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Bou Zerdan M, Kassab J, Saba L, Haroun E, Bou Zerdan M, Allam S, Nasr L, Macaron W, Mammadli M, Abou Moussa S, Chaulagain CP. Liquid biopsies and minimal residual disease in lymphoid malignancies. Front Oncol 2023; 13:1173701. [PMID: 37228488 PMCID: PMC10203459 DOI: 10.3389/fonc.2023.1173701] [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: 02/25/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Minimal residual disease (MRD) assessment using peripheral blood instead of bone marrow aspirate/biopsy specimen or the biopsy of the cancerous infiltrated by lymphoid malignancies is an emerging technique with enormous interest of research and technological innovation at the current time. In some lymphoid malignancies (particularly ALL), Studies have shown that MRD monitoring of the peripheral blood may be an adequate alternative to frequent BM aspirations. However, additional studies investigating the biology of liquid biopsies in ALL and its potential as an MRD marker in larger patient cohorts in treatment protocols are warranted. Despite the promising data, there are still limitations in liquid biopsies in lymphoid malignancies, such as standardization of the sample collection and processing, determination of timing and duration for liquid biopsy analysis, and definition of the biological characteristics and specificity of the techniques evaluated such as flow cytometry, molecular techniques, and next generation sequencies. The use of liquid biopsy for detection of minimal residual disease in T-cell lymphoma is still experimental but it has made significant progress in multiple myeloma for example. Recent attempt to use artificial intelligence may help simplify the algorithm for testing and may help avoid inter-observer variation and operator dependency in these highly technically demanding testing process.
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Affiliation(s)
- Maroun Bou Zerdan
- Department of Internal Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | - Joseph Kassab
- Cleveland Clinic, Research Institute, Cleveland, OH, United States
| | - Ludovic Saba
- Department of Hematology-Oncology, Myeloma and Amyloidosis Program, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, United States
| | - Elio Haroun
- Department of Medicine, State University of New York (SUNY) Upstate Medical University, New York, NY, United States
| | | | - Sabine Allam
- Department of Medicine and Medical Sciences, University of Balamand, Balamand, Lebanon
| | - Lewis Nasr
- University of Texas MD Anderson Cancer Center, Texas, TX, United States
| | - Walid Macaron
- University of Texas MD Anderson Cancer Center, Texas, TX, United States
| | - Mahinbanu Mammadli
- Department of Internal Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | | | - Chakra P. Chaulagain
- Department of Hematology-Oncology, Myeloma and Amyloidosis Program, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, United States
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Gotti M, Sciarra R, Pulsoni A, Merli F, Luminari S, Zerbi C, Trentin L, Re A, Rusconi C, Viviani S, Rossi A, Cocito F, Botto B, Meli E, Pinto A, Dogliotti I, Gini G, Puccini B, Ricci F, Nassi L, Fabbri A, Liberati AM, Merli M, Filippi AR, Bonfichi M, Zoboli V, Tartaglia G, Annechini G, D’Elia GM, Del Giudice I, Alvarez I, Visentin A, Pravato S, Dalceggio D, Pagani C, Ferrari S, Cristinelli C, Lazic T, Ferretti VV, Ricardi U, Arcaini L. Role of Rituximab Addition to First-line Chemotherapy Regimens in Nodular Lymphocyte-predominant Hodgkin Lymphoma: A Study by Fondazione Italiana Linfomi. Hemasphere 2023; 7:e837. [PMID: 37034003 PMCID: PMC10079338 DOI: 10.1097/hs9.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/29/2022] [Indexed: 04/08/2023] Open
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare entity whose neoplastic cells retain a B-cell phenotype with expression of CD20. Radiotherapy is recommended for favorable stage IA disease while for other stages guidelines suggest therapeutic strategies similar to those used for classic HL. The role of rituximab, although quite widespread, is not completely elucidated. We retrospectively analyzed baseline characteristics of 308 consecutive patients with NLPHL diagnosed in 19 Italian centers from 2000 to 2018. With a median follow-up of 8.4 years (interquartile range: 4.5–12.4) for treated patients, median overall survival (OS) was not reached and estimated 5-year OS was 97.8% and 5-year progression-free survival (PFS) was 84.5%. Five-year cumulative incidence of histological transformation was 1.4%, 95% confidence interval (CI), 0.5%-3.8%. After adjusting for lymphocyte count, splenic involvement, bulky disease and B symptoms (fever, drenching night sweats, unintentional loss >10% of body weight within the preceding 6 months), patients with stage II or more showed superior PFS with immunochemotherapy in comparison to chemotherapy alone (hazard ratio = 0.4, 95% CI, 0.2-0.8; P = 0.015). Our data suggest an advantage of the use of rituximab combined with chemotherapy ± radiotherapy in the treatment of stage II–III–IV NLPHL.
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Affiliation(s)
- Manuel Gotti
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Sciarra
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Italy
| | - Alessandro Pulsoni
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Francesco Merli
- Division of Hematology, Azienda USL-IRCCS of Reggio Emilia, Italy
| | - Stefano Luminari
- Division of Hematology, Azienda USL-IRCCS of Reggio Emilia, Italy
- Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy
| | - Caterina Zerbi
- Department of Molecular Medicine, University of Pavia, Italy
| | - Livio Trentin
- Hematology Unit, Department of Medicine - DIMED, University of Padova, Italy
| | - Alessandro Re
- Division of Hematology, Spedali Civili, Brescia, Italy
| | - Chiara Rusconi
- Division of Hematology and Blood Marrow Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Simonetta Viviani
- Division of Hematology and Blood Marrow Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Rossi
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federica Cocito
- Division of Hematology, ASST Monza, Ospedale S. Gerardo, Monza, Italy
| | - Barbara Botto
- Division of Hematology, Azienda Ospedale Città della Salute e della Scienza, Torino, Italy
| | - Erika Meli
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Antonello Pinto
- Hematology-Oncology and Stem-Cell Transplantation Unit, Department of Hematology and Developmental Therapeutics, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Napoli, Italy
| | - Irene Dogliotti
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Italy
| | - Guido Gini
- Department of Hematology, Ospedali Riuniti, Ancona, Italy
| | | | - Francesca Ricci
- Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
| | - Luca Nassi
- Hematology, Department of Translational Medicine, AOU Maggiore della Carità and University of Eastern Piedmont, Novara, Italy
| | - Alberto Fabbri
- Division of Hematology, Azienda Ospedaliero- Universitaria Senese, Siena, Italy
| | - Anna Marina Liberati
- Division of Hematology, Azienda Ospedalaliera S. Maria di terni – Università degli Studi di Perugia, Italy
| | - Michele Merli
- Division of Hematology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Andrea Riccardo Filippi
- Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Maurizio Bonfichi
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Zoboli
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Germana Tartaglia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Giorgia Annechini
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Gianna Maria D’Elia
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Isabel Alvarez
- Division of Hematology, Azienda USL-IRCCS of Reggio Emilia, Italy
| | - Andrea Visentin
- Hematology Unit, Department of Medicine - DIMED, University of Padova, Italy
| | - Stefano Pravato
- Hematology Unit, Department of Medicine - DIMED, University of Padova, Italy
| | | | - Chiara Pagani
- Division of Hematology, Spedali Civili, Brescia, Italy
| | - Silvia Ferrari
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Tanja Lazic
- Department of Molecular Medicine, University of Pavia, Italy
| | - Virginia Valeria Ferretti
- Service of Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Umberto Ricardi
- Radiation Oncology, Department of Oncology, University of Turin, Italy
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Italy
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Oliveira BCD, Zica CDVA, Santos GCCD, Faria GF, Freire GS, Paim HO, Rezende LNP, Alencar MDSG, Faria STDR. A Terapêutica Cirúrgica e o Protocolo DH-II-90 no Tratamento da Doença de Hodgkin em Jovens e Adultos: um Estudo Ecológico. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n3.2200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Introdução: A doença de Hodgkin (DH) e uma patologia que se inicia nos linfonodos, desenvolve-se nos tecidos neoplásicos e manifesta-se, majoritariamente, em jovens adultos. Objetivo: Correlacionar os resultados da terapêutica cirúrgica e do protocolo DH-II-90 em jovens adultos acometidos pela DH, e associa-los ao perfil epidemiológico, aos dados de mortalidade pela doença e a distribuição de recursos físicos no Brasil. Método: Estudo ecológico exploratório, com informações coletadas do Departamento de Informática do Sistema Único de Saúde (DATASUS), do Instituto Nacional de Câncer Jose Alencar Gomes da Silva (INCA), do Cadastro Nacional de Estabelecimentos de Saúde (CNES) e do Sistema de Informações Ambulatoriais do SUS (SIA/SUS), entre 2013 e 2021. O estudo, portanto, compara os resultados da terapêutica cirúrgica e do protocolo DH-II-90 associados a dados epidemiológicos, sendo o protocolo considerado o método mais eficiente, por apresentar melhores resultados quando comparado a métodos mais invasivos. Resultados: A Região Sudeste concentra maior número de leitos e procedimentos com números mais expressivos de pacientes diagnosticados de 0 a 29 anos. Em resumo, as taxas de mortalidade bruta por DH reduziram-se a partir de 1990, período no qual o protocolo DH-II-90 foi aplicado. Conclusão: O presente estudo fornece uma visão relevante sobre o perfil epidemiológico da DH e contribui para a comparação entre a terapêutica cirúrgica e o protocolo DH-II-90, sendo possível concluir que, apos a aplicação do protocolo, houve redução da taxa de mortalidade por DH no Brasil e no mundo.
