recurrences among 60 patients, supported by targeted mutation analysis of lymphoma-associated genes. Clonal Ig rearrangements were detected by next-generation sequencing (NGS) in 69 of 120 (58%) diagnoses and recurrence samples. The clonal relationship could be established in 34 cases, identifying clonally related relapsed cHL in 24 of 34 patients (71%). Clonally unrelated cHL was observed in 10 of 34 patients (29%) as determined by IG-NGS clonality assessment and confirmed by the identification of predominantly mutually exclusive gene mutations in the paired cHL samples. In recurrences of >2 years, ∼60% of patients with cHL for whom the clonal relationship could be established showed a second primary cHL. Clonal TCR gene rearrangements were identified in 14 of 125 samples (11%), and TCL-associated gene mutations were detected in 7 of 14 samples. Retrospective pathology review with integration of the molecular findings were consistent with an underlying TCL in 5 patients aged >50 years. This study shows that cHL recurrences, especially after 2 years, sometimes represent a new primary cHL or TCL mimicking cHL, as uncovered by NGS-based Ig/TCR clonality testing and gene mutation analysis. Given the significant therapeutic consequences, molecular testing of a presumed relapse in cHL is crucial for subsequent appropriate treatment strategies adapted to the specific lymphoma presentation.
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Affiliation(s)
| | - Wendy B. C. Stevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leonie I. Kroeze
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ruben A. L. de Groen
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fleur A. de Groot
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Jos Rijntjes
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Irina Bonzheim
- Institute of Pathology and Neuropathology, Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | | | - Wouter J. Plattel
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Gerjo A. Velders
- Department of Internal Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Chantal Lensen
- Department of Hematology, Bernhoven Hospital, Uden, The Netherlands
| | - Esther R. van Bladel
- Department of Internal Medicine, Slingeland Hospital, Doetinchem, The Netherlands
| | - Birgit Federmann
- Institute of Pathology and Neuropathology, Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
- Department of Translational Immunology, German Cancer Research Center, Medical Hospital Tübingen, Tübingen, Germany
| | | | - Agata Pastorczak
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Jutte van der Werff ten Bosch
- Department of Pediatric Hematology and Oncology, University Hospital Brussels, Brussels, Belgium
- Department of Pediatrics, Paola Children’s Hospital, Antwerp, Belgium
| | - Joost S. P. Vermaat
- Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Konnie M. Hebeda
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Falko Fend
- Institute of Pathology and Neuropathology, Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Arjan Diepstra
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | - Blanca Scheijen
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
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7
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Rodday AM, Parsons SK, Upshaw JN, Friedberg JW, Gallamini A, Hawkes E, Hodgson D, Johnson P, Link BK, Mou E, Savage KJ, Zinzani PL, Maurer M, Evens AM. The Advanced-Stage Hodgkin Lymphoma International Prognostic Index: Development and Validation of a Clinical Prediction Model From the HoLISTIC Consortium. J Clin Oncol 2023; 41:2076-2086. [PMID: 36495588 PMCID: PMC10082254 DOI: 10.1200/jco.22.02473] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The International Prognostic Score (IPS) has been used in classic Hodgkin lymphoma (cHL) for 25 years. However, analyses have documented suboptimal performance of the IPS among contemporarily treated patients. Harnessing multisource individual patient data from the Hodgkin Lymphoma International Study for Individual Care consortium, we developed and validated a modern clinical prediction model. METHODS Model development via Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis guidelines was performed on 4,022 patients with newly diagnosed advanced-stage adult cHL from eight international phase III clinical trials, conducted from 1996 to 2014. External validation was performed on 1,431 contemporaneously treated patients from four real-world cHL registries. To consider association over a full range of continuous variables, we evaluated piecewise linear splines for potential nonlinear relationships. Five-year progression-free survival (PFS) and overall survival (OS) were estimated using Cox proportional hazard models. RESULTS The median age in the development cohort was 33 (18-65) years; nodular sclerosis was the most common histology. Kaplan-Meier estimators were 0.77 for 5-year PFS and 0.92 for 5-year OS. Significant predictor variables included age, sex, stage, bulk, absolute lymphocyte count, hemoglobin, and albumin, with slight variation for PFS versus OS. Moreover, age and absolute lymphocyte count yielded nonlinear relationships with outcomes. Optimism-corrected c-statistics in the development model for 5-year PFS and OS were 0.590 and 0.720, respectively. There was good discrimination and calibration in external validation and consistent performance in internal-external validation. Compared with the IPS, there was superior discrimination for OS and enhanced calibration for PFS and OS. CONCLUSION We rigorously developed and externally validated a clinical prediction model in > 5,000 patients with advanced-stage cHL. Furthermore, we identified several novel nonlinear relationships and improved the prediction of patient outcomes. An online calculator was created for individualized point-of-care use.
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Affiliation(s)
- Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Susan K. Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Jenica N. Upshaw
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- The CardioVascular Center and Advanced Heart Failure Program, Tufts Medical Center, Boston, MA
| | - Jonathan W. Friedberg
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | - Andrea Gallamini
- Research and Clinical Innovation Department, Antoine Lacassagne Cancer Center, Nice, France
| | - Eliza Hawkes
- Australasian Lymphoma and Related Diseases Registry, Monash University, Melbourne, Australia
| | - David Hodgson
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Peter Johnson
- Faculty of Medicine, School of Cancer Sciences, University of Southampton, United Kingdom
| | - Brian K. Link
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Eric Mou
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Kerry J. Savage
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seragnoli” Dipartimento di Medicina Specialistica, Diagnostica Sperimentale Università di Bologna, Bologna, Italy
| | - Matthew Maurer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Andrew M. Evens
- Division of Blood Disorders, Rutgers Cancer Institute New Jersey, New Brunswick, NJ
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Winter A, Liu N, Surinach A, Fanale M, Yu KS, Narkhede M. Real-World Patient Characteristics, Treatment Patterns, and Outcomes for Patients With Stage III or IV Classic Hodgkin Lymphoma Treated With Frontline ABVD: A Retrospective Database Review in the United States. CLINICAL LYMPHOMA MYELOMA AND LEUKEMIA 2023:S2152-2650(23)00112-X. [PMID: 37121857 DOI: 10.1016/j.clml.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/16/2023] [Accepted: 03/25/2023] [Indexed: 03/31/2023]
Abstract
In newly diagnosed stage III/IV classic Hodgkin lymphoma (cHL), A+AVD (brentuximab vedotin, doxorubicin, vinblastine, dacarbazine) improved overall survival (OS) versus ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine). As clinical trial and real-world populations may differ, real-world treatment characteristics and OS (rwOS) were assessed for patients with stage III/IV cHL treated with frontline ABVD. This retrospective, observational analysis of deidentified electronic health record data (1/1/2011-8/31/2020) evaluated baseline disease and clinical characteristics, treatment patterns, and rwOS in patients with stage III/IV cHL treated with frontline ABVD. Data for 167 patients were analyzed. A median of 6 ABVD cycles were received. Baseline/interim positron emission tomography (PET) scans were obtained for 60.5%/89.8% of patients. Of patients diagnosed in 2016 or later (n = 73), 89% received an interim PET scan; 15/46 patients with no documented Deauville score, 6/15 with a score of 1 to 3, and 3/4 with a score of 4 to 5 de-escalated to AVD. Following frontline ABVD, 55.1% of patients received subsequent systemic therapy and 31.7% stem cell transplantation (SCT). At a median follow-up of 31.8 months, 82.0% of patients were alive (median rwOS, 101.2 months). Patients with stage III/IV cHL treated with frontline ABVD in the real world versus in clinical trials receive more subsequent therapy, including SCTs. Interim PET scans and Deauville scores were not universally obtained after treatment cycle 2, yet treatment de-escalation was observed. Patients with stage III/IV cHL may benefit from frontline A+AVD versus ABVD, as it improves OS and reduces the burden of subsequent therapy, including SCTs.
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Post-Treatment Neutrophil and Lymphocyte Counts Predict Progression-Free Survival Following First-Line Chemotherapy in Hodgkin's Lymphoma. Hematol Rep 2023; 15:108-118. [PMID: 36810555 PMCID: PMC9944084 DOI: 10.3390/hematolrep15010012] [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: 11/19/2022] [Revised: 01/24/2023] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
Hodgkin's lymphoma carries an excellent prognosis with modern chemotherapy, but a significant proportion of patients remain refractory to or relapse after first-line treatment. Immunological changes post-treatment, such as chemotherapy-induced neutropenia (CIN) or lymphopenia, have shown prognostic significance in multiple tumor types. Our study aims to investigate the prognostic value of immunologic changes in Hodgkin's lymphoma by examining the post-treatment lymphocyte count (pALC), neutrophil count (pANC) and the neutrophil-lymphocyte ratio (pNLR). Patients treated for classical Hodgkin's lymphoma at the National Cancer Centre Singapore using ABVD-based regimens were retrospectively analyzed. An optimal cut-off value for high pANC, low pALC and high pNLR in predicting progression-free survival was determined by receiver operating curve analysis. Survival analysis was performed using the Kaplan-Meier method and multivariable Cox proportional models. Overall OS and PFS were excellent, with a 5-year OS of 99.2% and a 5-year PFS of 88.2%. Poorer PFS was associated with high pANC (HR 2.99, p = 0.0392), low pALC (HR 3.95, p = 0.0038) and high pNLR (p = 0.0078). In conclusion, high pANC, low pALC and high pNLR confer a poorer prognosis for Hodgkin's lymphoma. Future studies should evaluate the potential of improving treatment outcomes by the adjustment of chemotherapy dose intensity based on post-treatment blood counts.
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10
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Fromm JR, Tang C, Naresh KN. Predictors of risk of relapse in classic Hodgkin lymphoma. J Clin Pathol 2022; 76:414-417. [PMID: 36241372 DOI: 10.1136/jcp-2022-208552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/28/2022] [Indexed: 11/04/2022]
Abstract
Using multiparametric flow cytometric analysis, in a cohort of 62 patients with classic Hodgkin lymphoma having a median follow-up period of 69.5 months, we found-patients who experienced primary resistance or disease relapse (DR) had lower percentage of rosetted Hodgkin Reed-Sternberg cells (HRS-cells) as compared with patients who achieved sustained complete remission (SCR) (p=0.022); patients >35 years of age had higher percentage of HRS-cells (p=0.017) and lower percentage of B cells (p=0.017) and the nodular sclerosis subtype had higher percentage of B-cells (p=0.046) and activated B-cells (p=0.03). The proportion of SCR and DR subsets did not differ by histological subtypes, disease stage or age groups.
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Affiliation(s)
- Jonathan R Fromm
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Claire Tang
- University of Washington, Seattle, Washington, USA
| | - Kikkeri N Naresh
- Pathology / Cancer Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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11
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Li N, Jiang M, Wu WC, Zou LQ. Nomograms to predict progression of disease within 24 months in patients with localized natural killer/T-cell lymphoma. Future Oncol 2022; 18:3573-3583. [PMID: 36507722 DOI: 10.2217/fon-2022-0307] [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: 12/14/2022] Open
Abstract
Aims: Progression of disease within 24 months (POD24) is associated with poor survival in some subtypes of lymphoma.The aim is to identify high-risk patients with localized extranodal natural killer/T-cell lymphoma (ENKTL) and to define clinical factors associated with the risk of early recurrence after antitumor treatment. Methods: The authors retrospectively analyzed 330 cases with localized ENKTL, of which 89 experienced POD24. Results: The 5-year overall survival of the POD24 group was extremely inferior to that of the non-POD24 group. Risk factors for POD24 were Eastern Cooperative Oncology Group performance status ≥2, response evaluation (non-complete remission) after first-line treatment and elevated lactate dehydrogenase concentrations. Also, higher Epstein-Barr virus DNA titer was related to POD24. Based on these data with or without the availability of Epstein-Barr virus DNA, the authors conducted two nomograms to predict POD24, which showed good accuracy with high C statistics. Conclusion: The results showed that POD24 could serve as a marker to identify patients whose medical needs were unmet in ENKTL.
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Affiliation(s)
- Na Li
- Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China.,Department of Oncology, West China Fourth Hospital, West China School of Public Health, Sichuan University, Chengdu, 610041, China
| | - Ming Jiang
- Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Wan-Chun Wu
- Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
| | - Li-Qun Zou
- Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China
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12
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Frood R, Clark M, Burton C, Tsoumpas C, Frangi AF, Gleeson F, Patel C, Scarsbrook A. Utility of pre-treatment FDG PET/CT-derived machine learning models for outcome prediction in classical Hodgkin lymphoma. Eur Radiol 2022; 32:7237-7247. [PMID: 36006428 PMCID: PMC9403224 DOI: 10.1007/s00330-022-09039-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/13/2022] [Accepted: 07/16/2022] [Indexed: 12/22/2022]
Abstract
Objectives Relapse occurs in ~20% of patients with classical Hodgkin lymphoma (cHL) despite treatment adaption based on 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography response. The objective was to evaluate pre-treatment FDG PET/CT–derived machine learning (ML) models for predicting outcome in patients with cHL. Methods All cHL patients undergoing pre-treatment PET/CT at our institution between 2008 and 2018 were retrospectively identified. A 1.5 × mean liver standardised uptake value (SUV) and a fixed 4.0 SUV threshold were used to segment PET/CT data. Feature extraction was performed using PyRadiomics with ComBat harmonisation. Training (80%) and test (20%) cohorts stratified around 2-year event-free survival (EFS), age, sex, ethnicity and disease stage were defined. Seven ML models were trained and hyperparameters tuned using stratified 5-fold cross-validation. Area under the curve (AUC) from receiver operator characteristic analysis was used to assess performance. Results A total of 289 patients (153 males), median age 36 (range 16–88 years), were included. There was no significant difference between training (n = 231) and test cohorts (n = 58) (p value > 0.05). A ridge regression model using a 1.5 × mean liver SUV segmentation had the highest performance, with mean training, validation and test AUCs of 0.82 ± 0.002, 0.79 ± 0.01 and 0.81 ± 0.12. However, there was no significant difference between a logistic model derived from metabolic tumour volume and clinical features or the highest performing radiomic model. Conclusions Outcome prediction using pre-treatment FDG PET/CT–derived ML models is feasible in cHL patients. Further work is needed to determine optimum predictive thresholds for clinical use. Key points • A fixed threshold segmentation method led to more robust radiomic features. • A radiomic-based model for predicting 2-year event-free survival in classical Hodgkin lymphoma patients is feasible. • A predictive model based on ridge regression was the best performing model on our dataset. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-09039-0.
