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Mohite A, Rangarajan V, Goda J, Chugh S, Agrawal A, Sengar M. Metabolic tumor parameters complement clinicopathological factors in prognosticating advanced stage Hodgkin Lymphoma. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2023; 11:111-121. [PMID: 37324230 PMCID: PMC10261693 DOI: 10.22038/aojnmb.2023.69260.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/21/2023] [Accepted: 01/28/2023] [Indexed: 06/17/2023]
Abstract
Objectives Advanced Hodgkin Lymphoma has a higher probability of relapse and recurrence. Classical clinicopathological parameters including the International Prognostic Score (IPS) have not been reliable in predicting prognosis or tailoring treatment. Since FDG PET/CT is the standard of care in staging Hodgkin Lymphoma, this study attempted to evaluate the clinical utility of baseline metabolic tumor parameters in a cohort of advanced Hodgkin lymphoma (stage III and IV). Methods Histology-proven advanced Hodgkin Patients presenting to our institute between 2012-2016 and treated with chemo-radiotherapy (ABVD / AEVD) were followed up till 2019. Quantitative PET/CT and clinicopathological parameters were used to estimate the Event Free Survival (EFS) in 100 patients. Kaplan-Meier method with log-rank test was used to compare the survival times of prognostic factors. Results At a median follow-up of 48.83 months (IQR:33.31-63.05 months), the five-year-EFS was 81%. Of the 100 patients, 16 had relapsed (16%) and none died at the last follow-up. On Univariate analysis, among non-PET parameters bulky disease (P=0.03) and B-symptoms (P=0.04) were significant while among PET/CT parameters SUVmax (p=0.001), SUVmean (P=0.002), WBMTV2.5 (P<0.001), WBMTV41% (P<0.001), WBTLG2.5 (P<0.001) and WBTLG41% (P <0.001) predicted poorer EFS. 5-year EFS for patients with low WBMTV2.5 [<1038.3 cm3] was 89% and 35% for patients with high WBMTV2.5 [≥1038.3 cm3] (p <0.001). In a multivariate model, only WBMTV2.5 (P=0.03) independently predicted poorer EFS. Conclusion PET-based metabolic parameter (WBMTV2.5) was able to prognosticate and complement the classical clinical prognostic factors in advanced Hodgkin Lymphoma. This parameter could have a surrogate value for prognosticating advanced Hodgkin lymphoma. Better prognostication at baseline translates to tailored or risk-modified treatment and hence higher survival.
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Affiliation(s)
- Ashish Mohite
- Department of Nuclear medicine and Molecular Imaging, Tata Memorial Centre, Mumbai Maharashtra, India
- Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear medicine and Molecular Imaging, Tata Memorial Centre, Mumbai Maharashtra, India
- Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra, India
| | - Jayant Goda
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai Maharashtra, India
- Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra, India
| | - Swati Chugh
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai Maharashtra, India
- Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Nuclear medicine and Molecular Imaging, Tata Memorial Centre, Mumbai Maharashtra, India
- Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Haematooncology, Tata Memorial Centre, Mumbai Maharashtra, India
- Homi Bhabha National Institute, Anushaktinagar, Mumbai, Maharashtra, India
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Bhurani D, Nair R, Rajappa S, Rao SA, Sridharan N, Boya RR, Raman GS, Menon H, Seshachalam A, Nimmagadda R. Real-World Outcomes of Hodgkin Lymphoma: A Multi-Centric Registry From India. Front Oncol 2022; 11:799948. [PMID: 35223455 PMCID: PMC8881143 DOI: 10.3389/fonc.2021.799948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundHodgkin’s lymphoma (HL) is one of the most curable malignancies with a 5-year survival of over 80%. Most published literature from low-middle income countries comes from single institute experience.MethodologyThe OncoCollect Lymphoma group registry was set up in 2017 and has 9 major participating sites across India. Data of newly diagnosed classical HL (CHL) patients, treated between 2011 and 2017, were collected using OncoCollect software. The clinical features, subtypes, prognostic stratification, treatment patterns, response to first-line treatment, and 5-year outcomes were analyzed. All statistical analysis was done using Microsoft R Open statistical software linked to OncoCollect software.ResultsThere were 939 newly diagnosed CHL patients with a median age of 38 (range, 18–99) years at presentation. The male-to-female ratio was 2.07:1. Histological subtypes included mixed cellularity, CHL (MC, CHL), nodular sclerosis, CHL (NS, CHL), lymphocyte-rich, CHL (LR, CHL), and lymphocyte-depleted, CHL (LD, CHL), in 60.60%, 26.94%, 9.80%, and 2.66%, respectively. At presentation, 50.43% had B symptoms and 53.35% had advanced disease. 