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Saniasiaya J. Mediastinal lymphoma presenting with asymmetrical chest wall. BMJ Case Rep 2022; 15:e246953. [PMID: 34996771 PMCID: PMC8744107 DOI: 10.1136/bcr-2021-246953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/04/2022] Open
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Xu Y, Izumi R, Nguyen H, Kwan A, Kuo H, Madere J, Slatter JG, Podoll T, Vishwanathan K, Marbury T, Smith W, Preston RA, Sharma S, Ware JA. Evaluation of the Pharmacokinetics and Safety of a Single Dose of Acalabrutinib in Subjects With Hepatic Impairment. J Clin Pharmacol 2021; 62:812-822. [PMID: 34897701 PMCID: PMC9303693 DOI: 10.1002/jcph.2013] [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: 05/10/2021] [Accepted: 12/10/2021] [Indexed: 11/07/2022]
Abstract
Acalabrutinib received approval for treatment of adult patients with mantle cell lymphoma who received at least one prior therapy and adult patients with chronic lymphocytic leukemia or small lymphocytic lymphoma. This study investigated the impact of hepatic impairment (HI) on acalabrutinib PK and safety at a single 50-mg dose in fasted subjects. This study was divided into two studies: study 1, an open-label, parallel-group study in Child-Pugh Class A or B subjects and healthy subjects, and study 2, an open-label, parallel-group study in Child-Pugh Class C subjects and healthy subjects. Baseline characteristics and safety profiles were similar across groups. Acalabrutinib exposure (area under the curve [AUC]) increased slightly (1.90- and 1.48-fold) in subjects with mild (Child-Pugh Class A) and moderate (Child-Pugh Class B) HI compared with healthy subjects. In severe HI (Child-Pugh Class C), acalabrutinib exposure (AUC and maximum concentration [Cmax ]) increased approximately 5.0-fold and 3.6-fold, respectively. Results were consistent across total and unbound exposures. Severe HI did not impact total/unbound metabolite (ACP-5862) exposures; metabolite to parent ratio decreased to 0.6 - 0.8 (versus 3.1 - 3.6 in healthy subjects). In summary, single oral dose of 50 mg acalabrutinib was safe and well tolerated in subjects with mild, moderate and severe HI and in healthy control subjects. In subjects with severe HI, mean acalabrutinib exposure increased by up to 5-fold and should be avoided. Acalabrutinib does not require dose adjustment in patients with mild or moderate HI. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yan Xu
- Quantitative Clinical Pharmacology, AstraZeneca, South San Francisco, CA, USA
| | - Raquel Izumi
- Clinical Development, AstraZeneca, South San Francisco, CA, USA
| | - Helen Nguyen
- Clinical Development, AstraZeneca, South San Francisco, CA, USA
| | - Anna Kwan
- Clinical Development, AstraZeneca, South San Francisco, CA, USA
| | - Howard Kuo
- Quantitative Clinical Pharmacology, AstraZeneca, South San Francisco, CA, USA
| | - Jeannine Madere
- Clinical Development, AstraZeneca, South San Francisco, CA, USA
| | - J Greg Slatter
- Quantitative Clinical Pharmacology, AstraZeneca, South San Francisco, CA, USA
| | - Terry Podoll
- Quantitative Clinical Pharmacology, AstraZeneca, South San Francisco, CA, USA
| | - Karthick Vishwanathan
- Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, AstraZeneca, Boston, MA, USA
| | | | - William Smith
- Alliance for Multispecialty Research, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Richard A Preston
- Division of Clinical Pharmacology, Department of Medicine, The Peggy and Harold Katz Family Drug Discovery Center, University of Miami Clinical and Translational Science Institutes (CTSI), University of Miami, Miami, FL, USA
| | - Shringi Sharma
- Quantitative Clinical Pharmacology, AstraZeneca, South San Francisco, CA, USA
| | - Joseph A Ware
- Quantitative Clinical Pharmacology, AstraZeneca, South San Francisco, CA, USA
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Rodday AM, Hahn T, Kumar AJ, Lindenauer PK, Friedberg JW, Evens AM, Parsons SK. Association of Treatment Intensity With Survival in Older Patients With Hodgkin Lymphoma. JAMA Netw Open 2021; 4:e2128373. [PMID: 34673965 PMCID: PMC8531990 DOI: 10.1001/jamanetworkopen.2021.28373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Hodgkin lymphoma is an aggressive blood cancer that is highly curable in younger patients who receive multiagent chemotherapy. Worse survival in older patients may reflect less-aggressive treatment, competing risks of death, or different disease biological factors. OBJECTIVE To examine the association between treatment intensity and cause-specific mortality among older adults with Hodgkin lymphoma. DESIGN, SETTING, AND PARTICIPANTS This was a population-based cohort study of patients aged 65 years or older with Medicare Part A and B fee-for-service coverage who received a diagnosis of Hodgkin lymphoma from 2000 to 2013. The association between treatment intensity and cause-specific mortality was estimated separately for early-stage and advanced-stage disease with Cox proportional hazards models. Multivariable adjustment and propensity score weighting helped control for confounding. Data are from the 1999 to 2016 Surveillance, Epidemiology, and End Results Medicare database. Data analysis was performed from April 2020 to June 2021. EXPOSURES First-line treatment categorized as (1) full chemotherapy regimen, (2) partial chemotherapy regimen, (3) single chemotherapy agent or radiotherapy, or (4) no treatment. MAIN OUTCOMES AND MEASURES The main outcome was 3-year Hodgkin lymphoma-specific and other-cause mortality. RESULTS Among 2686 patients (mean [SD] age, 75.7 [6.9] years; 1333 men [50%]), 1307 had early-stage disease and 1379 had advanced-stage disease. For Hodgkin lymphoma-specific mortality in patients with early-stage disease, hazard ratios (HRs) were higher for partial regimens (HR, 1.77; 95% CI, 1.22-2.57) or no treatment (HR, 1.91; 95% CI, 1.31-2.79) than for full regimens; there was no difference between single-agent chemotherapy or radiotherapy and full regimens. For other-cause mortality in patients with early-stage disease, HRs were higher for partial regimens (HR, 1.69; 95% CI, 1.18-2.44), single-agent chemotherapy or radiotherapy (HR, 1.62; 95% CI, 1.13-2.33), or no treatment (HR, 2.71; 95% CI, 1.95-3.78) than for full regimens. For Hodgkin lymphoma-specific mortality in patients with advanced-stage disease, HRs were higher for partial regimens (HR, 3.26; 95% CI, 2.44-4.35), single-agent chemotherapy or radiotherapy (HR, 2.85; 95% CI, 1.98-4.11), or no treatment (HR, 4.06; 95% CI, 3.06-5.37) than for full regimens. For other-cause mortality in patients with advanced-stage disease, HRs were higher for partial regimens (HR, 1.76; 95% CI, 1.32-2.33), single-agent chemotherapy or radiotherapy (HR, 1.65; 95% CI, 1.15-2.37), or no treatment (HR, 2.24; 95% CI, 1.71-2.94) than for full regimens. CONCLUSIONS AND RELEVANCE This cohort study found variability in the magnitude of the association between treatment intensity and mortality by stage and cause-specific mortality, possibly reflecting competing risks of death. However, full chemotherapy regimens were associated with lower mortality and could be considered for older adults who can tolerate them.