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Affiliation(s)
- Russell Frood
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK. .,Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK. .,Leeds Institute of Health Research, University of Leeds, Leeds, UK.
| | - Matt Clark
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Cathy Burton
- Department of Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Charalampos Tsoumpas
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center of Groningen, University of Groningen, Groningen, Netherlands.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Alejandro F Frangi
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), School of Computing and School of Medicine, University of Leeds, Leeds, UK.,Medical Imaging Research Center (MIRC), University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Fergus Gleeson
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Chirag Patel
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew Scarsbrook
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Leeds Institute of Health Research, University of Leeds, Leeds, UK
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13
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Vassilakopoulos TP, Kravvariti E, Panitsas F, Angelopoulou MK, Liaskas A, Kontopidou FN, Yiakoumis X, Variami E, Dimopoulou MN, Siakantaris MP, Asimakopoulos JV, Arapaki M, Dimou M, Diamantopoulos P, Sachanas S, Chatzidimitriou C, Belia M, Konstantinou E, Boutsikas G, Petevi K, Kanellopoulos A, Kokoris S, Kyrtsonis MC, Viniou NA, Lakiotaki E, Tsourouflis G, Korkolopoulou P, Konstantopoulos K, Panayiotidis P, Pangalis GA. Very late relapses in Hodgkin lymphoma treated with chemotherapy with or without radiotherapy: linear pattern and distinct prognostic factors. Blood Cancer J 2022; 12:102. [PMID: 35790712 PMCID: PMC9256621 DOI: 10.1038/s41408-022-00674-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/11/2022] [Accepted: 04/25/2022] [Indexed: 11/09/2022] Open
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14
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Assouline S, Wiesinger A, Spooner C, Jovanović J, Schlueter M. Validity of event-free survival as a surrogate endpoint in haematological malignancy: Review of the literature and health technology assessments. Crit Rev Oncol Hematol 2022; 175:103711. [DOI: 10.1016/j.critrevonc.2022.103711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/29/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022] Open
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15
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El-Galaly TC, Glimelius I. Late relapses in Hodgkin lymphoma - should we search for the needle in the haystack? Br J Haematol 2022; 198:11-13. [PMID: 35438825 PMCID: PMC9324958 DOI: 10.1111/bjh.18199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
Abstract
Hodgkin lymphoma is among the most curable cancers. For patients in remission for 24 months, residual lifetime becomes close to that of the background population. However, late relapses can occur after several years and, as shown by Andersen et al., the outcomes are not always good. Commentary on: Andersen MD, Hamilton-Dutoit S, Modvig L, Vase M, Christiansen I, Christensen JH, et al. Late recurrence of lymphoid malignancies after initial treatment for Hodgkin lymphoma - A study from the Danish Lymphoma Registry. Br J Haematol 2022 (online ahead of print). DOI: 10.1111/bjh.18180.
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Affiliation(s)
- Tarec Christoffer El-Galaly
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Section of Oncology, Uppsala University, Uppsala, Sweden
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16
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Casasnovas RO, Bouabdallah R, Brice P, Lazarovici J, Ghesquieres H, Stamatoullas A, Dupuis J, Gac AC, Gastinne T, Joly B, Bouabdallah K, Nicolas-Virelizier E, Feugier P, Morschhauser F, Sibon D, Bonnet C, Berriolo-Riedinger A, Edeline V, Parrens M, Damotte D, Coso D, André M, Meignan M, Rossi C. Positron Emission Tomography-Driven Strategy in Advanced Hodgkin Lymphoma: Prolonged Follow-Up of the AHL2011 Phase III Lymphoma Study Association Study. J Clin Oncol 2022; 40:1091-1101. [PMID: 34990281 DOI: 10.1200/jco.21.01777] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The AHL2011 study (ClinicalTrials.gov identifier: NCT01358747) demonstrated that a positron emission tomography (PET)-driven de-escalation strategy after two cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) provides similar progression-free survival (PFS) and overall survival (OS) and reduces early toxicity compared with a nonmonitored standard treatment. Here, we report, with a prolonged follow-up, the final study results. METHODS Patients with advanced Hodgkin lymphoma (stage III, IV, or IIB with mediastinum/thorax ratio > 0.33 or extranodal involvement) age 16-60 years were prospectively randomly assigned between 6 × BEACOPP and a PET-driven arm after 2 × BEACOPP delivering 4 × ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in PET2- and 4 × BEACOPP in PET2+ patients. PET performed after four cycles of chemotherapy had to be negative to complete the planned treatment. RESULTS In total, 823 patients were enrolled including 413 in the standard arm and 410 in the PET-driven arm. With a 67.2-month median follow-up, 5-year PFS (87.5% v 86.7%; hazard ratio [HR] = 1.07; 95% CI, 0.74 to 1.57; P = .67) and OS (97.7% in both arms; HR = 1.012; 95% CI, 0.50 to 2.10; P = .53) were similar in both randomization arms. In the whole cohort, full interim PET assessment predicted patients' 5-year PFS (92.3% in PET2-/PET4-, 75.4% [HR = 3.26; 95% CI, 18.3 to 5.77] in PET2+/PET4- and 46.5% [HR = 12.4; 95% CI, 7.31 to 19.51] in PET4+ patients, respectively; P < .0001) independent of international prognosis score. Five-year OS was also affected by interim PET results, and PET2+/PET4- patients (93.5%; HR = 3.3; 95% CI, 1.07 to 10.1; P = .036) and PET4+ patients (91.9%; HR = 3.756; 95% CI, 1.07 to 13.18; P = .038) had a significant lower OS than PET2-/PET4- patients (98.2%). Twenty-two patients (2.7%) developed a second primary malignancy, 13 (3.2%) and 9 (2.2%) in the standard and experimental arms, respectively. CONCLUSION The extended follow-up confirms the continued efficacy and favorable safety of AHL2011 PET-driven strategy, which is noninferior to standard six cycles of BEACOPP. PET4 provides additional prognostic information to PET2 and allows identifying patients with particularly poor prognosis.
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Affiliation(s)
- René-Olivier Casasnovas
- Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, Dijon, France
| | - Reda Bouabdallah
- Department of Hematology, Institut P. Calmette, Marseille, France.,Department of Hematology, Hopital privé de Provence, Aix en Provence, France
| | - Pauline Brice
- Department of Hematology, APHP, Hopital Saint Louis, Paris, France
| | | | - Hervé Ghesquieres
- Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, et Université Claude Bernard Lyon-1, Pierre Bénite, France
| | | | - Jehan Dupuis
- Lymphoid Malignancies Unit, Henri Mondor University Hospital, Créteil, France
| | - Anne-Claire Gac
- Department of Hematology, Institut d'hématologie de basse normandie, Caen, France
| | - Thomas Gastinne
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - Bertrand Joly
- Department of Hematology, Hospital Sud Francilien, Corbeille-Essonnes, France
| | - Krimo Bouabdallah
- Department of Hematology, University Hospital of Bordeaux, Bordeaux, France
| | | | - Pierre Feugier
- Department of Hematology, University Hospital of Nancy, Vandoeuvre les Nancy, France
| | - Franck Morschhauser
- Department of Hematology, CHU Lille, Unité GRITA, Université de Lille 2, Lille, France
| | - David Sibon
- Department of Hematology, Hopital Necker, Paris, France
| | | | | | - Véronique Edeline
- Department of Nuclear Medicine, Hopital R. Huguenin, Institut Curie, St-Cloud, France
| | - Marie Parrens
- Department of Pathology, University Hospital of Bordeaux and Inserm UMR 1053, Bordeaux, France
| | - Diane Damotte
- Department of Pathology, Université de Paris et GH Paris Centre APHP, Paris, France
| | - Diane Coso
- Department of Hematology, Institut P. Calmette, Marseille, France
| | - Marc André
- Department of Hematology, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium.,Pole Mont, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Michel Meignan
- Department of Nuclear Medicine, University Hospital H. Mondor, Creteil, France
| | - Cédric Rossi
- Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, Dijon, France
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17
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Eyre TA, Jensen P, Booth S, El-Galaly TC. Bone health and glucocorticoid-containing lymphoma therapy - a review of risk factors and preventative measures. Br J Haematol 2022; 198:431-442. [PMID: 35235226 DOI: 10.1111/bjh.18104] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 01/20/2023]
Abstract
With survival outcomes ever improving for patients with a wide range of lymphoma histologies, the focus on reducing long-term complications of therapy has increased. Recently published, complimentary population and retrospective series have highlighted the importance of considering bone health in patients treated for lymphoma. Fracture-related events or the requirement for secondary bone prophylaxis, likely linked to glucocorticoid-induced osteoporosis (GIO) are substantial and clinically meaningful in a significant minority of patients following routinely employed steroid-containing immunochemotherapy. In this review, we describe the pathophysiology of GIO, the risk of GIO in observational front-line lymphoma studies and efficacy of prophylactic measures from several prospective clinical trials are summarized. Finally, areas of importance for future research are discussed and recommendations for GIO risk assessment and management in lymphoma are provided based on the current available literature.
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Affiliation(s)
- Toby A Eyre
- Department of Haematology, Haematology and Cancer Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Paw Jensen
- Department of Haematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Stephen Booth
- Department of Haematology, Royal Berkshire Hospital NHS Foundation Trust, Reading, UK
| | - Tarec Christoffer El-Galaly
- Department of Haematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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18
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Beyond CD19 CAR-T cells in lymphoma. Curr Opin Immunol 2022; 74:46-52. [PMID: 34800921 PMCID: PMC8901457 DOI: 10.1016/j.coi.2021.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 02/03/2023]
Abstract
Adoptive transfer of CD19-specific chimeric antigen receptor T-cells (CAR-T cells) has transformed the treatment paradigm of relapsed/refractory (R/R) CD19 B-cell malignancies, dramatically improving remission rates and cures in patients with chemo-refractory disease. However, the applicability of CD19 CAR-T cells is limited to B cell malignancies and antigen loss can result in treatment failure, prompting the exploration of alternative targets to overcome tumor escape via CD19 antigen loss, as well as extend the CAR-T cell platform to treat Hodgkin and T cell lymphomas. This review highlights recent clinical trials testing CAR-T cell targets beyond CD19.
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19
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Kumar AJ, Chao CR, Rodday AM, Chang H, Xu L, Evens AM, Parsons SK. Treatment patterns for relapsed and refractory Hodgkin lymphoma in a community oncology setting. Leuk Lymphoma 2021; 63:1119-1126. [PMID: 34886751 DOI: 10.1080/10428194.2021.2012660] [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: 10/19/2022]
Abstract
There is little data about treatment practices for relapsed/refractory Hodgkin Lymphoma (HL) in nonacademic settings. We describe sequential treatments and outcomes among HL patients who experienced treatment failure in an integrated community-oncology setting. We performed a retrospective cohort study among patients ≥12 years diagnosed with Stage II-IV HL from 2007 to 2012 at Kaiser Permanente Southern California (KPSC). Of 463 HL patients, 75 (16.1%) experienced treatment failure. Patients with failure received between 1 and 8 salvage therapies; 28% received ≥4 lines of therapy. Fifty-nine of 75 (79%) were initially salvaged with ifosfamide-based therapy, 44 of whom underwent hematopoietic cell transplant. Ultimately, 47% of patients died, with most deaths due to HL. Survival was shorter with increasing age at diagnosis (p = 0.02) and with greater number of lines of therapy (p = 0.02). In a community oncology setting, HL patients received multiple lines of salvage. Despite extensive treatment, nearly half of patients died of HL following relapsed/refractory disease.
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Affiliation(s)
- Anita J Kumar
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, USA.,Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
| | - Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Angie Mae Rodday
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Hong Chang
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Lanfang Xu
- MedHealth Statistical Consulting Inc., Solon, OH, USA
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Susan K Parsons
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, USA.,Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA.,Department of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA, USA
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20
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Brice P, de Kerviler E, Friedberg JW. Classical Hodgkin lymphoma. Lancet 2021; 398:1518-1527. [PMID: 33493434 DOI: 10.1016/s0140-6736(20)32207-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 06/11/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022]
Abstract
Classical Hodgkin lymphoma is one of the more frequent lymphomas and is generally considered a highly curable disease with standard first-line chemotherapy and radiotherapy in some cases. Despite these outstanding results, major problems remain unresolved. First, there are still patients who will not be cured with front-line regimens and, second, many patients who are cured of classical Hodgkin lymphoma continue to die prematurely due to the late toxic effects of their therapy. Because the median age of patients with classical Hodgkin lymphoma is in the mid-30s, the disease's impact on the number of years lost from productive life is remarkable. In recent years, the gold standard of chemotherapy (often combined with radiotherapy) has changed, with the approval of immunotherapy mostly in relapse settings.