29.71% of advanced-stage patients had high Hodgkin IPI score. 79% and 21% of patients received 1st-line treatment with chemotherapy alone or combined modality treatment with chemotherapy and radiotherapy. The most common first-line chemotherapy was ABVD-based regimen (94.68%). The overall response rate was 93.48%. Complete response rates among early-stage favorable and unfavorable risk groups were 92.73% and 86.79%, and those among advanced-stage low- and high-risk groups were 76.64% and 69.78%, respectively. The median relapse-free follow-up duration was 51 months (IQR 22–69). A significant difference was found in 5-year EFS between the early- and advanced-stage disease 83.53% and 73.55% (p = 0.00087), respectively. Similarly, significant difference was found in EFS among early-stage patients treated with a combination of 4-cycle chemotherapy and radiotherapy vs. chemotherapy alone 88.57% and 66.33% (p = 0.0042), respectively.ConclusionsIn this large cohort from India, survival of patients with HL was comparable to the developed world. With a median follow-up of 51 months, the 5-year EFS and OS of all patients were 78.24% and 83.63%, respectively.
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Affiliation(s)
- Dinesh Bhurani
- Department of Haematology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
- *Correspondence: Dinesh Bhurani,
| | - Reena Nair
- Department of Haematology, Tata Medical Centre, Kolkata, India
| | - Senthil Rajappa
- Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - Suparna Ajit Rao
- Department of Medical Oncology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | | | - Rakesh Reddy Boya
- Department of Medical Oncology, Mahatama Gandhi Cancer Hospital and Research Center, Visakhapatnam, India
| | - Ganapathi S. Raman
- Department of Medical Oncology, Kumaran Hospital Private Ltd., Chennai, India
| | - Hari Menon
- Department of Medical Oncology, CyteCare Cancer Hospitals, Bengaluru, India
| | | | - Ramesh Nimmagadda
- Department of Medical Oncology, Apollo Cancer Institute, Chennai, India
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Nayak L, Jain H, Bonda A, Epari S, Laskar S, Gokarn A, Shet T, Gujral S, Khanna N, Bagal B, Punatar S, Goda J, Thorat J, Rengaraj K, Sengar M. Hodgkin Lymphoma in Adolescent and Young Adults: Real-World Data from a Single Tertiary Cancer Center in India. J Adolesc Young Adult Oncol 2020; 10:581-587. [PMID: 33090916 DOI: 10.1089/jayao.2020.0061] [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: 11/13/2022] Open
Abstract
Purpose: There is lack of consensus on management of adolescent and young adult (AYA) Hodgkin lymphoma with respect to chemotherapy approach (adult or pediatric). Hence we sought to evaluate the efficacy and safety of Adriamycin, Bleomycin, Vinblastine and Dacarbazine (ABVD) chemotherapy in AYA Hodgkin lymphoma. Patients and Methods: It is a retrospective, observational, single-center study. From January 2013 to December 2016, all consecutive patients with AYA (15-25 years, all stages) were analyzed. The primary endpoint of the study was event-free survival (EFS). Secondary endpoints were complete response rates (CR) and overall survival (OS). Results: A total of 220 patients (70% men) with median age 20 years were evaluated. A significant proportion of patients had adverse features such as stage III/IV disease (63%), bulky disease (63%), extranodal involvement (37%), and marrow involvement (22%). After two cycles and end of therapy, 77% patients achieved complete response. Primary progressive disease was seen in 6% patients. With a median follow-up of 2.6 years, 19 (8.6%) patients relapsed, 1 patient developed second malignancy, and 6 patients died. Three-year EFS and OS were 81.3% and 97%, respectively. Bleomycin-induced lung injury was seen in 16% patients. On multivariate analysis stage at presentation, bone marrow involvement, partial response at interim positron emission tomography and International prognosis score (IPS) >3 were predictors of poor EFS. Conclusion: ABVD is an effective and safe regimen in AYA Hodgkin lymphoma. Advanced disease with high IPS (>3) score needs an early escalation approach to escBEACOPP regimen.