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Affiliation(s)
- Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Theresa Hahn
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Anita J. Kumar
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Peter K. Lindenauer
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School Baystate, Springfield
| | | | | | - Susan K. Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
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Kahn JM, Maguire FB, Li Q, Abrahão R, Flerlage JE, Alvarez E, Keegan THM. Initial cancer treatment and survival in children, adolescents, and young adults with Hodgkin lymphoma: A population-based study. Cancer 2021; 127:4613-4619. [PMID: 34494662 DOI: 10.1002/cncr.33868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hodgkin lymphoma (HL) is a treatable tumor affecting children, adolescents and young adults (AYAs; 15-39 years old). Population-based studies report worse survival for non-White children and AYAs but have limited data on individual therapeutic exposures. This study examined overall and HL-specific survival in a population-based cohort of patients while adjusting for sociodemographic factors and treatment. METHODS Data for 4807 patients younger than 40 years with HL (2007-2017) were obtained from the California Cancer Registry. Individual treatment information was extracted from text fields; chemotherapy regimens were defined by standard approaches for pediatric and adult HL. Multivariable Cox models examined the influence of patient and treatment factors on survival. RESULTS At a median follow-up of 4.4 years, 95% of the patients were alive. Chemotherapy differed by age, with 70% of 22- to 39-year-olds and 41% of <22-year-olds receiving doxorubicin, bleomycin, vinblastine, and dacarbazine (P < .001). In multivariable models, older patients (22-39 vs < 21 y; hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.11-2.10), Black (vs White patients); HR, 1.90; 95% CI, 1.25-2.88), and Hispanic patients (HR, 1.45; 95% CI, 1.06-1.99) experienced worse survival; among those < 21 y, Black race was associated with a 3.3-fold increased risk of death (HR, 3.26; 95% CI, 1.43-7.42). CONCLUSIONS In children and AYAs with HL, older age and non-White race/ethnicity predicted worse survival after adjustments for treatment data. Further work is needed to identify the biological and nonbiological factors driving disparities in these at-risk populations.
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Affiliation(s)
- Justine M Kahn
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Frances B Maguire
- California Cancer Reporting and Epidemiologic Surveillance Program, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Qian Li
- Center for Oncology Hematology Outcomes Research and Training and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, California
| | - Renata Abrahão
- Center for Oncology Hematology Outcomes Research and Training and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, California.,Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, California
| | - Jamie E Flerlage
- Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, California.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Elysia Alvarez
- Center for Oncology Hematology Outcomes Research and Training and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, California.,Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California
| | - Theresa H M Keegan
- Center for Oncology Hematology Outcomes Research and Training and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, California
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How I treat nodular lymphocyte-predominant Hodgkin lymphoma. Blood 2020; 136:2987-2993. [DOI: 10.1182/blood.2019004044] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 08/25/2020] [Indexed: 12/19/2022] Open
Abstract
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare lymphoma entity with distinct pathologic and clinical characteristics. Unlike the malignant cells in classical Hodgkin lymphoma, the disease-defining lymphocyte-predominant cells in NLPHL are consistently positive for CD20, but do not express CD30. The clinical course of NLPHL is indolent in the majority of cases. Most patients present with early-stage disease at the initial diagnosis. First-line treatment of stage IA NLPHL usually consists of limited-field radiotherapy alone. Patients with early-stage NLPHL other than stage IA and intermediate-stage disease mostly receive combined-modality treatment, whereas individuals with advanced NLPHL are treated with chemotherapy alone. In relapsed NLPHL, conventional chemotherapy, anti-CD20 antibodies, and radiotherapy represent active treatment modalities. Only patients with poor-risk characteristics such as early disease recurrence are candidates for aggressive salvage treatment with high-dose chemotherapy and autologous stem cell transplantation. The overall and relative survival of patients with NLPHL is excellent as indicated by a low excess mortality compared with the general population. This article discusses treatment options for patients with NLPHL and factors that influence the choice of therapy on the basis of the available data and 2 clinical cases.
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Rodday AM, Hahn T, Kumar AJ, Lindenauer PK, Friedberg JW, Evens AM, Parsons SK. First-line treatment in older patients with Hodgkin lymphoma: a Surveillance, Epidemiology, and End Results (SEER)-Medicare population-based study. Br J Haematol 2020; 190:222-235. [PMID: 32090325 PMCID: PMC7368808 DOI: 10.1111/bjh.16525] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/14/2020] [Indexed: 11/26/2022]
Abstract
While Hodgkin lymphoma (HL) is highly curable in younger patients, older patients have higher relapse and death rates, which may reflect age-related factors, distinct disease biology and/or treatment decisions. We described the association between patient, disease and geographic factors and first-line treatment in older patients (≥65 years) with incident HL using Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 1999 to 2014 (n = 2825). First-line treatment initiated at ≤4 months after diagnosis was categorised as: full chemotherapy regimen (n = 699, 24·7%); partial chemotherapy regimen (n = 1016, 36·0%); single chemotherapy agent or radiotherapy (n = 382, 13·5%); and no treatment (n = 728, 25·8%). Among the fully treated, ABVD [doxorubicin (Adriamycin), bleomycin, vinblastine, dacarbazine]/AVD was most common (n = 635, 90·8%). Adjusted multinomial logistic regression identified factors associated with treatment. Older age, Medicaid dual eligibility, not married, frailty, cardiac comorbidity, prior cancer, earlier diagnosis date, histology, advanced disease Stage, B symptoms and South region were independently associated with increased odds of not receiving full chemotherapy regimens. In conclusion, we found variability in first-line HL treatment for older patients. Treatment differences by Medicaid and region may indicate disparities. Even after adjusting for frailty and cardiac comorbidity, age was associated with treatment, suggesting factors such as end-of-life care or shared decision-making may influence treatment in older patients.
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Affiliation(s)
- Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Theresa Hahn
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Anita J. Kumar
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Peter K. Lindenauer
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School - Baystate, Springfield, MA
| | | | - Andrew M. Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Susan K. Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
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Glober G, Gunther J, Fang P, Milgrom S, Korivi BR, Jensen CT, Wagner-Bartak NA, Ahmed S, Lee HJ, Nair R, Steiner R, Parmar S, Iyer S, Westin J, Fayad L, Rodriguez MA, Neelapu S, Nastoupil L, Flowers CR, Dabaja BS, Pinnix CC. Imaging Surveillance of Limited-stage Classic Hodgkin Lymphoma Patients After PET-CT-documented First Remission. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:533-541. [PMID: 32291233 PMCID: PMC10071957 DOI: 10.1016/j.clml.2020.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/03/2020] [Accepted: 02/09/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Early stage Hodgkin lymphoma (ESHL) is highly curable; however, 10% to 15% of patients experience relapse. We examined the utilization of follow-up imaging for patients with ESHL who achieved a metabolic complete response after upfront therapy. MATERIALS AND METHODS The records of adult patients treated at a single institution between 2003 and 2014 were reviewed. Positron emission tomography-computed tomography (PET-CT) and CT scan frequency was quantified during the 2 years following treatment and subsequent visits beyond 2 years. RESULTS The study cohort contained 179 patients. The median age was 31 years; bulky disease was present in 30%. ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) or AVD (doxorubicin, vinblastine, and dacarbazine) was given in 97%; 75% received radiation therapy. At a median follow-up of 6.9 years, the 5-year progression-free and overall survival rates were 93.7% and 98.1%, respectively. Relapse occurred in 5% (n = 9) of patients at a median of 9.1 months (range, 4.6-27.2 months) from therapy. Two patients presented with symptoms prompting imaging in follow-up. Within 2 years after therapy, 376 PET-CT scans and 3325 CT scans were performed, yielding an average of 2.1 PET-CTs and 18.6 CTs per patient. Of the initial 179 patients, 113 had follow-up conducted beyond 2 years post-therapy; an average of 2.7 PET-CTs and 33.2 CTs were performed. In the 2-year post-therapy period, 463 scans were performed per relapse detected. CONCLUSION In this cohort of patients with ESHL who responded completely to frontline therapy, the relapse rate was low. Routine imaging surveillance lacks clinical benefit in this patient population.
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Affiliation(s)
- Gordon Glober
- University of Central Florida College of Medicine, Orlando, FL
| | - Jillian Gunther
- Departments of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Penny Fang
- Departments of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Sarah Milgrom
- Department of Radiation Oncology, University of Colorado, Denver, CO
| | - Brinda Rao Korivi
- Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, TX
| | - Corey T Jensen
- Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, TX
| | | | - Sairah Ahmed
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Hun Ju Lee
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Ranjit Nair
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Raphael Steiner
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Simrit Parmar
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Swaminathan Iyer
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Jason Westin
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Luis Fayad
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - M Alma Rodriguez
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Sattva Neelapu
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | - Loretta Nastoupil
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, Houston, TX
| | | | - Bouthaina S Dabaja
- Departments of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Chelsea C Pinnix
- Departments of Radiation Oncology, MD Anderson Cancer Center, Houston, TX.