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Affiliation(s)
- Pauline Brice
- Department of Oncohaematology, Hôpital saint Louis APHP, Université Paris 7, Paris, France.
| | - Eric de Kerviler
- Department of Radiology, Hôpital saint Louis APHP, Université Paris 7, Paris, France
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21
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Potre O, Pescaru M, Sima A, Ionita I, Tudor R, Borsi E, Samfireag M, Potre C. Evaluation of the Relapse Risk and Survival Rate in Patients with Hodgkin Lymphoma: A Monocentric Experience. ACTA ACUST UNITED AC 2021; 57:medicina57101026. [PMID: 34684063 PMCID: PMC8540813 DOI: 10.3390/medicina57101026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022]
Abstract
Background and objectives: Hodgkin lymphoma (HL) is characterized by the presence of malignant Reed Sternberg cells. Although the current curability rate in patients with HL has increased, up to 30% of those in the advanced stages and 5% to 10% of those in limited stages of the disease, relapse. According to the studies, the relapse risk in HL decreases after 2 years. The purpose of this study is to evaluate the relapse risk and event free survival (EFS) in patients with HL treated with Doxorubicin, Bleomycin, Vinblastine and Dacarbazine (ABVD), or treated with Bleomycin, Etoposide, Doxorubicin, Cyclophosphamide, Vincristine, Procarbazine, and Prednisone (BEACOPP) regimens. Material and methods: In an observational, consecutive-case scenario, 71 patients (median age 32 years; range 16 to 80 years) diagnosed within a 4-year timeframe were enrolled; all patients were treated according to standards of care. The average follow-up duration was 26 months. Results: The risk of relapse, in patients older than 40 years, decreased after 1 year, OR = 0.707 (95% CI 0.506 to 0.988), and 2 years, OR = 0.771 (95% CI 0.459 to 1.295), respectively. Patients in the advanced stages had a higher International Prognostic Score (IPS) (score ≥ 4). The overall survival at 2 years was 57.74% and the disease-specific survival at 2 years was 71.83%. Regardless, the chemotherapy regimen and the EFS time, advanced stage, high IPS and bulky disease were still associated with an increased relapse risk in patients with HL. Conclusions: The use of ABVD chemotherapy regimen followed by 2 years EFS was associated with a reduced relapse risk.
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Affiliation(s)
- Ovidiu Potre
- Department of Internal Medicine, Hematology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.P.); (M.P.); (I.I.); (E.B.); (C.P.)
- Hematology Clinic, Timisoara’s Emergency City Hospital, 300723 Timisoara, Romania
| | - Monica Pescaru
- Department of Internal Medicine, Hematology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.P.); (M.P.); (I.I.); (E.B.); (C.P.)
- Hematology Clinic, Timisoara’s Emergency City Hospital, 300723 Timisoara, Romania
| | - Alexandra Sima
- Second Department of Internal Medicine, Diabetes, Nutrition, Metabolic Diseases and Systemic Rheumatology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- 3rd Medical Clinic, Pius Brinzeu Emergency Hospital, 300041 Timisoara, Romania
- Correspondence:
| | - Ioana Ionita
- Department of Internal Medicine, Hematology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.P.); (M.P.); (I.I.); (E.B.); (C.P.)
- Hematology Clinic, Timisoara’s Emergency City Hospital, 300723 Timisoara, Romania
| | - Raluca Tudor
- Department of Neurology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Ema Borsi
- Department of Internal Medicine, Hematology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.P.); (M.P.); (I.I.); (E.B.); (C.P.)
- Hematology Clinic, Timisoara’s Emergency City Hospital, 300723 Timisoara, Romania
| | - Miruna Samfireag
- Department of Internal Medicine, Clinical Practical Skills, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Cristina Potre
- Department of Internal Medicine, Hematology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (O.P.); (M.P.); (I.I.); (E.B.); (C.P.)
- Hematology Clinic, Timisoara’s Emergency City Hospital, 300723 Timisoara, Romania
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22
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Nuersulitan R, Yang M, Mi L, Wu M, Liu X, Ping L, Xie Y, Liu W, Song Y, Zhu J. Conditional Survival and Annual Hazard Estimates of Classical Hodgkin Lymphoma. Cancer Manag Res 2021; 13:6731-6741. [PMID: 34471386 PMCID: PMC8405168 DOI: 10.2147/cmar.s324543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background In the present study, we have tried to understand how the level of risk and survival probability changes over time for patients with classical Hodgkin’s lymphoma by employing conditional survival and annual hazard as dynamic estimates of prognosis and survival. Methods This retrospective study reviewed the clinical data of patients with newly diagnosed classical Hodgkin’s lymphoma admitted to Peking University Cancer Hospital between January 1, 2008, and December 31, 2017. Conditional survival and annual hazard rate were defined as the survival probability and yearly event rate, respectively, assuming that patients have survived for a defined time. Results A total of 384 patients were included (median age, 32 years; range, 6–77 years), of which 218 (56.8%) patients had early-stage disease. The median follow-up time was 41.3 months. The 5-year conditional overall survival (COS) rates remained favorable and showed an increase from 89% at treatment to 94% at year 5, while the 5-year conditional failure-free survival (CFFS) rate increased from 70% at treatment to 96% at year 5. The annual hazard of failure decreased from over 15% at diagnosis to less than 5% after 3 years. Early-stage patients had constantly lower annual estimates for hazard of death (range, 0–3.0%) and failure (range, 0–14.3%). However, the hazard of failure in advanced-stage patients decreased from 24.2% at diagnosis to below 8% after 3 years, whereas the hazard of death was always at relatively low levels. Patients with a high IPS risk score (≥3) had significantly lower COS and CFFS during the first 4 years. Patients who received the BEACOPP regimen had better 5-year COS and 5-year CFFS than those who received the ABVD regimen. Conclusion The survival probability increased and hazard of failure decreased over time.
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Affiliation(s)
- Reyizha Nuersulitan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Mingzi Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Lan Mi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Meng Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Xin Liu
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, 100021, People's Republic of China
| | - Lingyan Ping
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Yan Xie
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Weiping Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Yuqin Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Jun Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
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Kim YR, Kim SJ, Lee HS, Jeon S, Cho H, Chung H, Jang JE, Cheong JW, Min YH, Kim JS. Predictive Factors of Event-Free Survival at 24 Months in Patients with Peripheral T-cell Lymphoma: A Retrospective Study. Cancer Res Treat 2021; 54:613-620. [PMID: 34352996 PMCID: PMC9016304 DOI: 10.4143/crt.2021.270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/30/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose Event-free survival at 24 months (EFS24) is known to be a surrogate marker for overall survival (OS) for patients with peripheral T-cell lymphoma (PTCL). We examined the role of EFS24 in PTCL compared to diffuse large B-cell lymphoma (DLBCL), and then assessed the clinical predictive factors of achieving EFS24. Materials and Methods Patients with newly diagnosed PTCL treated with anthracycline-based chemotherapy were included. Subsequent OS was defined as the time elapsed from 24 months after diagnosis until death from any cause in those who achieved EFS24. Results Overall, 153 patients were evaluated, and 51 patients (33.3%) achieved EFS24. Patients who achieved EFS24 showed superior OS compared to patients who did not (p < 0.001). EFS24 could stratify the subsequent OS although it did not reach to that of the general population. After matching the PTCL group to the DLBCL group based on the international prognostic index, the subsequent OS in patients who achieved EFS24 was similar between the two groups (p=0.094). Advanced stage was a significant factor to predict the failing EFS24 by multivariable analysis (p < 0.001). Conclusion Patients with PTCL who achieve EFS24 could have a favorable subsequent OS. Since advanced disease stage is a predictor of EFS24 failure, future efforts should focus on developing novel therapeutic strategies for PTCL patients presenting with advanced disease.
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Affiliation(s)
- Yu Ri Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soo-Jeong Kim
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Soyoung Jeon
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunsoo Cho
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Haerim Chung
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Eun Jang
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - June-Won Cheong
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoo Hong Min
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Straus DJ, Długosz-Danecka M, Connors JM, Alekseev S, Illés Á, Picardi M, Lech-Maranda E, Feldman T, Smolewski P, Savage KJ, Bartlett NL, Walewski J, Ramchandren R, Zinzani PL, Hutchings M, Munoz J, Lee HJ, Kim WS, Advani R, Ansell SM, Younes A, Gallamini A, Liu R, Little M, Fenton K, Fanale M, Radford J. Brentuximab vedotin with chemotherapy for stage III or IV classical Hodgkin lymphoma (ECHELON-1): 5-year update of an international, open-label, randomised, phase 3 trial. LANCET HAEMATOLOGY 2021; 8:e410-e421. [PMID: 34048680 DOI: 10.1016/s2352-3026(21)00102-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite advances in the treatment of Hodgkin lymphoma with the introduction of PET-adapted regimens, practical challenges prevent more widespread use of these approaches. The ECHELON-1 study assessed the safety and efficacy of front-line A+AVD (brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine) versus ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in patients with stage III or IV classical Hodgkin lymphoma. The primary analysis showed improved modified progression-free survival with A+AVD. We present an updated analysis of ECHELON-1 at 5 years, an important landmark for this patient population. METHODS ECHELON-1 was an international, open-label, randomised, phase 3 trial done at 218 clinical sites, including hospitals, cancer centres, and community clinics, in 21 countries. Previously untreated patients (≥18 years with an Eastern Cooperative Oncology Group performance status of ≤2) with stage III or IV classical Hodgkin lymphoma were randomly assigned (1:1) to receive A+AVD (brentuximab vedotin, 1·2 mg/kg of bodyweight, doxorubicin 25 mg/m2 of body surface area, vinblastine 6 mg/m2, and dacarbazine 375 mg/m2) or ABVD (doxorubicin 25 mg/m2, bleomycin 10 U/m2, vinblastine 6 mg/m2, and dacarbazine 375 mg/m2) intravenously on days 1 and 15 of each 28-day cycle for up to six cycles. Stratification factors included region (Americas vs Europe vs Asia) and International Prognostic Score risk group (low, intermediate, or high risk). The primary endpoint was modified progression-free survival; this 5-year update includes analysis of progression-free survival as per investigator assessment in the intention-to-treat population, which was an exploratory endpoint, although the 5-year analysis was not prespecified in the protocol. This trial is registered with ClinicalTrials.gov (NCT01712490) and EudraCT (2011-005450-60), and is ongoing. FINDINGS Between Nov 19, 2012, and Jan 13, 2016, 1334 patients were randomly assigned to receive A+AVD (n=664) or ABVD (n=670). At a median follow-up of 60·9 months (IQR 52·2-67·3), 5-year progression-free survival was 82·2% (95% CI 79·0-85·0) with A+AVD and 75·3% (71·7-78·5) with ABVD (hazard ratio [HR] 0·68 [95% CI 0·53-0·87]; p=0·0017). Among PET-2-negative patients, 5-year progression-free survival was higher with A+AVD than with ABVD (84·9% [95% CI 81·7-87·6] vs 78·9% [75·2-82·1]; HR 0·66 [95% CI 0·50-0·88]; p=0·0035). 5-year progression-free survival for PET-2-positive patients was 60·6% (95% CI 45·0-73·1) with A+AVD versus 45·9% (32·7-58·2) with ABVD (HR 0·70 [95% CI 0·39-1·26]; p=0·23). Peripheral neuropathy continued to improve or resolve over time with both A+AVD (375 [85%] of 443 patients) and ABVD (245 [86%] of 286 patients); more patients had ongoing peripheral neuropathy in the A+AVD group (127 [19%] of 662) than in the ABVD group (59 [9%] of 659). Fewer secondary malignancies were reported with A+AVD (19 [3%] of 662) than with ABVD (29 [4%] of 659). More livebirths were reported in the A+AVD group (n=75) than in the ABVD group (n=50). INTERPRETATION With 5 years of follow-up, A+AVD showed robust and durable improvement in progression-free survival versus ABVD, regardless of PET-2 status, and a consistent safety profile. On the basis of these findings, A+AVD should be preferred over ABVD for patients with previously untreated stage III or IV classical Hodgkin lymphoma. FUNDING Millennium Pharmaceuticals (a wholly owned subsidiary of Takeda Pharmaceutical Company), and Seagen.