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Affiliation(s)
- Lingaraj Nayak
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Hasmukh Jain
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Avinash Bonda
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sridhar Epari
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anant Gokarn
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Bhausaheb Bagal
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sachin Punatar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Jayant Goda
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Jayashree Thorat
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Karthik Rengaraj
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Dalal M, Gupta J, Price K, Zomas A, Miao H, Ashaye A. Efficacy and safety of front-line treatments for advanced Hodgkin lymphoma: a systematic literature review. Expert Rev Hematol 2020; 13:907-922. [PMID: 32749937 DOI: 10.1080/17474086.2020.1793666] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess evidence on the safety and efficacy of ABVD (doxorubicin [Adriamycin®], bleomycin, vinblastine, and dacarbazine), BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone), and A+AVD (brentuximab vedotin, with doxorubicin, vinblastine, and dacarbazine) for advanced-stage Hodgkin lymphoma (HL). METHODS A systematic literature review (SLR) was conducted on 29 July 2016 (updated 26 July 2018) to identify randomized controlled trials (RCTs) and non-RCTs assessing the treatment of newly-diagnosed advanced-stage HL with ABVD and BEACOPP (and their variants), and A+AVD. RESULTS The SLR identified 62 RCTs and 42 non-RCTs. Five-year overall survival rates for ABVD and BEACOPP were 60-97% and 84-99%, and 5-year progression-free survival rates were 58-81% and 83-96%, respectively. Both regimens were associated with tolerability issues and side effects. Discontinuation or dose reduction of bleomycin resulted in fewer adverse events, without significantly affecting efficacy. A head-to-head trial demonstrated improved efficacy for A+AVD vs ABVD, with an acceptable tolerability profile. No data from head-to-head trials comparing A+AVD with BEACOPP were available, and an indirect treatment comparison was not feasible. CONCLUSION New therapies, such as A+AVD, maintain the efficacy observed with current treatments, and may provide a more tolerable treatment option for patients with advanced-stage HL.
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Affiliation(s)
- Mehul Dalal
- Global Evidence & Outcomes - Oncology, Millennium Pharmaceuticals, Inc. a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge, MA, USA
| | - Jatin Gupta
- Global Access, Decision Resources Group , Gurugram, Haryana, 122002, India
| | - Kim Price
- Global Access, Decision Resources Group, 6 Talisman Business Centre, Bicester , Oxfordshire, USA
| | - Athanasios Zomas
- Global Medical Affairs - Oncology, Millennium Pharmaceuticals, Inc. a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Harry Miao
- Clinical Sciences , Millennium Pharmaceuticals, Inc. a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Ajibade Ashaye
- Global Evidence & Outcomes - Oncology, Millennium Pharmaceuticals, Inc. a wholly owned subsidiary of Takeda Pharmaceutical Company Limited , Cambridge, MA, USA
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Seshachalam A, Karpurmath SV, Rathnam K, Raman SG, Janarthinakani M, Prasad K, Patil C, Anoop P, Reddy N, Anumula SK, Roopa SP, Golamari KR, Danthala M, Gunari P, Malipatil B, Rangarajan B, Udupa KS, Nandennavar M, Niraimathi K, Shewade HD. Does Interim PET Scan After 2 Cycles of ABVD Predict Outcome in Hodgkin Lymphoma? Real-World Evidence. J Glob Oncol 2020; 5:1-13. [PMID: 31834832 PMCID: PMC6939745 DOI: 10.1200/jgo.19.00179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) improves overall survival (OS) in patients with Hodgkin lymphoma (HL) relative to ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy. However, the associated higher cost and toxicity discourage clinicians from prescribing it. Identifying high-risk patients and administering escalated BEACOPP remains an effective strategy. We assessed the significance of interim positron emission tomography (iPET) scan after 2 cycles (iPET2) in identifying this high-risk subset. PATIENTS AND METHODS This cohort study used secondary data from 12 tertiary care centers in South India gathered over 10 years (2008-2018). OS, event-free survival (EFS), determinants of EFS, and complete response (CR) in iPET2 were assessed. RESULTS The study included 409 patients with HL (mean age, 34.5 years; male/female ratio, 1.4:1). The median duration of follow-up was 2.8 years. Of 409 