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11
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Novo M, Nowakowski GS, Habermann TM, Witzig TE, Micallef IN, Johnston PB, Inwards DJ, Botto B, Ristow KM, Young JR, Vitolo U, Ansell SM. Persistent mediastinal FDG uptake on PET-CT after frontline therapy for Hodgkin lymphoma: biopsy, treat or observe? Leuk Lymphoma 2019; 61:318-327. [DOI: 10.1080/10428194.2019.1663422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mattia Novo
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Torino, Italy
| | | | | | | | | | | | | | - Barbara Botto
- Division of Hematology, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Torino, Italy
| | - Kay M. Ristow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Jason R. Young
- Division of Nuclear Medicine, Mayo Clinic, Rochester, MN, USA
| | - Umberto Vitolo
- Division of Hematology, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Torino, Italy
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12
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Milgrom SA, Elhalawani H, Lee J, Wang Q, Mohamed ASR, Dabaja BS, Pinnix CC, Gunther JR, Court L, Rao A, Fuller CD, Akhtari M, Aristophanous M, Mawlawi O, Chuang HH, Sulman EP, Lee HJ, Hagemeister FB, Oki Y, Fanale M, Smith GL. A PET Radiomics Model to Predict Refractory Mediastinal Hodgkin Lymphoma. Sci Rep 2019; 9:1322. [PMID: 30718585 PMCID: PMC6361903 DOI: 10.1038/s41598-018-37197-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 12/03/2018] [Indexed: 12/14/2022] Open
Abstract
First-order radiomic features, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), are associated with disease progression in early-stage classical Hodgkin lymphoma (HL). We hypothesized that a model incorporating first- and second-order radiomic features would more accurately predict outcome than MTV or TLG alone. We assessed whether radiomic features extracted from baseline PET scans predicted relapsed or refractory disease status in a cohort of 251 patients with stage I-II HL who were managed at a tertiary cancer center. Models were developed and tested using a machine-learning algorithm. Features extracted from mediastinal sites were highly predictive of primary refractory disease. A model incorporating 5 of the most predictive features had an area under the curve (AUC) of 95.2% and total error rate of 1.8%. By comparison, the AUC was 78% for both MTV and TLG and was 65% for maximum standardize uptake value (SUVmax). Furthermore, among the patients with refractory mediastinal disease, our model distinguished those who were successfully salvaged from those who ultimately died of HL. We conclude that our PET radiomic model may improve upfront stratification of early-stage HL patients with mediastinal disease and thus contribute to risk-adapted, individualized management.
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Affiliation(s)
- Sarah A Milgrom
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA.
| | - Hesham Elhalawani
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Joonsang Lee
- Department of Radiation Physics, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Qianghu Wang
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Bouthaina S Dabaja
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Chelsea C Pinnix
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jillian R Gunther
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Laurence Court
- Department of Radiation Physics, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Arvind Rao
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA.,Department of Bioinformatics and Computational Biology, Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Mani Akhtari
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Michalis Aristophanous
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Osama Mawlawi
- Department of Imaging Physics, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hubert H Chuang
- Department of Nuclear Medicine, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erik P Sulman
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Translational Molecular Pathology, Division of Pathology/Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hun J Lee
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Frederick B Hagemeister
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yasuhiro Oki
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle Fanale
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Grace L Smith
- Department of Radiation Oncology, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
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13
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Petralia G, Padhani AR. Whole-Body Magnetic Resonance Imaging in Oncology: Uses and Indications. Magn Reson Imaging Clin N Am 2019; 26:495-507. [PMID: 30316463 DOI: 10.1016/j.mric.2018.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Whole-body MRI (WB-MRI) has emerged as a radiation-free method for the diagnosis, staging, and therapy response assessments in cancer patients. This article reviews the current roles for WB-MRI in the clinical context of limitations of currently used techniques, focusing on bone marrow disease applications. Indication for broader clinical use are discussed, including guideline recommendations. The emerging screening role of WB-MRI in subjects at high risk of cancer is discussed, as is normal population screening.
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Affiliation(s)
- Giuseppe Petralia
- Department of Radiology, IEO - European Institute of Oncology IRCCS, Via Ripamonti, 435, Milan 20141, Italy; Department of Oncology and Hematology, University of Milan, Via Festa del Perdono 7, Milan 20122, Italy.
| | - Anwar R Padhani
- MR unit, Paul Strickland Scanner Centre, Mount Vernon Hospital, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK
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14
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Petralia G, Padhani AR, Pricolo P, Zugni F, Martinetti M, Summers PE, Grazioli L, Colagrande S, Giovagnoni A, Bellomi M. Whole-body magnetic resonance imaging (WB-MRI) in oncology: recommendations and key uses. Radiol Med 2018; 124:218-233. [PMID: 30430385 DOI: 10.1007/s11547-018-0955-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/23/2018] [Indexed: 12/16/2022]
Abstract
The past decade has witnessed a growing role and increasing use of whole-body magnetic resonance imaging (WB-MRI). Driving these successes are developments in both hardware and software that have reduced overall examination times and significantly improved MR imaging quality. In addition, radiologists and clinicians have continued to find promising new applications of this innovative imaging technique that brings together morphologic and functional characterization of tissues. In oncology, the role of WB-MRI has expanded to the point of being recommended in international guidelines for the assessment of several cancer histotypes (multiple myeloma, melanoma, prostate cancer) and cancer-prone syndromes (Li-Fraumeni and hereditary paraganglioma-pheochromocytoma syndromes). The literature shows growing use of WB-MRI for the staging and follow-up of other cancer histotypes and cancer-related syndromes (including breast cancer, lymphoma, neurofibromatosis, and von Hippel-Lindau syndromes). The main aim of this review is to examine the current scientific evidence for the use of WB-MRI in oncology.
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Affiliation(s)
- Giuseppe Petralia
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hematology, University of Milan, Milan, Italy.,Advanced Screening Centers - ASC Italia, Castelli Calepio, Bergamo, Italy
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK
| | - Paola Pricolo
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Fabio Zugni
- Postgraduate School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Marco Martinetti
- Advanced Screening Centers - ASC Italia, Castelli Calepio, Bergamo, Italy
| | - Paul E Summers
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Luigi Grazioli
- First Department of Radiology, Civic and University Hospital of Brescia, Brescia, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Massimo Bellomi
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hematology, University of Milan, Milan, Italy.,Advanced Screening Centers - ASC Italia, Castelli Calepio, Bergamo, Italy
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15
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Sasse S, Goergen H, Plütschow A, Böll B, Eichenauer DA, Fuchs M, Behringer K, Zijlstra JM, Greil R, Markova J, Topp MS, Meissner J, Neubauer A, Baues C, Engert A, Borchmann P, von Tresckow B. Outcome of Patients With Early-Stage Infradiaphragmatic Hodgkin Lymphoma: A Comprehensive Analysis From the German Hodgkin Study Group. J Clin Oncol 2018; 36:2603-2611. [PMID: 29989855 DOI: 10.1200/jco.2018.78.7192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The prognostic effect of isolated infradiaphragmatic involvement in Hodgkin lymphoma (HL) is controversial, and there are little data about patients treated with current therapies. Therefore, we performed a risk factor analysis to focus on isolated nodal infradiaphragmatic disease in patients treated within the German Hodgkin Study Group trials HD13 (clinical trial information: ISRCTN63474366) and HD14 (clinical trial information: ISRCTN04761296) for early-stage HL. Patients and Methods Characteristics and outcomes of patients who had infradiaphragmatic HL were compared with patients who had supradiaphragmatic disease. Progression-free survival (PFS) and overall survival (OS) were estimated according to Kaplan-Meier methods and were compared between groups using the log-rank test and Cox proportional hazards regression, which was also applied for multivariable analyses that adjusted for relevant baseline characteristics. Results Of 2,903 qualified patients, 223 (7.7%) were diagnosed with isolated nodal infradiaphragmatic disease. In general, these patients were older, had a poorer performance status, were more often male, and had the nodular sclerosis subtype less often than those with supradiaphragmatic disease. After a median follow-up time of 51 months, PFS and OS were significantly worse in patients with infradiaphragmatic disease (5-year PFS and OS, 80.1% and 91.5% v 91.2% and 97.6% in patients with supradiaphragmatic disease; each P < .001). In multivariable analyses, infradiaphragmatic HL remained a significant risk factor in terms of PFS (hazard ratio [HR], 1.5; 95% CI, 1.04 to 2.2; P = .03) and OS (HR, 2.0; 95% CI, 1.2 to 3.5; P = .01). However, inferior PFS and OS could not be observed among those patients treated with the more intensive chemotherapy (two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine [ABVD] in HD13, and two cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone [BEACOPPescalated] plus two cycles of ABVD in HD14; all patients received 30 Gy of involved-field radiotherapy). Conclusion Early-stage HL that presents with infradiaphragmatic disease only represents a distinct patient group with an inferior outcome. However, this adverse outcome can be outweighed by appropriate combined modality treatment.