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Affiliation(s)
- David J Straus
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Monika Długosz-Danecka
- Department of Clinical Oncology, Maria Skłodowska-Curie National Research Institute of Oncology, Kraków, Poland
| | - Joseph M Connors
- Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Sergey Alekseev
- Petrov Research Institute of Oncology, St Petersburg, Russia
| | | | - Marco Picardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Ewa Lech-Maranda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Tatyana Feldman
- John Theurer Cancer Center, Hackensack Meridian Health School of Medicine, Hackensack, NJ, USA
| | | | - Kerry J Savage
- Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Nancy L Bartlett
- Washington University School of Medicine Siteman Cancer Center, St Louis, MO, USA
| | - Jan Walewski
- Maria Sklodowska-Curie National Research Institute of Oncology, European Reference Network, Warszawa, Poland
| | | | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia Seràgnoli, Bologna, Italy; Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università degli Studi, Bologna, Italy
| | - Martin Hutchings
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Javier Munoz
- Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Hun Ju Lee
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ranjana Advani
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
| | | | - Anas Younes
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; AstraZeneca Pharmaceuticals, LP Wilmington, DE, USA
| | - Andrea Gallamini
- Research Innovation and Statistics, Antoine-Lacassagne Cancer Centre, Nice, France
| | - Rachael Liu
- Millennium Pharmaceuticals, a wholly owned subsidiary of Takeda Pharmaceuticals, Cambridge, MA, USA
| | - Meredith Little
- Millennium Pharmaceuticals, a wholly owned subsidiary of Takeda Pharmaceuticals, Cambridge, MA, USA
| | | | | | - John Radford
- University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Impact of event-free survival status after stem cell transplantation on subsequent survival of patients with lymphoma. Blood Adv 2021; 5:1412-1424. [PMID: 33666656 DOI: 10.1182/bloodadvances.2020003735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/07/2021] [Indexed: 11/20/2022] Open
Abstract
We evaluated the impact of event-free survival (EFS) status at 24 months (EFS24) and 60 months (EFS60) after hematopoietic stem cell transplantation (HSCT) using registry data. Patients who underwent their first autologous HSCT (auto-HSCT) or allogeneic HSCT (allo-HSCT) for lymphoma between 1981 and 2018 were included. Overall survival was compared with that of the age-, sex, and calendar period-matched general population. A total of 14 977 patients, including 10 964 and 4013 who underwent auto-HSCT and allo-HSCT, respectively, were analyzed. Although patients who achieved EFS24 and EFS60 had favorable outcomes, most had significantly poorer survival rates than the general population. The standardized mortality ratios (SMRs) of patients with diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) were significantly higher than that of the general population even after achieving EFS24 or EFS60. The SMRs of those after auto-HSCT were 2.5 to 3.5 and 2.7 to 3.7, respectively. The SMR was consistently highest in Hodgkin lymphoma (HL) patients after HSCT. By contrast, subsequent survival of patients with primary mediastinal large B-cell lymphoma, intravascular large B-cell lymphoma, or peripheral T-cell lymphoma, not otherwise specified, who achieved EFS60 after auto-HSCT, and those with extranodal natural killer/T-cell lymphoma who achieved EFS60 after allo-HSCT did not significantly differ from that of the general population, with SMRs of 1.6, 1.2, 1.8, and 1.3, respectively. Our results suggest that EFS24 and EFS60 were clinically useful end points after HSCT for lymphoma patients. Furthermore, patients with certain lymphoma subtypes who achieved EFS had a comparable prognosis with that of the general population and were potentially cured after HSCT.
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ABVD followed by BV consolidation in risk-stratified patients with limited-stage Hodgkin lymphoma. Blood Adv 2021; 4:2548-2555. [PMID: 32516414 DOI: 10.1182/bloodadvances.2020001871] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/24/2020] [Indexed: 01/12/2023] Open
Abstract
Approximately 90% of limited-stage Hodgkin lymphoma (HL) patients are projected to be cured with standard therapy, but many do not live their expected life span because of late treatment-related complications. New treatment paradigms are needed to reduce the use of radiation therapy (RT) as well as conventional chemotherapy drugs while improving upon current standard-of-care survival outcomes. In this phase 2 multicenter study, patients with non-bulky limited-stage HL received doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by brentuximab vedotin (BV) consolidation. Forty-one patients were enrolled, and patient characteristics included median age of 29 years (range, 19 to 67 years), 58% were female, 45% had unfavorable disease, and 98% had stage II disease. Based on positron emission tomography (PET)-based risk stratification, patients received 2 to 6 cycles of ABVD followed by 6 cycles of BV. After ABVD followed by BV, 95% of evaluable patients (37 out of 39; 95% confidence interval [CI], 83%-99%) achieved PET-negative status. In the intent-to-treat patient population, the estimated 3-year progression-free survival (PFS) rate was 92%, and the overall survival (OS) rate was 97%, with a median follow-up of 47 months. All 37 patients who achieved negative PET status after BV consolidation effectively avoided RT and remain in remission with estimated 3-year PFS and OS rates of 100%. In conclusion, BV demonstrates encouraging clinical activity when it follows ABVD therapy in limited-stage HL. Early incorporation of BV may reduce the use of RT as well as conventional chemotherapy drugs while achieving favorable survival outcomes in risk-stratified patients with non-bulky limited-stage HL. This trial was registered at www.clinicaltrials.gov as #NCT01578967.
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Gao H, Ji X, Liu X, Mi L, Liu W, Wang X, Zhu J, Song Y. Conditional survival and hazards of death for peripheral T-cell lymphomas. Aging (Albany NY) 2021; 13:10225-10239. [PMID: 33819191 PMCID: PMC8064157 DOI: 10.18632/aging.202782] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/18/2021] [Indexed: 12/12/2022]
Abstract
Typically, peripheral T-cell lymphoma (PTCLs) prognosis is estimated using overall survival before treatment. However, these estimates cannot show how prognosis evolves with the changing hazard rate over time. Patients (n = 650) with newly diagnosed PTCLs were enrolled retrospectively. After a median follow-up of 5.4 years, angioimmunoblastic T-cell lymphoma, peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) and NK/T cell lymphoma had initially lower 3-year conditional overall survival (COS3; i.e., the 3-year conditional overall survival was defined as the probability of surviving an additional 3 years) and higher hazards of death (26–44.3%). However, after 2 years, the COS3 increased and the death risk decreased over time, whereas anaplastic lymphoma kinase-positive anaplastic large-cell lymphoma constantly had a lower risk over time (0–19.5%). For patients with complete remission after initial treatment, prognosis varied by histological subtypes, with PTCL, NOS having a negative impact. Our data suggested that the risk stratification using the International Prognostic Index might not accurately predict the COS3 for survivors of PTCLs. The COS3 provided time-dependent prognostic information for PTCLs, representing a possible surrogate prognosis indicator for long-term survivors after systemic chemotherapy.
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Affiliation(s)
- Hongye Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital and Institute, Haidian 100142, Beijing, China
| | - Xinqiang Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Medical Record Statistics, Peking University Cancer Hospital and Institute, Haidian 100142, Beijing, China
| | - Xin Liu
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Chaoyang 100021, Beijing, China
| | - Lan Mi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital and Institute, Haidian 100142, Beijing, China
| | - Weiping Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital and Institute, Haidian 100142, Beijing, China
| | - Xiaopei Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital and Institute, Haidian 100142, Beijing, China
| | - Jun Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital and Institute, Haidian 100142, Beijing, China
| | - Yuqin Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital and Institute, Haidian 100142, Beijing, China
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28
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Ghesquières H, Rossi C, Cherblanc F, Le Guyader-Peyrou S, Bijou F, Sujobert P, Fabbro-Peray P, Bernier A, Belot A, Chartier L, Fornecker LM, Baldi I, Bouabdallah K, Laurent C, Oberic L, Morineau N, Le Gouill S, Morschhauser F, Haioun C, Damaj G, Guidez S, Labouré G, Fitoussi O, Lebras L, Gressin R, Salles G, Ysebaert L, Monnereau A. A French multicentric prospective prognostic cohort with epidemiological, clinical, biological and treatment information to improve knowledge on lymphoma patients: study protocol of the "REal world dAta in LYmphoma and survival in adults" (REALYSA) cohort. BMC Public Health 2021; 21:432. [PMID: 33653294 PMCID: PMC7927409 DOI: 10.1186/s12889-021-10433-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/12/2021] [Indexed: 12/24/2022] Open
Abstract
Background Age-adjusted lymphoma incidence rates continue to rise in France since the early 80’s, although rates have slowed since 2010 and vary across subtypes. Recent improvements in patient survival in major lymphoma subtypes at population level raise new questions about patient outcomes (i.e. quality of life, long-term sequelae). Epidemiological studies have investigated factors related to lymphoma risk, but few have addressed the extent to which socioeconomic status, social institutional context (i.e. healthcare system), social relationships, environmental context (exposures), individual behaviours (lifestyle) or genetic determinants influence lymphoma outcomes, especially in the general population. Moreover, the knowledge of the disease behaviour mainly obtained from clinical trials data is partly biased because of patient selection. Methods The REALYSA (“REal world dAta in LYmphoma and Survival in Adults”) study is a real-life multicentric cohort set up in French areas covered by population-based cancer registries to study the prognostic value of epidemiological, clinical and biological factors with a prospective 9-year follow-up. We aim to include 6000 patients over 4 to 5 years. Adult patients without lymphoma history and newly diagnosed with one of the following 7 lymphoma subtypes (diffuse large B-cell, follicular, marginal zone, mantle cell, Burkitt, Hodgkin, mature T-cell) are invited to participate during a medical consultation with their hematologist. Exclusion criteria are: having already received anti-lymphoma treatment (except pre-phase) and having a documented HIV infection. Patients are treated according to the standard practice in their center. Clinical data, including treatment received, are extracted from patients’ medical records. Patients’ risk factors exposures and other epidemiological data are obtained at baseline by filling out a questionnaire during an interview led by a clinical research assistant. Biological samples are collected at baseline and during treatment. A virtual tumor biobank is constituted for baseline tumor samples. Follow-up data, both clinical and epidemiological, are collected every 6 months in the first 3 years and every year thereafter. Discussion This cohort constitutes an innovative platform for clinical, biological, epidemiological and socio-economic research projects and provides an opportunity to improve knowledge on factors associated to outcome of lymphoma patients in real life. Trial registration 2018-A01332–53, ClinicalTrials.gov identifier: NCT03869619. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10433-4.
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Affiliation(s)
- Hervé Ghesquières
- Hospices Civils de Lyon, Lyon Sud Hospital, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France.
| | - Cédric Rossi
- CHU Dijon, 10 Boulevard Maréchal De Lattre De Tassigny, 21000, Dijon, France
| | - Fanny Cherblanc
- LYSARC, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | | | - Fontanet Bijou
- Bergonié Institute, 229 Cours de l'Argonne, 33076, Bordeaux, France
| | - Pierre Sujobert
- Hospices Civils de Lyon, Lyon Sud Hospital, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | | | - Adeline Bernier
- LYSARC, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | - Aurélien Belot
- LYSARC, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | - Loic Chartier
- LYSARC, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | - Luc-Matthieu Fornecker
- Cancerology Institute Strasbourg Europe, Avenue Molière, BP 428, 67098, Strasbourg, France
| | - Isabelle Baldi
- Inserm U1219 - EPICENE team, Université de Bordeaux, Bordeaux, France
| | | | - Camille Laurent
- Toulouse Research Center in Cancerology, 2 Avenue Hubert Curien, 31037, Toulouse, France
| | - Lucie Oberic
- IUCT Oncopole, 1 Avenue Irène Joliot Curie, 31100, Toulouse, France
| | - Nadine Morineau
- CHD Vendée, Boulevard Stéphane Moreau, 85000, La Roche-sur-Yon, France
| | | | | | - Corinne Haioun
- Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Gandhi Damaj
- Hematology Institute of Basse Normandie, 6 Avenue Côte de Nacre, 14033, Caen, France
| | | | - Gaëlle Labouré
- CH Libourne, 112 Rue de la Marne, 33500, Libourne, France
| | - Olivier Fitoussi
- Polyclinique Bordeaux Nord Aquitaine, 15-35 Rue Claude Boucher, 33300, Bordeaux, France
| | - Laure Lebras
- Léon Bérard Center, 28 rue Laennec, 69008, Lyon, France
| | - Rémy Gressin
- CHU Grenoble, Bd de la Chantourne BP 217, 38043, Grenoble, France
| | - Gilles Salles
- Hospices Civils de Lyon, Lyon Sud Hospital, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | - Loïc Ysebaert
- IUCT Oncopole, 1 Avenue Irène Joliot Curie, 31100, Toulouse, France
| | - Alain Monnereau
- Inserm U1219 - EPICENE team, Université de Bordeaux, Bordeaux, France
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29
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Suzuki Y, Yano T, Suehiro Y, Iwasaki H, Hidaka M, Otsuka M, Sunami K, Ikeda H, Sawamura M, Ito T, Iida H, Nagai H. Evaluation of prognosis following early disease progression in peripheral T-cell lymphoma. Int J Hematol 2020; 112:817-824. [PMID: 32886278 DOI: 10.1007/s12185-020-02987-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 03/16/2023]
Abstract
Recently, progression of disease within 24 months (POD24) has been demonstrated as a strong prognostic indicator in various types of malignant lymphoma. Peripheral T-cell lymphoma (PTCL) has an aggressive course and poor clinical outcomes. In this multicenter retrospective study, 111 consecutively registered patients with newly diagnosed PTCL were analyzed. Of these patients, 72 (64.9%) experienced POD24 (POD24 group), and the other 39 patients (35.1%) were analyzed as the no POD24 group. In the POD24 group, overall survival (OS) was significantly inferior to all patients, and in the no POD24 group, subsequent OS was significantly superior to the POD24 group, although the clinical characteristics between the POD24 group and no POD24 group were not significantly different. Twenty-three patients (20.7%) showed primary refractory disease to first-line therapy, and the prognosis was poor. The International Prognostic Index score and POD24 were identified as independent predictors in multivariate analysis for OS in all patients, and only performance status was an independent prognostic factor for OS in the POD24 group in multivariate analysis. In conclusion, the clinical significance of assessing POD24 in PTCL and the poor prognosis in patients with early disease progression were demonstrated.