patients, 63% underwent PET-based staging and 37% underwent computerized tomography (CT) staging. Stage IV (28.9%) and bone involvement (9.2%) were seen more often with PET than with CT staging (9.2% and 2%, respectively). Among 171 patients with iPET2 results, 24% did not achieve CR, and no factors were significantly associated. The 5-year EFS and OS rates of the entire cohort were 78% and 97%, respectively. The 5-year EFS and OS rates of patients with CR on iPET2 were 90% and 99%, respectively, whereas these were 65% and 100%, respectively, for patients not achieving CR. On univariable analysis, sex, stage, and iPET2 response significantly predicted inferior EFS. On multivariate analysis, only iPET2 response significantly predicted EFS (P < .000). CONCLUSION Our study supports the use of PET for staging and iPET2 for response assessment. Nonachievement of CR on iPET2 indicates unfavorable outcome, and such patients may benefit from more intensive treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,Karuna Trust, Bengaluru, India
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Nair R, Kakroo A, Bapna A, Gogia A, Vora A, Pathak A, Korula A, Chakrapani A, Doval D, Prakash G, Biswas G, Menon H, Bhattacharya M, Chandy M, Parihar M, Vamshi Krishna M, Arora N, Gadhyalpatil N, Malhotra P, Narayanan P, Nair R, Basu R, Shah S, Bhave S, Bondarde S, Bhartiya S, Nityanand S, Gujral S, Tilak TVS, Radhakrishnan V. Management of Lymphomas: Consensus Document 2018 by an Indian Expert Group. Indian J Hematol Blood Transfus 2018; 34:398-421. [PMID: 30127547 PMCID: PMC6081314 DOI: 10.1007/s12288-018-0991-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 12/20/2022] Open
Abstract
The clinical course of lymphoma depends on the indolent or aggressive nature of the disease. Hence, the optimal management of lymphoma needs a correct diagnosis and classification as B cell, T-cell or natural killer (NK)/T-cell as well as indolent or high-grade type lymphoma. The current consensus statement, developed by experts in the field across India, is intended to help healthcare professionals manage lymphomas in adults over 18 years of age. However, it should be noted that the information provided may not be appropriate to all patients and individual patient circumstances may dictate alternative approaches. The consensus statement discusses the diagnosis, staging and prognosis applicable to all subtypes of lymphoma, and detailed treatment regimens for specific entities of lymphoma including diffuse large B-cell lymphoma, Hodgkin's lymphoma, follicular lymphoma, T-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, Burkitt's lymphoma, and anaplastic large cell lymphoma.
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Affiliation(s)
- Reena Nair
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | - Ajay Bapna
- Bhagwan Mahavir Cancer Hospital Research Center (BMCHRC), Jaipur, India
| | - Ajay Gogia
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | | | - Anu Korula
- Christian Medical College (CMC), Vellore, India
| | | | - Dinesh Doval
- Rajiv Gandhi Cancer Institute and Research Centre (RGCI), New Delhi, Delhi India
| | - Gaurav Prakash
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ghanashyam Biswas
- Sparsh Hospital American Oncology Institute (AOI), Bhubaneswar, India
| | - Hari Menon
- Cytecare Cancer Hospitals, Bangalore, India
| | | | - Mammen Chandy
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | - Mayur Parihar
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | - Neeraj Arora
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | - Pankaj Malhotra
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Rekha Nair
- Regional Cancer Centre (RCC), Thiruvananthapuram, India
| | - Rimpa Basu
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | - Sandip Shah
- Vedant Institute of Medical Sciences, Ahmedabad, India
| | - Saurabh Bhave
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | | | - Soniya Nityanand
- Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | | | | | - Vivek Radhakrishnan
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
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Das R, Ahluwalia J, Sachdeva MUS. Hematological Practice in India. Hematol Oncol Clin North Am 2016; 30:433-44. [DOI: 10.1016/j.hoc.2015.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Saikia TK. Managing advanced stage Hodgkin lymphoma. J Postgrad Med 2015; 61:75-6. [PMID: 25766336 PMCID: PMC4943447 DOI: 10.4103/0022-3859.153102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- T K Saikia
- Department of Medical Oncology and Research, Prince Aly Khan Hospital, Mumbai, Maharashtra, India
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