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Affiliation(s)
- Stephanie Sasse
- Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Helen Goergen
- Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Annette Plütschow
- Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Boris Böll
- Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Dennis A Eichenauer
- Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Michael Fuchs
- Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Karolin Behringer
- Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Joseé M Zijlstra
- Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Richard Greil
- Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jana Markova
- Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Max S Topp
- Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Julia Meissner
- Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Andreas Neubauer
- Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Christian Baues
- Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Andreas Engert
- Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Peter Borchmann
- Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Bastian von Tresckow
- Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
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16
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Contrast-Enhanced Ultrasound Improves the Pathological Outcomes of US-Guided Core Needle Biopsy That Targets the Viable Area of Anterior Mediastinal Masses. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9825709. [PMID: 29581992 PMCID: PMC5822857 DOI: 10.1155/2018/9825709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/18/2017] [Indexed: 01/13/2023]
Abstract
Based on the option that ultrasound-guided core needle biopsy (US-CNB) of the enhanced portion of anterior mediastinal masses (AMMs) identified by contrast-enhanced ultrasound (CEUS) would harvest viable tissue and benefit the histological diagnoses, a retrospective study was performed to elucidate the correlation between the prebiopsy CEUS and diagnostic yield of AMMs and found that CEUS potentially improved the diagnostic yield of AMMs compared with conventional US with a significant increase in the cellularity of samples. Furthermore, the marginal blood flow signals and absence of necrosis can predict the diagnostic yield of AMM. It was concluded that US-CNB of the viable part of AMMs, as verified by CEUS, was able to harvest sufficient tissue with more cellularity that could be used for ancillary studies and improve the diagnostic yield. And CEUS was recommended to those patients with AMMs undergoing repeated US-CNB, with the absence of marginal blood signals or presence of necrosis.
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17
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Pharmacokinetics of dacarbazine (DTIC) in pregnancy. Cancer Chemother Pharmacol 2018; 81:455-460. [PMID: 29305638 DOI: 10.1007/s00280-017-3511-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/28/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this report is to describe, for the first time, the pharmacokinetics of dacarbazine (DTIC) and its metabolites [5-[3-methyl-triazen-1-yl]-imidazole-4-carboxamide (MTIC), 5-[3-hydroxymethyl-3-methyl-triazen-1-yl]-imidazole-4-carboxamide (HMMTIC) and 5-aminoimidazole-4-carboxamide (AIC)] during pregnancy (n = 2) and postpartum (n = 1). METHODS Non-compartmental DTIC, MTIC, HMMTIC, and AIC pharmacokinetics (PK) were estimated in one case at 29 week gestation and 18 day postpartum and a second case at 32 week gestation, in women receiving DTIC in combination with doxorubicin, bleomycin, and vinblastine for treatment of Hodgkin's lymphoma. Drug concentrations were measured by HPLC. RESULTS In the subject who completed both pregnancy and postpartum study days, DTIC area under the concentration-time curve (AUC) was 27% higher and metabolite AUCs were lower by 27% for HMMTIC, 38% for MTIC, and 83% of AIC during pregnancy compared to postpartum. At 7 and 9 year follow-up, both subjects were in remission of their Hodgkin's lymphoma. CONCLUSIONS Based on these two case reports, pregnancy appears to decrease the metabolism of the pro-drug dacarbazine, likely through inhibition of CYP1A2 activity. Lower concentrations of active metabolites and decreased efficacy may result, although both these subjects experienced long-term remission of their Hodgkin's lymphoma.
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18
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Bender Ignacio R, Ghadrshenas M, Low D, Orem J, Casper C, Phipps W. HIV Status and Associated Clinical Characteristics Among Adult Patients With Cancer at the Uganda Cancer Institute. J Glob Oncol 2017; 4:1-10. [PMID: 30241139 PMCID: PMC6181185 DOI: 10.1200/jgo.17.00112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose HIV increases cancer incidence and mortality. In Uganda, the HIV epidemic has
led to an elevated incidence of AIDS-defining cancers (ADCs) and
non–AIDS-defining cancers (NADCs). Limited information exists about
how frequently HIV infection complicates the presentation and manifestations
of cancer in sub-Saharan Africa. Methods We abstracted medical records from patients with cancer who were age 18 years
or older who registered at the Uganda Cancer Institute from June through
September 2015 to determine the burden of HIV. We used χ2
tests and generalized linear models to evaluate factors associated with HIV
positivity. A sensitivity analysis estimated HIV prevalence in those
untested. Results Among 1,137 patients with cancer, 23% were HIV infected, 48% were HIV
negative, and 29% had no recorded HIV status. Of those with recorded HIV
status, 32% were HIV positive. Forty-two percent (149 of 361 patients) with
ADCs were documented as HIV infected (51% of those with documented status)
compared with 14% (108 of 776 patients) of those with NADCs (21% of those
with documented status). In multivariable analysis, HIV infection was
associated with ADC diagnosis (adjusted prevalence ratio [aPR] compared with
NADC, 2.2; 95% CI, 1.5 to 3.0), younger age (aPR, 0.9 per decade increase;
95% CI, 0.8 to 1.0), and worse performance status scores (aPR, 1.2 per point
ECOG increase; 95% CI, 1.0 to 1.5). When sensitivity analysis accounted for
undocumented HIV status, the expected prevalence of HIV infection was 29%
(range, 23% to 32%), and almost one fourth of expected HIV cases were
undiagnosed or unrecorded. Conclusion The prevalence of HIV infection among Ugandan patients with cancer is
substantially higher than in the general population. Patients with cancer
and HIV tend to be younger and have poorer performance status. Greater
awareness of the dual burden of cancer and HIV in Uganda and universal
testing of patients with cancer may improve outcomes of HIV-associated
malignancies.
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Affiliation(s)
- Rachel Bender Ignacio
- Rachel Bender Ignacio, Corey Casper, and Warren Phipps, Fred Hutchinson Cancer Research Center; Rachel Bender Ignacio, Matine Ghadrshenas, Daniel Low, Corey Casper, and Warren Phipps, University of Washington; Corey Casper, Infectious Diseases Research Institute, Seattle, WA; and Jackson Orem, Uganda Cancer Institute, Kampala, Uganda
| | - Matine Ghadrshenas
- Rachel Bender Ignacio, Corey Casper, and Warren Phipps, Fred Hutchinson Cancer Research Center; Rachel Bender Ignacio, Matine Ghadrshenas, Daniel Low, Corey Casper, and Warren Phipps, University of Washington; Corey Casper, Infectious Diseases Research Institute, Seattle, WA; and Jackson Orem, Uganda Cancer Institute, Kampala, Uganda
| | - Daniel Low
- Rachel Bender Ignacio, Corey Casper, and Warren Phipps, Fred Hutchinson Cancer Research Center; Rachel Bender Ignacio, Matine Ghadrshenas, Daniel Low, Corey Casper, and Warren Phipps, University of Washington; Corey Casper, Infectious Diseases Research Institute, Seattle, WA; and Jackson Orem, Uganda Cancer Institute, Kampala, Uganda
| | - Jackson Orem
- Rachel Bender Ignacio, Corey Casper, and Warren Phipps, Fred Hutchinson Cancer Research Center; Rachel Bender Ignacio, Matine Ghadrshenas, Daniel Low, Corey Casper, and Warren Phipps, University of Washington; Corey Casper, Infectious Diseases Research Institute, Seattle, WA; and Jackson Orem, Uganda Cancer Institute, Kampala, Uganda
| | - Corey Casper
- Rachel Bender Ignacio, Corey Casper, and Warren Phipps, Fred Hutchinson Cancer Research Center; Rachel Bender Ignacio, Matine Ghadrshenas, Daniel Low, Corey Casper, and Warren Phipps, University of Washington; Corey Casper, Infectious Diseases Research Institute, Seattle, WA; and Jackson Orem, Uganda Cancer Institute, Kampala, Uganda
| | - Warren Phipps
- Rachel Bender Ignacio, Corey Casper, and Warren Phipps, Fred Hutchinson Cancer Research Center; Rachel Bender Ignacio, Matine Ghadrshenas, Daniel Low, Corey Casper, and Warren Phipps, University of Washington; Corey Casper, Infectious Diseases Research Institute, Seattle, WA; and Jackson Orem, Uganda Cancer Institute, Kampala, Uganda
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19
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Shankar AG, Roques G, Kirkwood AA, Lambilliotte A, Freund K, Leblanc T, Hayward J, Abbou S, Ramsay AD, Schmitt C, Gorde-Grosjean S, Pacquement H, Haouy S, Boudjemaa S, Aladjidi N, Hall GW, Landman-Parker J. Advanced stage nodular lymphocyte predominant Hodgkin lymphoma in children and adolescents: clinical characteristics and treatment outcome - a report from the SFCE & CCLG groups. Br J Haematol 2017; 177:106-115. [PMID: 28220934 DOI: 10.1111/bjh.14518] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/07/2016] [Indexed: 12/21/2022]
Abstract
Advanced stage nodular lymphocyte predominant Hodgkin lymphoma (nLPHL) is extremely rare in children and as a consequence, optimal treatment for this group of patients has not been established. Here we retrospectively evaluated the treatments and treatment outcomes of 41 of our patients from the UK and France with advanced stage nLPHL. Most patients received chemotherapy, some with the addition of the anti CD20 antibody rituximab or radiotherapy. Chemotherapy regimens were diverse and followed either classical Hodgkin lymphoma or B non-Hodgkin lymphoma protocols. All 41 patients achieved a complete remission with first line treatment and 40 patients are alive and well in remission. Eight patients subsequently relapsed and 1 patient died of secondary cancer (9 progression-free survival events). The median time to progression for those who progressed was 21 months (5·9-73·8). The median time since last diagnosis is 87·3 months (8·44-179·20). Thirty-six (90%), 30 (75%) and 27 (68%) patients have been in remission for more than 12, 24 and 36 months, respectively. Overall, the use of rituximab combined with multi-agent chemotherapy as first line treatment seems to be a reasonable therapeutic option.