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Affiliation(s)
- Yasuhiro Suzuki
- Department of Hematology, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan.
| | - Takahiro Yano
- Department of Hematology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Youko Suehiro
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Hiromi Iwasaki
- Department of Hematology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Michihiro Hidaka
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Maki Otsuka
- Department of Hematology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Kazutaka Sunami
- Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Hirokazu Ikeda
- Department of Hematology, National Hospital Organization Osaka Medical Center, Osaka, Japan
| | - Morio Sawamura
- Department of Hematology, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan
| | - Takuo Ito
- Department of Hematology, National Hospital Organization Kure Medical Center, Kure, Japan
| | - Hiroatsu Iida
- Department of Hematology, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Hirokazu Nagai
- Department of Hematology, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan.,Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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30
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Event-free survival at 24 months is a robust surrogate endpoint for long-term survival in pediatric, adolescent, and adult T cell lymphoblastic lymphoma. Ann Hematol 2020; 99:2847-2857. [PMID: 32712792 DOI: 10.1007/s00277-020-04195-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/20/2020] [Indexed: 12/29/2022]
Abstract
T cell lymphoblastic lymphoma (T-LBL) has an aggressive clinical behavior. To date, powerful and consistent prognostic factors have not been established for T-LBL. In this study, we first evaluated the association of event-free survival (EFS) at 24 months (EFS24) with overall survival (OS) in T-LBL patients. Besides, we sought to identify clinical factors of prognostic importance in this rare entity. Between January 2006 and December 2017, ninety-one patients with newly diagnosed T-LBL were retrospectively analyzed. EFS was defined as the time from diagnosis to relapse or progression, unplanned retreatment, death from any cause, or to the last follow-up. In total, 91 patients with a median age of 24 years were enrolled. At a median follow-up of 40.4 months (range, 1.4 to 163.3 months), the 5-year OS and EFS was 47.9% and 43.2%, respectively. Of all patients, 45 (49.5%) achieved EFS24 and 46 (50.5%) did not. Patients who achieved EFS24 showed a markedly superior outcome, compared with those who failed to achieve EFS24 (5-year OS, 90.5% vs 3%, P < 0.001). Univariate analysis indicated bone marrow involvement, response to induction treatment, and stem cell transplantation (SCT) consolidation to be prognostic factors for EFS and OS. In addition, compared with the patients receiving non-Hodgkin's lymphoma (NHL)-like treatment protocols, patients treated with hyper-CVAD showed significantly improved EFS and OS. Such survival advantage in terms of EFS and OS was also observed of BMF-90 regimens over NHL-like therapy, despite that the difference in EFS did not reach statistical significance (P = 0.056). Multivariate analysis demonstrated that achievement of complete remission (CR) after induction therapy and SCT consolidation were independent prognostic indicators for both EFS and OS. We confirm that EFS24 is a strong surrogate endpoint for long-term survival in T-LBL, which is clinically useful for individualized risk reassessment, future clinical trial design, and biomarker discovery validation. Further validation in the context of directed prospective clinical trials is warranted.
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Zhu J, Yang Y, Tao J, Wang SL, Chen B, Dai JR, Hu C, Qi SN, Li YX. Association of progression-free or event-free survival with overall survival in diffuse large B-cell lymphoma after immunochemotherapy: a systematic review. Leukemia 2020; 34:2576-2591. [PMID: 32651542 PMCID: PMC7515849 DOI: 10.1038/s41375-020-0963-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/01/2020] [Indexed: 12/18/2022]
Abstract
To investigate progression-free survival (PFS) and event-free survival (EFS) as early efficacy endpoints in diffuse large B-cell lymphoma (DLBCL), this systematic review included phase III randomized controlled trials (RCTs), phase II trials, and retrospective studies in newly diagnosed DLBCL receiving rituximab-containing chemotherapy through databases search up to 2019. Quality control was performed, where studies with high risk of bias were excluded. Prediction models were first established using the RCTs, and then externally validated in the phase II and retrospective populations. Trial-level surrogacy analysis was conducted by correlating the logarithmic (log) hazard ratio (HR) for PFS or EFS and log HR for OS. Correlation analysis at treatment arm-level was performed between 1-, 2-, 3-, and 5-year PFS or EFS rates and 5-year OS. The correlation was evaluated using the Pearson correlation coefficient r in weighted linear regression, with weight equal to patient size. Sensitivity analyses were performed to assess the consistency of predictive model by leaving one subgroup of trials out at a time. Twenty-six phase III RCTs, 4 phase II trials and 47 retrospective studies were included. In trial-level surrogacy, PFS (r, 0.772; 95% confidence interval [CI], 0.471-0.913) or EFS (r, 0.838; 95% CI, 0.625-0.938) were associated with OS. For rituximab immunochemotherapy treatment arms in RCTs, there was a linear correlation between 1 and 5-year PFS (r, 0.813-0.873) or EFS (r, 0.853-0.931) and 5-year OS. Sensitivity analysis demonstrated reasonable overall consistency. The correlation between PFS and OS was externally validated using independent phase II, and retrospective data (r, 0.795-0.897). We recommend PFS and EFS as earlier efficacy endpoints in patients with DLBCL primarily treated with rituximab-containing immunochemotherapy.
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Affiliation(s)
- Jie Zhu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Collaborative Innovation Center for Cancer Medicine, Beijing, P.R. China.,Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, P.R. China
| | - Yong Yang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Collaborative Innovation Center for Cancer Medicine, Beijing, P.R. China
| | - Jin Tao
- Institute of Basic Medical Sciences, Department of Human Anatomy, Histology and Embryology, Neuroscience Center, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, P.R. China
| | - Shu-Lian Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Collaborative Innovation Center for Cancer Medicine, Beijing, P.R. China
| | - Bo Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Collaborative Innovation Center for Cancer Medicine, Beijing, P.R. China
| | - Jian-Rong Dai
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Collaborative Innovation Center for Cancer Medicine, Beijing, P.R. China
| | - Chen Hu
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Shu-Nan Qi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Collaborative Innovation Center for Cancer Medicine, Beijing, P.R. China.
| | - Ye-Xiong Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Collaborative Innovation Center for Cancer Medicine, Beijing, P.R. China.
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Wudhikarn K, Bunworasate U, Julamanee J, Lekhakula A, Ekwattanakit S, Khuhapinant A, Niparuck P, Chuncharunee S, Numbenjapon T, Prayongratana K, Kanitsap N, Wongkhantee S, Makruasi N, Wong P, Norasetthada L, Nawarawong W, Sirijerachai C, Chansung K, Suwanban T, Praditsuktavorn P, Intragumtornchai T. Event-free survival at 12 months is a strong surrogate endpoint for stage 1 diffuse large B cell lymphoma: a report from Nation Wide Registry Thai Lymphoma Study Group. Leuk Lymphoma 2020; 61:2614-2621. [PMID: 32573294 DOI: 10.1080/10428194.2020.1780586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Event-free survival at 12 months (EFS12) is a surrogate endpoint for long-term outcomes in many histologic lymphoma subtypes. However, most reports have primarily investigated the implication of EFS12 in advanced-stage non-Hodgkin lymphoma (NHL). There are limited data regarding the significance of EFS12 in early-stage NHL. Herein, we evaluated the prognostic significance of EFS12 in patients with stage 1 diffuse large B-cell lymphoma (DLBCL). Out of 282 patients with stage 1 DLBCL who received intensive therapy, 227 (80.5%) achieved EFS12. The 4-year overall survival (OS) was 91.4% and 4.0% for patients who achieved and failed to achieve EFS12, respectively. Multivariable analyses demonstrated response to treatment and achievement of EFS12 as independent predictors for OS. In conclusion, our study demonstrated EFS12 as a powerful prognostic factor for stage 1 DLBCL. Further validation in more extensive prospective studies is warranted.
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Affiliation(s)
- Kitsada Wudhikarn
- Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Udomsak Bunworasate
- Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Research Unit in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jakrawadee Julamanee
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Arnuparp Lekhakula
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Supachai Ekwattanakit
- Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Archrob Khuhapinant
- Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pimjai Niparuck
- Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suporn Chuncharunee
- Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tontanai Numbenjapon
- Department of Internal Medicine, Faculty of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Kannadit Prayongratana
- Department of Internal Medicine, Faculty of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Nonglak Kanitsap
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Bangkok, Thailand
| | - Somchai Wongkhantee
- Department of Internal Medicine, Khonkaen Regional Hospital, Khon Kaen, Thailand
| | - Nisa Makruasi
- Department of Internal Medicine, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Thailand
| | - Peerapon Wong
- Department of Internal Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Lalita Norasetthada
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Weerasak Nawarawong
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chittima Sirijerachai
- Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kanchana Chansung
- Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Pannee Praditsuktavorn
- Department of Internal Medicine, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Tanin Intragumtornchai
- Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Jakobsen LH, Andersson TML, Biccler JL, Poulsen LØ, Severinsen MT, El-Galaly TC, Bøgsted M. On estimating the time to statistical cure. BMC Med Res Methodol 2020; 20:71. [PMID: 32216765 PMCID: PMC7098130 DOI: 10.1186/s12874-020-00946-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 03/04/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The mortality risk among cancer patients measured from the time of diagnosis is often elevated in comparison to the general population. However, for some cancer types, the patient mortality risk will over time reach the same level as the general population mortality risk. The time point at which the mortality risk reaches the same level as the general population is called the cure point and is of great interest to patients, clinicians, and health care planners. In previous studies, estimation of the cure point has been handled in an ad hoc fashion, often without considerations about margins of clinical relevance. METHODS We review existing methods for estimating the cure point and discuss new clinically relevant measures for quantifying the mortality difference between cancer patients and the general population, which can be used for cure point estimation. The performance of the methods is assessed in a simulation study and the methods are illustrated on survival data from Danish colon cancer patients. RESULTS The simulations revealed that the bias of the estimated cure point depends on the measure chosen for quantifying the excess mortality, the chosen margin of clinical relevance, and the applied estimation procedure. These choices are interdependent as the choice of mortality measure depends both on the ability to define a margin of clinical relevance and the ability to accurately compute the mortality measure. The analysis of cancer survival data demonstrates the importance of considering the confidence interval of the estimated cure point, as these may be wide in some scenarios limiting the applicability of the estimated cure point. CONCLUSIONS Although cure points are appealing in a clinical context and has widespread applicability, estimation remains a difficult task. The estimation relies on a number of choices, each associated with pitfalls that the practitioner should be aware of.
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Affiliation(s)
- Lasse H Jakobsen
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, Aalborg, 9000, Denmark. .,Department of Hematology, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, 9000, Denmark.
| | - Therese M-L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg, Stockholm, 171 65, Sweden
| | - Jorne L Biccler
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, Aalborg, 9000, Denmark.,Department of Hematology, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, 9000, Denmark
| | - Laurids Ø Poulsen
- Department of Oncology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark
| | - Marianne T Severinsen
- Department of Hematology, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, 9000, Denmark
| | - Tarec C El-Galaly
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, Aalborg, 9000, Denmark.,Department of Hematology, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, 9000, Denmark
| | - Martin Bøgsted
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, Aalborg, 9000, Denmark.,Department of Hematology, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, 9000, Denmark
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Bai Z, Li Z, Guan T, Wang L, Wang J, Wu S, Su L. Primary Gastric Diffuse Large B-Cell Lymphoma: Prognostic Factors in the Immuno-Oncology Therapeutics Era. Turk J Haematol 2020; 37:193-202. [PMID: 32160735 PMCID: PMC7463217 DOI: 10.4274/tjh.galenos.2020.2019.0332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective: This study aimed to explore the prognostic factors for primary gastric diffuse large B-cell lymphoma (PG-DLBCL). Materials and Methods: This retrospective study analyzed 72 PG-DLBCL patients between January 2012 and December 2017 in the Shanxi Cancer Hospital of Shanxi Medical University to identify the different prognostic factors in PG-DLBCL. The clinical features, treatment, and follow-up information were analyzed. Results: The low CD4:CD8 ratio group (median subsequent overall survival [OS]: 36.06 months; 95% confidence interval [CI]: 25.73-46.40) showed a significant decrease in subsequent OS compared to the normal group among PG-DLBCL patients who were newly diagnosed and did not receive rituximab (median OS: 52.58 months; 95% CI: 44.18-60.97; p=0.029). Event-free survival status 24 months after the date of diagnosis (EFS24) also decreased significantly in the low CD4:CD8 group (median EFS24: 16.27 months; 95% CI: 13.09-19.45) compared to the normal group (median EFS24: 20.34 months; 95% CI: 17.05-23.63; p=0.014). Multivariate analysis showed that low CD4:CD8 at diagnosis was an independent poor prognostic factor for subsequent OS and EFS24. Conclusion: Our data suggest that identifying prognostic factors, especially host immunity, may provide useful information for assessing prognosis or clinical management.
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Affiliation(s)
- ZhiMin Bai
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - ZhenHua Li
- Department of Hematology, Shanxi Tumor Hospital affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
| | - Tao Guan
- Department of Hematology, Shanxi Tumor Hospital affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
| | - LieYang Wang
- Department of Hematology, Shanxi Tumor Hospital affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
| | - JingRong Wang
- Department of Hematology, Shanxi Tumor Hospital affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
| | - ShaoHua Wu
- Department of Hematology, Shanxi Tumor Hospital affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
| | - LiPing Su
- Department of Hematology, Shanxi Tumor Hospital affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
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Cost-effectiveness of first-line treatment options for patients with advanced-stage Hodgkin lymphoma: a modelling study. LANCET HAEMATOLOGY 2020; 7:e146-e156. [PMID: 31948928 DOI: 10.1016/s2352-3026(19)30218-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/28/2019] [Accepted: 09/11/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Several strategies are available for the initial treatment of advanced-stage Hodgkin lymphoma, but the optimal strategy in terms of cost-effectiveness is unclear. The aim of this study was to compare the quality-adjusted effectiveness and costs of five modern treatment options for transplantation-eligible patients with newly diagnosed advanced-stage Hodgkin lymphoma. METHODS A Markov decision-analytic model was developed using a 20-year time horizon. Five of the most common treatment approaches were selected based on clinical experience and expert opinion: (1) six cycles of doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD), including data from the HD2000 trial, Viviani and colleagues, and EORTC trial; (2) six cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP; from the HD15 trial or PET-adapted as in the HD18 trial, two initial cycles of BEACOPP followed by four additional cycles for patients with a positive PET and either two or four additional cycles of BEACOPP for patients with a negative PET); (3) PET-adapted escalation (as in the RATHL trial, two cycles of standard ABVD chemotherapy followed by an additional four cycles of ABVD or AVD in PET-negative patients and four cycles of BEACOPP in PET-positive patients); (4) six cycles of brentuximab vedotin, doxorubicin, vinblastine, dacarbazine (A-AVD) or ABVD as in the Echelon-1 trial; and (5) PET-adapted de-escalation (as in the AHL2011 trial, two cycles of BEACOPP followed by PET2 scan; PET-positive patients received two additional BEACOPP cycles and PET-negative patients received two cycles of ABVD; at PET4, PET-negative patients completed two further cycles of either ABVD or BEACOPP depending on what they received after PET2, and PET-positive patients received salvage therapy). Note that all uses of BEACOPP in these strategies were BEACOPPescalated. The randomised groups of interest from these studies comprised 4255 patients enrolled between April, 2000, and January, 2016. Baseline probability estimates and utilities were derived from the included trials in addition to a systematic review of published studies. A Canadian public health payer's perspective was considered (CAN$1=US$0·74) and adjusted for inflation for 2018. All costs and benefits were discounted by 1·5% per year because life-years now are more valuable than future potential life-years. FINDINGS Probabilistic analyses (10 000 simulations) showed that, for a willingness-to-pay threshold of CAN$50 000, a PET-adapted de-escalation strategy based on AHL2011 was more cost-effective 87% of the time. This strategy had the highest number of life-years (14·6 years [95% CI 13·7-15·1]) and quality-adjusted life years (13·2 years [95% CI 10·2-14·4]), and the lowest direct costs ($53 129 [95% CI 31 914-94 446]) compared with the other treatment regimens. Sensitivity analyses showed that the model was robust to key variables, including probability of treatment-related mortality, relapse, frequency of secondary malignancy, death from secondary malignancy, and probability of infertility after BEACOPP. INTERPRETATION Our results suggest that, when considering cost, effectiveness, and short and long-term toxicities, the preferred treatment strategy for patients with newly diagnosed advanced-stage Hodgkin lymphoma is the PET-adapted de-escalation regimen starting with BEACOPP and de-escalating to ABVD as appropriate. Although our findings do not provide an absolute best treatment approach for clinicians to follow for all patients, they can contribute to shared decision making between patients and treating physicians. FUNDING None.
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Pálmarsdóttir R, Kiesbye Øvlisen A, Severinsen MT, Glimelius I, Smedby KE, El-Galaly T. Socioeconomic impact of Hodgkin lymphoma in adult patients: a systematic literature review. Leuk Lymphoma 2019; 60:3116-3131. [PMID: 31167589 DOI: 10.1080/10428194.2019.1613538] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hodgkin lymphoma is a highly curable disease with a peak incidence in young adulthood at times where education, family, and social relations are established. We performed a systematic literature review to assess the impact of Hodgkin lymphoma on the socioeconomic status of adolescent and adult survivors (including educational achievements, occupational aspects, marriage, and parenthood). In total, 39 articles were included. Overall, 26-36% of survivors perceived Hodgkin lymphoma as negatively affecting their socioeconomic status. Studies consistently found educational achievements in line with general population. Employment rates for survivors were comparable to the general population, but lower than before Hodgkin lymphoma diagnosis, with a post-diagnosis increase in disability pension and early retirement. Employed survivors encountered problems related to physical restrictions and recruitment. Marriage and parenthood were not substantially affected. In conclusion, current studies suggest acceptable socioeconomic outcomes following a Hodgkin lymphoma diagnosis but the use of standardized reporting methods hampers comparability across studies.
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Affiliation(s)
| | - Andreas Kiesbye Øvlisen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marianne Tang Severinsen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ingrid Glimelius
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.,Department of Immunology, Genetics and Pathology, Clinical and Experimental Oncology, Uppsala University and Uppsala Akademiska Hospital, Uppsala, Sweden
| | - Karin E Smedby
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.,Hematology Center, Karolinska University Hospital, Solna, Sweden
| | - Tarec El-Galaly
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Tracy SI, Larson MC, Feldman AL, Maurer MJ, Novak AJ, Slager SL, Villasboas JC, Allmer C, Habermann TM, Farooq U, Syrbu S, Cerhan JR, Link BK. The utility of prognostic indices, early events, and histological subtypes on predicting outcomes in non-follicular indolent B-cell lymphomas. Am J Hematol 2019; 94:658-666. [PMID: 30916801 DOI: 10.1002/ajh.25473] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/22/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023]
Abstract
Indolent B-cell lymphomas other than follicular lymphoma account for up to 10% of all B-cell neoplasms. While they typically follow a slowly progressive course, some patients experience rapid progression and early mortality. Prognostic scoring systems have not been adopted, hindering the ability of clinicians or researchers to predict outcomes, or risk-stratify patients during clinical trials. To address this, we evaluated the utility of existing prognostic indices and novel, early disease-related outcomes, to predict subsequent long term survival. Baseline characteristics and outcomes data were generated from a longitudinal cohort study that prospectively enrolled 632 patients newly diagnosed with marginal zone lymphoma, lymphoplasmacytic lymphomas, or B-cell lymphomas not otherwise specified, beginning in 2002. The International Prognostic Index (IPI), Follicular Lymphoma International Prognostic Index (FLIPI), and MALT International prognostic index (MALT-IPI) demonstrated c-statistics that ranged from 0.593-0.612 for event-free survival (EFS), and 0.683-0.714 for overall survival (OS). Patients who attained event-free survival at 12 months (EFS12) experienced similar mortality to the US general population (standardized mortality ratio [SMR] 1.19; 95% CI 0.95-1.46). Patients who did not attain EFS12 had subsequent worse morality (SMR 3.14 (95% CI 2.05-4.59). The MALT-IPI demonstrated utility in predicting subsequent long-term outcomes among patients with non-follicular indolent B-cell lymphomas. This index should be used by clinicians giving guidance to patients at the time of initial diagnosis, and risk stratification during clinical studies. The divergent long-term outcomes experienced by patients who do or do not attain EFS12 suggest there exists a subset of patients who harbor high-risk disease. Future research efforts should focus on methods to identify these patients at the time of diagnosis, in order to enable risk-tailored therapy.
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Affiliation(s)
- Sean I. Tracy
- Division of Hematology, Oncology, and Bone Marrow TransplantationUniversity of Minnesota Minneapolis Minnesota
| | | | | | | | - Anne J. Novak
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Susan L. Slager
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | | | - Cristine Allmer
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | | | - Umar Farooq
- Division Hematology, Oncology, and Bone Marrow TransplantationUniversity of Iowa Iowa City Iowa
| | - Sergei Syrbu
- Division Hematology, Oncology, and Bone Marrow TransplantationUniversity of Iowa Iowa City Iowa
| | - James R. Cerhan
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Brian K. Link
- Division Hematology, Oncology, and Bone Marrow TransplantationUniversity of Iowa Iowa City Iowa
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El-Galaly TC, Cheah CY, Villa D. Real world data as a key element in precision medicine for lymphoid malignancies: potentials and pitfalls. Br J Haematol 2019; 186:409-419. [PMID: 31140600 DOI: 10.1111/bjh.15965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Molecular genetic studies of lymphoma have led to refinements in disease classification in the most recent World Health Organization update. Nevertheless, a 'one-size-fits-most' treatment strategy based on morphology remains widely used for lymphoma despite significant molecular heterogeneity within histopathologically-defined subtypes. Precision medicine aims to improve patient outcomes by leveraging disease- and patient-specific information to optimise treatment strategies, but implementation of precision medicine strategies is challenged by the biological diversity and rarity of lymphomas. In this review, we explore existing and emerging real-world data sources that can be used to facilitate the development of precision medicine strategies in lymphoma. We provide illustrative examples of the use of real-world analyses to refine treatment strategies, provide comparators for clinical trials, improve risk-stratification to identify patients with unmet clinical needs and describe long-term and rare toxicities.
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Affiliation(s)
- Tarec C El-Galaly
- Department of Haematology, Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital and Pathwest Laboratory Medicine, Nedlands, WA, Australia
| | - Diego Villa
- Division of Medical Oncology and Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC, Canada
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Liu X, Wu T, Zhu SY, Shi M, Su H, Wang Y, He X, Xu LM, Yuan ZY, Zhang LL, Wu G, Qu BL, Qian LT, Hou XR, Zhang FQ, Zhang YJ, Zhu Y, Cao JZ, Lan SM, Wu JX, Qi SN, Yang Y, Li YX. Risk-Dependent Conditional Survival and Failure Hazard After Radiotherapy for Early-Stage Extranodal Natural Killer/T-Cell Lymphoma. JAMA Netw Open 2019; 2:e190194. [PMID: 30821826 PMCID: PMC6484659 DOI: 10.1001/jamanetworkopen.2019.0194] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Prognosis of early-stage extranodal natural killer/T-cell lymphoma (NKTCL) is usually estimated and stratified at diagnosis, but how the prognosis actually evolves over time for patients who survived after curative treatment is unknown. OBJECTIVE To assess conditional survival and failure hazard over time based on risk categories, previous survival, and treatment. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study reviewed the clinical data of 2015 patients with early-stage NKTCL treated with radiotherapy identified from the China Lymphoma Collaborative Group multicenter database between January 1, 2000, and December 31, 2015. Patients were stratified into low-, intermediate- and high-risk groups according to a previously established prognostic model. Median follow-up was 61 months for surviving patients. Data analysis was performed from December 1, 2017, to January 30, 2018. EXPOSURES All patients received radiotherapy with or without chemotherapy. MAIN OUTCOMES AND MEASURES Conditional survival defined as the survival probability, given patients have survived for a defined time, and annual hazard rates defined as yearly event rate. RESULTS A total of 2015 patients were included in the study (mean [SD] age, 43.3 [14.6] years; 1414 [70.2%] male); 1628 patients (80.8%) received radiotherapy with chemotherapy, and 387 (19.2%) received radiotherapy without chemotherapy. The 5-year survival rates increased from 69.1% (95% CI, 66.6%-71.4%) at treatment to 85.3% (95% CI, 81.7%-88.2%) at year 3 for conditional overall survival and from 60.9% (95% CI, 58.3%-63.3%) at treatment to 84.4% (95% CI, 80.6%-87.6%) at year 3 for conditional failure-free survival. The annual hazards decreased from 13.7% (95% CI, 13.0%-14.3%) for death and 22.1% (95% CI, 21.0%-23.1%) for failure at treatment to less than 5% after 3 years (death: range, 0%-3.9% [95% CI, 3.7%-4.2%]; failure: 1.2% [95% CI, 1.0%-1.4%] to 4.2% [95% CI 3.9%-4.6%]). Intermediate-risk (11.4% [95% CI, 10.5%-12.3%]) and high-risk (21.6% [95% CI, 20.0%-23.2%]) patients had initially higher but significantly decreased death hazards after 3 years (<6%, range: 0%-5.9% [95% CI, 5.2%-6.7%]), whereas low-risk patients maintained a constantly lower death hazard of less than 5% (range, 0%-4.8%; 95% CI, 4.4%-5.3%). In high-risk patients, radiotherapy combined with non-anthracycline-based regimens were associated with higher conditional overall survival before year 3 compared with anthracycline-based regimens (hazard ratio [HR] for death, 1.49; 95% CI, 1.13-1.95; P = .004 at treatment; HR, 1.60; 95% CI, 1.07-2.39; P = .02 at 1 year; and HR, 1.77; 95% CI, 0.94-3.33; P = .07 at 2 years) or radiotherapy alone (HR, 2.42; 95% CI, 1.73-3.39; P < .001 at treatment; HR, 1.82; 95% CI, 1.05-3.17; P = .03 at 1 year; and HR, 2.69; 95% CI, 1.23-5.90; P = .01 at 2 years). CONCLUSIONS AND RELEVANCE The survival probability increased and the hazards of failure decreased in a risk-dependent manner among patients with early NKTCL after radiotherapy. These dynamic data appear to provide accurate information on disease processes and continual survival expectations and may help researchers design additional prospective clinical trials and formulate risk-adapted therapies and surveillance strategies.