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Affiliation(s)
- Ananth G Shankar
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Amy A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | | | - Katja Freund
- Department of Paediatric and Adolescent Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Janis Hayward
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | | | - Alan D Ramsay
- Department of Cellular Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | | | - Sabah Boudjemaa
- Service d'hématologie et d'oncologie pédiatrique, Hopital A, Trousseau, 75571 APHP/UPMC Univ Paris 06, Paris, France
| | | | - Georgina W Hall
- Paediatric Haematology/Oncology Unit, Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Judith Landman-Parker
- Service d'hématologie et d'oncologie pédiatrique, Hopital A, Trousseau, 75571 APHP/UPMC Univ Paris 06, Paris, France
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20
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Seith F, Schmidt H, Kunz J, Küstner T, Gatidis S, Nikolaou K, la Fougère C, Schwenzer N. Simulation of Tracer Dose Reduction in 18F-FDG PET/MRI: Effects on Oncologic Reading, Image Quality, and Artifacts. J Nucl Med 2017; 58:1699-1705. [DOI: 10.2967/jnumed.116.184440] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 03/16/2017] [Indexed: 01/09/2023] Open
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21
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Shieh Y, Eklund M, Madlensky L, Sawyer SD, Thompson CK, Stover Fiscalini A, Ziv E, Van't Veer LJ, Esserman LJ, Tice JA. Breast Cancer Screening in the Precision Medicine Era: Risk-Based Screening in a Population-Based Trial. J Natl Cancer Inst 2017; 109:2938659. [PMID: 28130475 DOI: 10.1093/jnci/djw290] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/13/2016] [Accepted: 10/31/2016] [Indexed: 01/14/2023] Open
Abstract
Ongoing controversy over the optimal approach to breast cancer screening has led to discordant professional society recommendations, particularly in women age 40 to 49 years. One potential solution is risk-based screening, where decisions around the starting age, stopping age, frequency, and modality of screening are based on individual risk to maximize the early detection of aggressive cancers and minimize the harms of screening through optimal resource utilization. We present a novel approach to risk-based screening that integrates clinical risk factors, breast density, a polygenic risk score representing the cumulative effects of genetic variants, and sequencing for moderate- and high-penetrance germline mutations. We demonstrate how thresholds of absolute risk estimates generated by our prediction tools can be used to stratify women into different screening strategies (biennial mammography, annual mammography, annual mammography with adjunctive magnetic resonance imaging, defer screening at this time) while informing the starting age of screening for women age 40 to 49 years. Our risk thresholds and corresponding screening strategies are based on current evidence but need to be tested in clinical trials. The Women Informed to Screen Depending On Measures of risk (WISDOM) Study, a pragmatic, preference-tolerant randomized controlled trial of annual vs personalized screening, will study our proposed approach. WISDOM will evaluate the efficacy, safety, and acceptability of risk-based screening beginning in the fall of 2016. The adaptive design of this trial allows continued refinement of our risk thresholds as the trial progresses, and we discuss areas where we anticipate emerging evidence will impact our approach.
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Affiliation(s)
- Yiwey Shieh
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Martin Eklund
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Lisa Madlensky
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Sarah D Sawyer
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Carlie K Thompson
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Allison Stover Fiscalini
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Elad Ziv
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Laura J Van't Veer
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Laura J Esserman
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Jeffrey A Tice
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
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Zwarthoed C, El-Galaly TC, Canepari M, Ouvrier MJ, Viotti J, Ettaiche M, Viviani S, Rigacci L, Trentin L, Rusconi C, Luminari S, Cantonetti M, Bolis S, Borra A, Darcourt J, Salvi F, Subocz E, Tajer J, Kulikowski W, Malkowski B, Zaucha JM, Gallamini A. Prognostic Value of Bone Marrow Tracer Uptake Pattern in Baseline PET Scans in Hodgkin Lymphoma: Results from an International Collaborative Study. J Nucl Med 2017; 58:1249-1254. [PMID: 28126883 DOI: 10.2967/jnumed.116.184218] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/21/2016] [Indexed: 12/28/2022] Open
Abstract
PET/CT-ascertained bone marrow involvement (BMI) constitutes the single most important reason for upstaging by PET/CT in Hodgkin lymphoma (HL). However, BMI assessment in PET/CT can be challenging. This study analyzed the clinicopathologic correlations and prognostic meaning of different patterns of bone marrow (BM) 18F-FDG uptake in HL. Methods: One hundred eighty newly diagnosed early unfavorable and advanced-stage HL patients, all scanned at baseline and after 2 adriamycin-bleomycin-vinblastine-dacarbazine (ABVD) courses with 18F-FDG PET, enrolled in 2 international studies aimed at assessing the role of interim PET scanning in HL, were retrospectively included. Patients were treated with ABVD × 4-6 cycles and involved-field radiation when needed, and no treatment adaptation on interim PET scanning was allowed. Two masked reviewers independently reported the scans. Results: Thirty-eight patients (21.1%) had focal lesions (fPET+), 10 of them with a single (unifocal) and 28 with multiple (multifocal) BM lesions. Fifty-three patients (29.4%) had pure strong (>liver) diffuse uptake (dPET+) and 89 (48.4%) showed no or faint (≤liver) BM uptake (nPET+). BM biopsy was positive in 6 of 38 patients (15.7%) for fPET+, in 1 of 53 (1.9%) for dPET+, and in 5 of 89 (5.6%) for nPET+ dPET+ was correlated with younger age, higher frequency of bulky disease, lower hemoglobin levels, higher leukocyte counts, and similar diffuse uptake in the spleen. Patients with pure dPET+ had a 3-y progression-free survival identical to patients without any 18F-FDG uptake (82.9% and 82.2%, respectively, P = 0.918). However, patients with fPET+ (either unifocal or multifocal) had a 3-y progression-free survival significantly inferior to patients with dPET+ and nPET+ (66.7% and 82.5%, respectively, P = 0.03). The κ values for interobserver agreement were 0.84 for focal uptake and 0.78 for diffuse uptake. Conclusion: We confirmed that 18F-FDG PET scanning is a reliable tool for BMI assessment in HL, and BM biopsy is no longer needed for routine staging. Moreover, the interobserver agreement for BMI in this study proved excellent and only focal 18F-FDG BM uptake should be considered as a harbinger of HL.