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Affiliation(s)
- Xin Liu
- State Key Laboratory of Molecular Oncology, Beijing, People’s Republic of China
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Center for Cancer Precision Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, People’s Republic of China
| | - Tao Wu
- Affiliated Hospital of Guizhou Medical University, Guizhou Cancer Hospital, Guiyang, Guizhou, People’s Republic of China
| | - Su-Yu Zhu
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan, People’s Republic of China
| | - Mei Shi
- Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People’s Republic of China
| | - Hang Su
- 307 Hospital, Academy of Military Medical Science, Beijing, People’s Republic of China
| | - Ying Wang
- Chongqing Cancer Hospital & Cancer Institute, Chongqing, People’s Republic of China
| | - Xia He
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, People’s Republic of China
| | - Li-Ming Xu
- Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, People’s Republic of China
| | - Zhi-Yong Yuan
- Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, People’s Republic of China
| | - Li-Ling Zhang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Gang Wu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Bao-Lin Qu
- The General Hospital of Chinese People's Liberation Army, Beijing, People’s Republic of China
| | - Li-Ting Qian
- The Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Xiao-Rong Hou
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Fu-Quan Zhang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yu-Jing Zhang
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, People’s Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People’s Republic of China
| | - Yuan Zhu
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Jian-Zhong Cao
- Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Sheng-Min Lan
- Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Jun-Xin Wu
- Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Shu-Nan Qi
- State Key Laboratory of Molecular Oncology, Beijing, People’s Republic of China
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Center for Cancer Precision Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, People’s Republic of China
| | - Yong Yang
- State Key Laboratory of Molecular Oncology, Beijing, People’s Republic of China
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Center for Cancer Precision Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, People’s Republic of China
| | - Ye-Xiong Li
- State Key Laboratory of Molecular Oncology, Beijing, People’s Republic of China
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Center for Cancer Precision Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, People’s Republic of China
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Biccler JL, Glimelius I, Eloranta S, Smeland KB, Brown PDN, Jakobsen LH, Frederiksen H, Jerkeman M, Fosså A, Andersson TML, Holte H, Bøgsted M, El-Galaly TC, Smedby KE. Relapse Risk and Loss of Lifetime After Modern Combined Modality Treatment of Young Patients With Hodgkin Lymphoma: A Nordic Lymphoma Epidemiology Group Study. J Clin Oncol 2019; 37:703-713. [PMID: 30726176 DOI: 10.1200/jco.18.01652] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Estimates of short- and long-term survival for young patients with classic Hodgkin lymphoma (cHL) are of considerable interest. We investigated cHL prognosis in the era of contemporary treatment at different milestones during the follow-up. PATIENTS AND METHODS On the basis of a Nordic cohort of 2,582 patients diagnosed at ages 18 to 49 years between 2000 and 2013, 5-year relapse risks and 5-year restricted losses in expectation of lifetime were estimated for all patients and for patients who achieved event-free survival (EFS) for 12 (EFS12), 24 (EFS24), 36 (EFS36) or 60 (EFS60) months. The median follow-up time was 9 years (range, 2.9 to 16.8 years). RESULTS The 5-year overall survival was 95% (95% CI, 94% to 96%). The 5-year risk of relapse was 13.4% (95% CI, 12.1% to 14.8%) overall but decreased to 4.2% (95% CI, 3.8% to 4.6%) given that patients reached EFS24. Relapse risk for patients treated with six to eight courses of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) was comparable to that of patients treated with six to eight courses of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) despite more adverse risk criteria among patients treated with BEACOPP. Both from diagnosis and if EFS24 was reached, the losses in expectation of lifetime during the following 5 years were small (from diagnosis, 45 days [95% CI, 35 to 54 days] and for patients who reached EFS24, 13 days [95% CI, 7 to 20 days]). In stage-stratified analyses of 5-year restricted loss in expectation of lifetime, patients with stages I to IIA disease had no noteworthy excess risk of death after they reached EFS24, whereas risk remained measurable for patients with stages IIB to IV cHL. CONCLUSION Real-world data on young patients with cHL from the Nordic countries show excellent outcomes. The outlook is particularly favorable for patients who reach EFS24, which supports limited relapse-oriented clinical follow-up.
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Affiliation(s)
- Jorne Lionel Biccler
- 1 Aalborg University Hospital, Aalborg, Denmark.,2 Aalborg University, Aalborg, Denmark
| | - Ingrid Glimelius
- 3 Karolinska Institutet, Solna, Sweden.,4 Uppsala University and Uppsala Akademiska Hospital, Uppsala, Sweden
| | | | | | | | - Lasse Hjort Jakobsen
- 1 Aalborg University Hospital, Aalborg, Denmark.,2 Aalborg University, Aalborg, Denmark
| | | | | | - Alexander Fosså
- 5 Oslo University Hospital, Oslo, Norway.,9 K.G. Jebsen Center for B-Cell Malignancies, Oslo, Norway
| | | | - Harald Holte
- 5 Oslo University Hospital, Oslo, Norway.,9 K.G. Jebsen Center for B-Cell Malignancies, Oslo, Norway
| | - Martin Bøgsted
- 1 Aalborg University Hospital, Aalborg, Denmark.,2 Aalborg University, Aalborg, Denmark
| | | | - Karin E Smedby
- 3 Karolinska Institutet, Solna, Sweden.,10 Karolinska University Hospital, Solna, Sweden
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41
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Real-life feasibility of salvage allogeneic transplantation in peripheral T-cell lymphomas. Bone Marrow Transplant 2018; 54:1237-1244. [PMID: 30531956 DOI: 10.1038/s41409-018-0417-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/22/2018] [Accepted: 11/02/2018] [Indexed: 12/31/2022]
Abstract
Relapsed/refractory Peripheral T-cell Lymphomas are characterized by a poor prognosis, especially for patients who are not candidates for allogeneic hematopoietic stem-cell transplantation. We conducted a retrospective analysis on 73 consecutive patients affected by relapsed/refractory T-Cell lymphomas who were considered eligible for allogeneic transplant. All patients were referred at our center from 2001 to 2017. With a median follow-up of 40 months (range 9-192 months), 4-year second-line failure-free survival and overall survival were 14% (CI95%:7-24) and 34% (CI95%:22-46). Extranodal disease at relapse (HR 2.25, CI95%: 1.11-4.56, p = 0.02) and first-line failure-free survival < 12 months (HR 3.37, CI95%: 1.67-6.88, p < 0.01) had a negative prognostic impact on survival. Only 45 out of 73 patients (62%) received allogeneic transplant. For the 28 (38%) patients who did not proceed to transplant, disease progression was the main reason for ineligibility. Median survival from time of transplant was 31 months (range 4-185 months). A first-line failure-free survival < 12 months had a negative prognostic impact also for allografted patients (2-year survival 45% vs 73%, p = 0.03) identifying a very high-risk population which requires novel treatments pre and post-transplant to obtain a long-term disease control.
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42
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Yamaguchi M, Suzuki R, Kim SJ, Ko YH, Oguchi M, Asano N, Miyazaki K, Terui Y, Kubota N, Maeda T, Kobayashi Y, Amaki J, Soejima T, Saito B, Shimoda E, Fukuhara N, Tsukamoto N, Shimada K, Choi I, Utsumi T, Ejima Y, Kim WS, Katayama N. Early disease progression in patients with localized natural killer/T-cell lymphoma treated with concurrent chemoradiotherapy. Cancer Sci 2018; 109:2056-2062. [PMID: 29601137 PMCID: PMC5989836 DOI: 10.1111/cas.13597] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 12/19/2022] Open
Abstract
Prognosis of patients with localized nasal extranodal natural killer/T‐cell lymphoma, nasal type (ENKL) has been improved by non‐anthracycline‐containing treatments such as concurrent chemoradiotherapy (CCRT). However, some patients experience early disease progression. To clarify the clinical features and outcomes of these patients, data from 165 patients with localized nasal ENKL who were diagnosed between 2000 and 2013 at 31 institutes in Japan and who received radiotherapy with dexamethasone, etoposide, ifosfamide, and carboplatin (RT‐DeVIC) were retrospectively analyzed. Progression of disease within 2 years after diagnosis (POD24) was used as the definition of early progression. An independent dataset of 60 patients with localized nasal ENKL who received CCRT at Samsung Medical Center was used in the validation analysis. POD24 was documented in 23% of patients who received RT‐DeVIC and in 25% of patients in the validation cohort. Overall survival (OS) from risk‐defining events of the POD24 group was inferior to that of the reference group in both cohorts (P < .00001). In the RT‐DeVIC cohort, pretreatment elevated levels of serum soluble interleukin‐2 receptor (sIL‐2R), lactate dehydrogenase, C‐reactive protein, and detectable Epstein‐Barr virus DNA in peripheral blood were associated with POD24. In the validation cohort, no pretreatment clinical factor associated with POD24 was identified. Our study indicates that POD24 is a strong indicator of survival in localized ENKL, despite the different CCRT regimens adopted. In the treatment of localized nasal ENKL, POD24 is useful for identifying patients who have unmet medical needs.
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Affiliation(s)
- Motoko Yamaguchi
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ritsuro Suzuki
- Department of Oncology/Hematology, Shimane University Hospital, Izumo, Japan
| | - Seok Jin Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Masahiko Oguchi
- Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoko Asano
- Department of Molecular Diagnostics, Nagano Prefectural Shinshu Medical Center, Suzaka, Japan
| | - Kana Miyazaki
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yasuhiko Terui
- Department of Hematology and Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Nobuko Kubota
- Division of Hematology, Saitama Cancer Center, Ina, Japan
| | - Takeshi Maeda
- Department of Hematology and Oncology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yukio Kobayashi
- Hematology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Amaki
- Division of Hematology & Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Toshinori Soejima
- Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Bungo Saito
- Division of Hematology, Showa University School of Medicine, Tokyo, Japan
| | - Emiko Shimoda
- Department of Radiation Oncology, Nara Medical University, Kashihara, Japan
| | - Noriko Fukuhara
- Department of Hematology & Rheumatology, Tohoku University Hospital, Sendai, Japan
| | | | - Kazuyuki Shimada
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ilseung Choi
- Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Takahiko Utsumi
- Department of Hematology, Shiga Medical Center for Adults, Moriyama, Japan
| | - Yasuo Ejima
- Department of Radiology, Dokkyo Medical University, Shimotsuga, Japan
| | - Won Seog Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Naoyuki Katayama
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
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43
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Affiliation(s)
- Joseph M Connors
- British Columbia Cancer Centre for Lymphoid Cancer, Vancouver, BC, Canada
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44
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Bosch X, Sanclemente-Ansó C, Escoda O, Monclús E, Franco-Vanegas J, Moreno P, Guerra-García M, Guasch N, López-Soto A. Time to diagnosis and associated costs of an outpatient vs inpatient setting in the diagnosis of lymphoma: a retrospective study of a large cohort of major lymphoma subtypes in Spain. BMC Cancer 2018; 18:276. [PMID: 29530002 PMCID: PMC5848556 DOI: 10.1186/s12885-018-4187-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/06/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Mainly because of the diversity of clinical presentations, diagnostic delays in lymphoma can be excessive. The time spent in primary care before referral to the specialist may be relatively short compared with the interval between hospital appointment and diagnosis. Although studies have examined the diagnostic intervals and referral patterns of patients with lymphoma, the time to diagnosis of outpatient compared to inpatient settings and the costs incurred are unknown. METHODS We performed a retrospective study at two academic hospitals to evaluate the time to diagnosis and associated costs of hospital-based outpatient diagnostic clinics or conventional hospitalization in four representative lymphoma subtypes. The frequency, clinical and prognostic features of each lymphoma subtype and the activities of the two settings were analyzed. The costs incurred during the evaluation were compared by microcosting analysis. RESULTS A total of 1779 patients diagnosed between 2006 and 2016 with classical Hodgkin, large B-cell, follicular, and mature nodal peripheral T-cell lymphomas were identified. Clinically aggressive subtypes including large B-cell and peripheral T-cell lymphomas were more commonly diagnosed in inpatients than in outpatients (39.1 vs 31.2% and 18.9 vs 13.5%, respectively). For each lymphoma subtype, inpatients were older and more likely than outpatients to have systemic symptoms, worse performance status, more advanced Ann Arbor stages, and high-risk prognostic scores. The admission time for diagnosis (i.e. from admission to excisional biopsy) of inpatients was significantly shorter than the time to diagnosis of outpatients (12.3 [3.3] vs 16.2 [2.7] days; P < .001). Microcosting revealed a mean cost of €4039.56 (513.02) per inpatient and of €1408.48 (197.32) per outpatient, or a difference of €2631.08 per patient. CONCLUSIONS Although diagnosis of lymphoma was quicker with hospitalization, the outpatient approach seems to be cost-effective and not detrimental. Despite the considerable savings with the latter approach, there may be hospitalization-associated factors which may not be properly managed in an outpatient unit (e.g. aggressive lymphomas with severe symptoms) and the cost analysis did not account for this potentially added value. While outcomes were not analyzed in this study, the impact on patient outcome of an outpatient vs inpatient diagnostic setting may represent a challenging future research.
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Affiliation(s)
- Xavier Bosch
- Quick Diagnosis Unit, Adult Day Care Center, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
- Quick Diagnosis Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Carmen Sanclemente-Ansó
- Quick Diagnosis Unit, Department of Internal Medicine, Hospital of Bellvitge, University of Barcelona, Barcelona, Spain
| | - Ona Escoda
- Quick Diagnosis Unit, Adult Day Care Center, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Esther Monclús
- Quick Diagnosis Unit, Adult Day Care Center, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Jonathan Franco-Vanegas
- Quick Diagnosis Unit, Department of Internal Medicine, Hospital of Bellvitge, University of Barcelona, Barcelona, Spain
| | - Pedro Moreno
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Mar Guerra-García
- Adult Day Care Center, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Neus Guasch
- Adult Day Care Center, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Alfons López-Soto
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
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45
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Maurer MJ, Ellin F, Srour L, Jerkeman M, Bennani NN, Connors JM, Slack GW, Smedby KE, Ansell SM, Link BK, Cerhan JR, Relander T, Savage KJ, Feldman AL. International Assessment of Event-Free Survival at 24 Months and Subsequent Survival in Peripheral T-Cell Lymphoma. J Clin Oncol 2017; 35:4019-4026. [PMID: 29072976 DOI: 10.1200/jco.2017.73.8195] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Purpose Peripheral T-cell lymphomas (PTCLs) have aggressive clinical behavior. We have previously shown that event-free survival (EFS) at 24 months (EFS24) is a clinically useful end point in diffuse large B-cell lymphoma. Here, we assess EFS24 and subsequent overall survival (OS) in large, multinational PTCL cohorts. Patients and Methods Patients with systemic PTCL newly diagnosed from 2000 to 2012 and treated with curative intent were included from the United States and Sweden (initial cohorts) and from Canada (replication cohort). EFS was defined as time from date of diagnosis to progression after primary treatment, retreatment, or death. Subsequent OS was measured after achieving EFS24 or from the time of progression if it occurred within 24 months. OS rates were compared with the age-, sex-, and country-matched general population. Results Seven hundred seventy-five patients were included in the study (the median age at diagnosis was 64 years; 63% were men). Results were similar in the initial and replication cohorts, and a combined analysis was undertaken. Sixty-four percent of patients progressed within the first 24 months and had a median OS of only 4.9 months (5-year OS, 11%). In contrast, median OS after achieving EFS24 was not reached (5-year OS, 78%), although relapses within 5 years of achieving EFS24 occurred in 23% of patients. Superior outcomes after achieving EFS24 were observed in younger patients (≤ 60 years of age: 5-year OS, 91%). Conclusion EFS24 stratifies subsequent outcome in PTCL. Patients with PTCL with primary refractory disease or early relapse have extremely poor survival. However, more than one third of patients with PTCL remain in remission 2 years after diagnosis with encouraging subsequent OS, especially in younger patients. These marked differences in outcome suggest that EFS24 has utility for patient counseling, study design, and risk stratification in PTCL.
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Affiliation(s)
- Matthew J Maurer
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Fredrik Ellin
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Line Srour
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Mats Jerkeman
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - N Nora Bennani
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Joseph M Connors
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Graham W Slack
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Karin E Smedby
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Stephen M Ansell
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Brian K Link
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - James R Cerhan
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Thomas Relander
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Kerry J Savage
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Andrew L Feldman
- Matthew J. Maurer, N. Nora Bennani, Stephen M. Ansell, James R. Cerhan, and Andrew L. Feldman, Mayo Clinic, Rochester, MN; Fredrik Ellin, Kalmar County Hospital, Kalmar; Fredrik Ellin and Thomas Relander, Lund University; Mats Jerkeman and Thomas Relander, Skåne University Hospital, Lund; Karin E. Smedby, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Line Srour, Joseph M. Connors, Graham W. Slack, and Kerry J. Savage, Centre for Lymphoid Cancer, BC Cancer Agency, Vancouver, British Columbia, Canada; and Brian K. Link, University of Iowa Hospitals and Clinics, Iowa City, IA
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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: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Marr KC, Connors JM, Savage KJ, Goddard KJ, Deyell RJ. ABVD chemotherapy with reduced radiation therapy rates in children, adolescents and young adults with all stages of Hodgkin lymphoma. Ann Oncol 2017; 28:849-854. [PMID: 28327925 DOI: 10.1093/annonc/mdx005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Indexed: 11/13/2022] Open
Abstract
Background We adopted ABVD chemotherapy with risk-adapted radiation therapy (RT) as first-line therapy for children, adolescents and young adults with Hodgkin lymphoma (HL) in British Columbia in 2004. Patients and methods Patients ≤ 25 years diagnosed from 2004 to 2013 with all stages of HL who received ABVD as initial therapy were included. Results Among 55 children (age < 18 year) and 154 young adults (18-25 year), there were no significant differences among age groups for sex, histologic subtype, tumour bulk, B symptoms, prognostic risk groups or treatment received. The rates of complete response, partial response and progressive disease were 84%, 7% and 10% for children and 95%, 4% and 1% for young adults (P=0.01), respectively. Treatment failures in children all occurred within one year of completion, while 8/21 (38%) relapses in young adults occurred later (P=0.04). With a median follow-up of 66 months the 5-year progression-free (PFS) and overall survival (OS) were 85 ± 3% and 97 ± 1%, respectively. For limited stage disease, PFS was 90 ± 7% for children and 93 ± 3% for young adults (P=0.65); OS was 100% for both. For advanced stage patients, PFS and OS were also similar for the children and young adults (77 ± 7% versus 81 ± 4%; P=0.38 and OS 90 ± 6% versus 97 ± 2%; P=0.17). The rate of consolidative RT was low (21%) and did not differ between age groups. Conclusion ABVD is an effective treatment in children, adolescents and young adults with HL. Children were less likely to achieve complete response and demonstrated earlier relapses compared to young adults. RT may be omitted for the majority of patients while maintaining excellent 5-year OS.
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Affiliation(s)
- K C Marr
- Division of Paediatric Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children's Hospital
| | - J M Connors
- British Columbia Cancer Agency, Centre for Lymphoid Cancer
| | - K J Savage
- British Columbia Cancer Agency, Centre for Lymphoid Cancer
| | - K J Goddard
- British Columbia Cancer Agency, Department of Radiation Oncology, University of British Columbia, Vancouver, Canada
| | - R J Deyell
- Division of Paediatric Hematology/Oncology/Bone Marrow Transplantation, British Columbia Children's Hospital
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Cederleuf H, Hjort Jakobsen L, Ellin F, de Nully Brown P, Stauffer Larsen T, Bøgsted M, Relander T, Jerkeman M, El-Galaly TC. Outcome of peripheral T-cell lymphoma in first complete remission: a Danish-Swedish population-based study. Leuk Lymphoma 2017; 58:2815-2823. [DOI: 10.1080/10428194.2017.1300888] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Henrik Cederleuf
- Department of Clinical Sciences, Oncology and Pathology, Lund University, Lund, Sweden
| | - Lasse Hjort Jakobsen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Fredrik Ellin
- Department of Clinical Sciences, Oncology and Pathology, Lund University, Lund, Sweden
- Department of Internal Medicine, Kalmar County Hospital, Kalmar, Sweden
| | - Peter de Nully Brown
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Martin Bøgsted
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Thomas Relander
- Department of Clinical Sciences, Oncology and Pathology, Lund University, Lund, Sweden
| | - Mats Jerkeman
- Department of Clinical Sciences, Oncology and Pathology, Lund University, Lund, Sweden
| | - Tarec Christoffer El-Galaly
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Glimelius I, Eloranta S, Ekberg S, Chang ET, Neovius M, Smedby KE. Increased healthcare use up to 10 years among relapse-free Hodgkin lymphoma survivors in the era of intensified chemotherapy and limited radiotherapy. Am J Hematol 2017; 92:251-258. [PMID: 28006849 DOI: 10.1002/ajh.24623] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/21/2016] [Accepted: 12/07/2016] [Indexed: 01/15/2023]
Abstract
With today's excellent cure rates for Hodgkin lymphoma (HL), the number of long-term survivors is increasing. This study aims to provide a global assessment of late adverse effects for working-age HL survivors treated with contemporary protocols (combination chemotherapy and limited radiotherapy). From Swedish nationwide registers we identified 1017 HL survivors diagnosed in 2000-2009, aged 18-60 years (median 32) and surviving at least one year post-diagnosis, and 4031 age-, sex-, and calendar-year-matched population comparators. Incidence rate ratios (IRR) and 95% confidence intervals (95%CI) for outpatient visits and inpatient bed-days after the first year up to 14 years post-diagnosis (through 2013) were estimated across treatment subgroups, considering relapse-free time and using negative binomial regression. Scheduled outpatient visits for HL were excluded. The rate of outpatient visits was nearly double (IRR = 1.8, 95%CI: 1.6-2.0) that among comparators and higher rates persisted up to 10 years post-diagnosis. The rate of inpatient bed-days among relapse-free survivors was more than three-fold (IRR = 3.6, 95%CI: 2.7-4.7) that of comparators and the increase persisted up to four years post-diagnosis. Patients requiring 6-8 chemotherapy courses had higher rates of outpatient visits (IRR = 1.4, 95%CI: 1.1-1.7) and bed-days (IRR = 4.7, 95%CI: 2.9-7.8) than patients treated with 2-4 courses + radiotherapy. Previously seldom reported reasons for the excess healthcare use included chest pain, keratitis, asthma, diabetes mellitus, and depression. Contemporary treatment, chemotherapy in particular, was associated with excess healthcare use among HL survivors during the first decade postdiagnosis. The reasons for healthcare visits reflected a wide range of disorders, indicating the need of broad individualized care in addition to specific screening programs.
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Affiliation(s)
- Ingrid Glimelius
- Department of MedicineClinical Epidemiology Unit, Karolinska Institutet and Karolinska University HospitalStockholm Sweden
- Department of Immunology, Genetics and Pathology, Clinical and Experimental OncologyUppsala University and Uppsala Akademiska Hospital Sweden
| | - Sandra Eloranta
- Department of MedicineClinical Epidemiology Unit, Karolinska Institutet and Karolinska University HospitalStockholm Sweden
| | - Sara Ekberg
- Department of MedicineClinical Epidemiology Unit, Karolinska Institutet and Karolinska University HospitalStockholm Sweden
| | - Ellen T. Chang
- Center for Epidemiology and Computational Biology, Health Sciences Practice, ExponentMenlo ParkCalifornia USA
- Division of Epidemiology, Department of Health Research and PolicyStanford University School of MedicineStanford California USA
| | - Martin Neovius
- Department of MedicineClinical Epidemiology Unit, Karolinska Institutet and Karolinska University HospitalStockholm Sweden
| | - Karin E. Smedby
- Department of MedicineClinical Epidemiology Unit, Karolinska Institutet and Karolinska University HospitalStockholm Sweden
- Department of MedicineKarolinska University Hospital and Karolinska InstitutetStockholm Sweden
- Division of HematologyKarolinska University Hospital and Karolinska InstitutetStockholm Sweden
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50
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Jakobsen LH, Bøgsted M, Brown PDN, Arboe B, Jørgensen J, Larsen TS, Juul MB, Schurmann L, Højberg L, Bergmann OJ, Lassen T, Josefsson PL, Jensen P, Johnsen HE, El-Galaly TC. Minimal Loss of Lifetime for Patients With Diffuse Large B-Cell Lymphoma in Remission and Event Free 24 Months After Treatment: A Danish Population-Based Study. J Clin Oncol 2017; 35:778-784. [PMID: 28095160 DOI: 10.1200/jco.2016.70.0765] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The general outlook for patients with diffuse large B-cell lymphoma (DLBCL) in first remission is important information for patients and for planning post-treatment follow-up. The purpose of this study was to evaluate the survival of patients with DLBCL in remission compared with a matched general population. Methods A total of 1,621 patients from the Danish Lymphoma Registry who were newly diagnosed with DLBCL between 2003 and 2011 were included in this study. All patients were ≥ 16 years of age at diagnosis and had achieved complete remission or complete remission unconfirmed after first-line rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or R-CHOP-like therapy. Results The 5-year post-treatment DLBCL survival was inferior to survival in the matched general population (78%; 95% CI, 76 to 80; v 87%; standardized mortality ratio, 1.75; P < .001). Excess mortality was present but reduced for patients achieving post-treatment event-free survival for 24 months (pEFS24; standardized mortality ratio, 1.27; P < .001). In age-stratified analyses, the survival of patients < 50 years of age was normalized to the general population after achieving pEFS24 ( P = .99). During the first 8 years after pEFS24, the average loss of lifetime was 0.31 mo/y (95% CI, 0.11 to 0.50 mo/y). Excess mortality diminished when analyzing death from lymphoma as competing event to death from other causes, suggesting that early and late relapse is responsible for increased mortality in patients with DLBCL. Conclusion Although this population-based study does not support complete normalization of survival for patients with DLBCL achieving pEFS24, the estimated loss of residual lifetime was low for patients in continuous remission 2 years after ending treatment. Therefore, pEFS24 is an appealing and relevant milestone for patient counseling and could be a surrogate end point in clinical trials.
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Affiliation(s)
- Lasse Hjort Jakobsen
- Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark
| | - Martin Bøgsted
- Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark
| | - Peter de Nully Brown
- Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark
| | - Bente Arboe
- Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark
| | - Judit Jørgensen
- Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark
| | - Thomas Stauffer Larsen
- Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark
| | - Maja Bech Juul
- Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark
| | - Lene Schurmann
- Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark
| | - Linda Højberg
- Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark
| | - Olav Jonas Bergmann
- Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark
| | - Therese Lassen
- Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark
| | - Pär Lars Josefsson
- Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark
| | - Paw Jensen
- Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark
| | - Hans Erik Johnsen
- Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark
| | - Tarec Christoffer El-Galaly
- Lasse Hjort Jakobsen, Martin Bøgsted, Paw Jensen, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University Hospital; Lasse Hjort Jakobsen, Martin Bøgsted, Hans Erik Johnsen, and Tarec Christoffer El-Galaly, Aalborg University, Aalborg; Peter de Nully Brown and Bente Arboe, Copenhagen University Hospital, Copenhagen; Judit Jørgensen, Aarhus University Hospital, Aarhus; Thomas Stauffer Larsen and Maja Bech Juul, Odense University Hospital, Odense; Lene Schurmann, Hospitalsenheden Vest, Holstebro; Linda Højberg, Sydvestjysk Sygehus, Esbjerg; Olav Jonas Bergmann, Vejle Sygehus, Vejle; Therese Lassen, Roskilde Sygehus, Roskilde; and Pär Lars Josefsson, Herlev Hospital, Herlev, Denmark
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