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Affiliation(s)
- Colette Zwarthoed
- Nuclear Medicine Department, A. Lacassagne Cancer Center, Nice, France
| | | | | | | | - Julien Viotti
- Research, Innovation and Statistics Department, A. Lacassagne Cancer Center, Nice, France
| | - Marc Ettaiche
- Research, Innovation and Statistics Department, A. Lacassagne Cancer Center, Nice, France
| | - Simonetta Viviani
- Hematology Department and Paediatric Onco-Haematology, National Tumour Institute, Milan, Italy
| | - Luigi Rigacci
- Hematology Chair University of Florence, Policlinico Careggi, Florence, Italy
| | - Livio Trentin
- Hematology Section, Department of Medicine, Padua University, Padua, Italy
| | - Chiara Rusconi
- Hematology Department, Ca-Granda Niguarda Hospital, Milan, Italy
| | - Stefano Luminari
- Hematology Department, Modena and Reggio Emilia University, Reggio Emilia, Italy
| | | | - Silvia Bolis
- Hematology Department, San Gerardo Hospital, Monza, Italy
| | - Anna Borra
- Hematology Department, S. Croce Hospital, Cuneo, Italy
| | - Jacques Darcourt
- Nuclear Medicine Department, A. Lacassagne Cancer Center, Nice, France
| | - Flavia Salvi
- Hematology Department, S. Antonio and Biagio Hospital, Alessandria, Italy
| | - Edyta Subocz
- Hematology Department, Military Institute of Medicine, Warszawa, Poland
| | - Joanna Tajer
- Lymphoproliferative Disease Department, Maria Sklodowska-Curie Memorial Institute, Warszawa, Poland
| | - Waldemar Kulikowski
- Hematology Department, Interior Ministry Hospital, Warmia and Mazury Medical University, Olsztyn, Poland
| | - Bogdan Malkowski
- Nuclear Medicine Department, Oncology Center, Bydgoszcz, Poland; and
| | - Jan Maciej Zaucha
- Gdynia Oncology Center and Department of Oncological Propaedeutic, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrea Gallamini
- Research, Innovation and Statistics Department, A. Lacassagne Cancer Center, Nice, France
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Özkaya N, Başsüllü N, Demiröz AS, Tüzüner N. Discrepancies in Lymphoma Diagnosis Over the Years: A 13-Year Experience in a Tertiary Center. Turk J Haematol 2016; 34:81-88. [PMID: 27956371 PMCID: PMC5451693 DOI: 10.4274/tjh.2016.0344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: In the past, accurate diagnosis of lymphoma was challenging since there were multiple competing classification systems that caused confusion and debate. After establishment of the World Health Organization lymphoma classification, lymphomas still remain a diagnostic challenge among general pathologists. The purpose of this study was to examine whether the discordance among centers has declined over the years. Materials and Methods: All lymphoma or lymphoma-suspected specimens that had been sent to the Cerrahpaşa Faculty of Medicine between 2000 and 2013 for a second opinion were deemed eligible. To evaluate the change in the discrepancy rates over time we compared the rates of revision between 2000-2008 and 2009-2013. Results: A total of 1824 patients in two time periods met the inclusion criteria. The overall discordance rate was 45.6%. This rate showed significant variations between different histologic subtypes. Discordance rates also varied significantly over time and decreased from 51.3% in 2000-2008 to 38.7% in 2009-2013 (p<0.0001). Conclusion: The high discordance rate, especially in the second period, indicates the need for easily accessible hematopathology consultation centers.
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Affiliation(s)
| | | | | | - Nükhet Tüzüner
- İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pathology, İstanbul, Turkey Phone: +90 532 686 63 70 E-mail:
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Ali S, Basit A, Kazmi AS, Sidhu A, Badar F, Hameed A. Chemotherapy alone or combined chemotherapy and involved field radiotherapy in favorable risk early-stage classical Hodgkin lymphoma-a 10 years experience. Pak J Med Sci 2016; 32:1408-1413. [PMID: 28083035 PMCID: PMC5216291 DOI: 10.12669/pjms.326.11080] [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: 08/02/2016] [Accepted: 10/15/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the outcome of patients with early-stage (stage I-II) favorable risk classical Hodgkin lymphoma treated with chemotherapy alone or combined modality treatment (CMT) utilizing chemotherapy and involved field radiotherapy. METHODS This retrospective study was done at Department of Medical oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan from January 2004 to December 2013. RESULTS There were 101 patients, with male predominance (71.3%). Mean age was 34 years. Sixty three (62.4%) patients received CMT and 38 (37.6%) patients had chemotherapy alone. Ninety eight percent patients had ABVD chemotherapy. Dose of radiotherapy ranged from 20 to 36 gray. Difference between baseline characteristics and major toxicities among the two groups was insignificant. Patients treated with CMT had better overall survival compared to chemotherapy alone: 100% versus 91% at five years and 96% versus 81% at 10 years, respectively (p=0.03). Progression free survival was also better with CMT against chemotherapy alone at five years (98% versus 81%) and 10 years (82% versus 71%) (p=0.01). CONCLUSION Favorable risk classical Hodgkin lymphoma patients had better overall survival and progression free survival when treated with CMT against chemotherapy alone.
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Affiliation(s)
- Sheeraz Ali
- Dr. Sheeraz Ali, MBBS, FCPS (Medicine), Fellow Medical Oncology, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Abdul Basit
- Dr. Abdul Basit, MBBS, FCPS (Medicine), Fellow Medical Oncology, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Ather S. Kazmi
- Dr. Ather Saeed Kazmi, MBBS, MRCP FRCR. Clinical Oncologist, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Armughan Sidhu
- Dr. Farhana Badar, Sr. Biostatistician & Cancer Epidemiologist Cancer Registry, & Clinical Data Management, Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Farhana Badar
- Dr. Armughan Sidhu, MBBS. Resident Medical Oncology, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Abdul Hameed
- Dr. Abdul Hameed MBBS, MD, FRCP (Edin). Consultant Hematologist, Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
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Abstract
Primary mediastinal Classical Hodgkin lymphoma (CHL) is rare. Nodular sclerosis CHL (NS-CHL) is the most common subtype involving the anterior mediastinum and/or mediastinal lymph nodes. Primary thymic CHL is exceedingly rare. The disease typically affects young women and is asymptomatic in 30% to 50% of patients. Common symptoms include fatigue, chest pain, dyspnea and cough, but vary depending on the location and size of the tumor. B-symptoms develop in 30% of cases. By imaging, primary mediastinal CHL presents as mediastinal widening/mediastinal mass that does not invade adjacent organs but may compress vital structures as bulky disease. Histopathology is the gold standard for diagnosis. Primary mediastinal NS-CHL consists of nodules of polymorphous inflammatory cells surrounded by broad fibrous bands extending from a thickened lymph node capsule. The cellular nodules contain variable numbers of large Hodgkin/Reed-Sternberg cells, required for diagnosis. Primary thymic CHL may exhibit prominent cystic changes. The histopathologic recognition of NS-CHL can be challenging in cases with prominent fibrosis, scant cellularity, artifactual cell distortion, or an exuberant granulomatous reaction. The differential diagnosis includes primary mediastinal non-HLs, mediastinal germ cell tumors, thymoma, and metastatic carcinoma or melanoma to the mediastinum. Distinction from primary mediastinal non-HLs is crucial for adequate therapeutic decisions. Approximately 95% of patients with primary mediastinal CHL will be alive and free of disease at 10 years after treatment with short courses of combined chemoradiotherapy. In this review, we discuss the history, classification, epidemiology, clinicoradiologic features, histopathology, immunohistochemistry, differential diagnosis, and treatment of primary mediastinal CHL.
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Burt LM, Poppe M, Kokeny KE, Gaffney DK, Shrieve DC, Tward JD. Comparison of treatment modalities for breast cancer arising in Hodgkin’s lymphoma survivors. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s13566-016-0262-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Procházka V, Klugar M, Bachanova V, Klugarová J, Tučková D, Papajík T. Comparing the accuracy of quantitative versus qualitative analyses of interim PET to prognosticate Hodgkin lymphoma: a systematic review protocol of diagnostic test accuracy. BMJ Open 2016; 6:e011729. [PMID: 27496236 PMCID: PMC4986203 DOI: 10.1136/bmjopen-2016-011729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Hodgkin lymphoma is an effectively treated malignancy, yet 20% of patients relapse or are refractory to front-line treatments with potentially fatal outcomes. Early detection of poor treatment responders is crucial for appropriate application of tailored treatment strategies. Tumour metabolic imaging of Hodgkin lymphoma using visual (qualitative) 18-fluorodeoxyglucose positron emission tomography (FDG-PET) is a gold standard for staging and final outcome assessment, but results gathered during the interim period are less accurate. Analysis of continuous metabolic-morphological data (quantitative) FDG-PET may enhance the robustness of interim disease monitoring, and help to improve treatment decision-making processes. The objective of this review is to compare diagnostic test accuracy of quantitative versus qualitative interim FDG-PET in the prognostication of patients with Hodgkin lymphoma. METHODS The literature on this topic will be reviewed in a 3-step strategy that follows methods described by the Joanna Briggs Institute (JBI). First, MEDLINE and EMBASE databases will be searched. Second, listed databases for published literature (MEDLINE, Tripdatabase, Pedro, EMBASE, the Cochrane Central Register of Controlled Trials and WoS) and unpublished literature (Open Grey, Current Controlled Trials, MedNar, ClinicalTrials.gov, Cos Conference Papers Index and International Clinical Trials Registry Platform of the WHO) will be queried. Third, 2 independent reviewers will analyse titles, abstracts and full texts, and perform hand search of relevant studies, and then perform critical appraisal and data extraction from selected studies using the DATARI tool (JBI). If possible, a statistical meta-analysis will be performed on pooled sensitivity and specificity data gathered from the selected studies. Statistical heterogeneity will be assessed. Funnel plots, Begg's rank correlations and Egger's regression tests will be used to detect and/or correct publication bias. ETHICS AND DISSEMINATION The results will be disseminated by publishing in a peer-reviewed journal. Ethical assessment will not be needed; only existing sources of literature will be searched. TRIAL REGISTRATION NUMBER CRD42016027953.
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Affiliation(s)
- Vít Procházka
- Faculty of Medicine and Dentistry, Department of Hemato-Oncology, Palacký University in Olomouc, Olomouc, Czech Republic
| | - Miloslav Klugar
- Faculty of Medicine and Dentistry, Department of Social Medicine and Public Health, Palacký University in Olomouc, Olomouc, Czech Republic
- Faculty of Medicine and Dentistry, The Czech Republic (Middle European) Centre for Evidence-Based Health Care: An Affiliated Centre of the Joanna Briggs Institute, Palacký University in Olomouc,Olomouc, Czech Republic
| | - Veronika Bachanova
- Division of Hematology, Oncology and Transplantation University of Minnesota, Minneapolis, Minnesota, USA
| | - Jitka Klugarová
- Faculty of Medicine and Dentistry, Department of Hemato-Oncology, Palacký University in Olomouc, Olomouc, Czech Republic
- Faculty of Medicine and Dentistry, The Czech Republic (Middle European) Centre for Evidence-Based Health Care: An Affiliated Centre of the Joanna Briggs Institute, Palacký University in Olomouc,Olomouc, Czech Republic
| | - Dagmar Tučková
- Faculty of Medicine and Dentistry, Department of Social Medicine and Public Health, Palacký University in Olomouc, Olomouc, Czech Republic
- Faculty of Medicine and Dentistry, The Czech Republic (Middle European) Centre for Evidence-Based Health Care: An Affiliated Centre of the Joanna Briggs Institute, Palacký University in Olomouc,Olomouc, Czech Republic
| | - Tomáš Papajík
- Faculty of Medicine and Dentistry, Department of Hemato-Oncology, Palacký University in Olomouc, Olomouc, Czech Republic
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Brentuximab vedotin and AVD followed by involved-site radiotherapy in early stage, unfavorable risk Hodgkin lymphoma. Blood 2016; 128:1458-64. [PMID: 27458003 DOI: 10.1182/blood-2016-03-703470] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/05/2016] [Indexed: 11/20/2022] Open
Abstract
This multicenter pilot study assessed the safety and efficacy of brentuximab vedotin (BV) and AVD (adriamycin, vinblastine, and dacarbazine) followed by 30 Gy involved site radiation therapy (ISRT). Patients with newly diagnosed, early stage classical Hodgkin lymphoma (HL) with unfavorable-risk features were treated with 4 cycles of BV and AVD. Patients who achieved a negative positron emission tomography (PET) scan (Deauville score of 1-3) received 30 Gy ISRT. Thirty patients received treatment and were assessable for toxicity. Twenty-nine patients completed 4 cycles of BV + AVD, and 25 patients BV + AVD + 30 Gy ISRT. No clinically significant noninfectious pneumonitis was observed. Serious adverse events (≥grade 3) were reported in 4 patients, including febrile neutropenia, peripheral neuropathy, and hypertension. After 2 and 4 cycles of BV + AVD, 90% (26 of 29) and 93% (27 or 29) of patients achieved a negative PET scan, respectively. Two patients with biopsy-proven primary refractory HL were treated off-study. All 25 patients who completed BV + AVD + ISRT achieved a complete response. With a median follow-up of 18.8 months, by intent to treat, the 1-year progression-free survival is 93.3% (95% confidence interval, 84-102). Overall, the treatment was well-tolerated with no evidence of significant pulmonary toxicity. The majority of patients (≥90%) achieved negative interim PET scans after 2 and 4 cycles of BV + AVD. Excluding the 2 primary refractory patients, all patients are disease free, suggesting that this is a highly active treatment program even in patients with substantial disease bulk. This trial was registered at www.clinicaltrials.gov as #NCT01868451.
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Kumar A, Burger IA, Zhang Z, Drill EN, Migliacci JC, Ng A, LaCasce A, Wall D, Witzig TE, Ristow K, Yahalom J, Moskowitz CH, Zelenetz AD. Definition of bulky disease in early stage Hodgkin lymphoma in computed tomography era: prognostic significance of measurements in the coronal and transverse planes. Haematologica 2016; 101:1237-1243. [PMID: 27390360 DOI: 10.3324/haematol.2016.141846] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 07/05/2016] [Indexed: 11/09/2022] Open
Abstract
Disease bulk is an important prognostic factor in early stage Hodgkin lymphoma, but its definition is unclear in the computed tomography era. This retrospective analysis investigated the prognostic significance of bulky disease measured in transverse and coronal planes on computed tomography imaging. Early stage Hodgkin lymphoma patients (n=185) treated with chemotherapy with or without radiotherapy from 2000-2010 were included. The longest diameter of the largest lymph node mass was measured in transverse and coronal axes on pre-treatment imaging. The optimal cut off for disease bulk was maximal diameter greater than 7 cm measured in either the transverse or coronal plane. Thirty patients with maximal transverse diameter of 7 cm or under were found to have bulk in coronal axis. The 4-year overall survival was 96.5% (CI: 93.3%, 100%) and 4-year relapse-free survival was 86.8% (CI: 81.9%, 92.1%) for all patients. Relapse-free survival at four years for bulky patients was 80.5% (CI: 73%, 88.9%) compared to 94.4% (CI: 89.1%, 100%) for non-bulky; Cox HR 4.21 (CI: 1.43, 12.38) (P=0.004). In bulky patients, relapse-free survival was not impacted in patients treated with chemoradiotherapy; however, it was significantly lower in patients treated with chemotherapy alone. In an independent validation cohort of 38 patients treated with chemotherapy alone, patients with bulky disease had an inferior relapse-free survival [at 4 years, 71.1% (CI: 52.1%, 97%) vs 94.1% (CI: 83.6%, 100%), Cox HR 5.27 (CI: 0.62, 45.16); P=0.09]. Presence of bulky disease on multidimensional computed tomography imaging is a significant prognostic factor in early stage Hodgkin lymphoma. Coronal reformations may be included for routine Hodgkin lymphoma staging evaluation. In future, our definition of disease bulk may be useful in identifying patients who are most appropriate for chemotherapy alone.
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Affiliation(s)
- Anita Kumar
- Lymphoma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Irene A Burger
- Department Medical Radiology, University Hospital Zurich, Switzerland
| | - Zhigang Zhang
- Biostatistics and Epidemiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Esther N Drill
- Biostatistics and Epidemiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jocelyn C Migliacci
- Lymphoma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andrea Ng
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ann LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Darci Wall
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Kay Ristow
- Department of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Craig H Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andrew D Zelenetz
- Lymphoma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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[IF-RT alone remains gold standard for stage IA nodular lymphocyte-predominant Hodgkin lymphoma]. Strahlenther Onkol 2016; 192:428-30. [PMID: 27194138 DOI: 10.1007/s00066-016-0975-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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Makita S, Maruyama D, Maeshima AM, Taniguchi H, Miyamoto KI, Kitahara H, Fukuhara S, Munakata W, Kobayashi Y, Itami J, Tobinai K. Clinical features and outcomes of 139 Japanese patients with Hodgkin lymphoma. Int J Hematol 2016; 104:236-44. [PMID: 27086350 DOI: 10.1007/s12185-016-2007-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/05/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
Abstract
Hodgkin lymphoma (HL) is a rare subtype of malignant lymphoma in Japan, and there are few reports of HL in Japan in recent years. We retrospectively analyzed the clinical features of 139 patients with HL who were diagnosed and treated at our institution between 1997 and 2011. The median age at diagnosis was 34 years with 83 male. Of these patients, 83 (60 %) were early stage and 56 (40 %) were advanced-stage. Seventy-three patients (88 %) with early stage disease received ABVd followed by irradiation. All of the 56 advanced-stage patients received chemotherapy, mainly ABVd. The 5-year progression-free survival (PFS) rates and overall survival rates were 90 and 94 % in patients with early stage disease, and 71 and 90 % in those with advanced-stage disease. The PFS of patients with advanced-stage disease was significantly lower than those with early stage (p = 0.014). In conclusion, the outcomes of Japanese patients with HL in recent years were not improved as compared with the results of previous reports. We confirmed that patients with advanced-stage disease have lower PFS than those with early stage disease. Prospective studies are needed to establish novel treatment strategies to improve the outcome of HL patients, especially those with advanced disease.
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Affiliation(s)
- Shinichi Makita
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Dai Maruyama
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | | | - Hirokazu Taniguchi
- Pathology and Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan
| | - Ken-Ichi Miyamoto
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hideaki Kitahara
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Suguru Fukuhara
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Wataru Munakata
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yukio Kobayashi
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Jun Itami
- Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kensei Tobinai
- Department of Hematology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Blaes A, Konety S, Hurley P. Cardiovascular Complications of Hematopoietic Stem Cell Transplantation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:25. [PMID: 26909819 PMCID: PMC4766226 DOI: 10.1007/s11936-016-0447-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OPINION STATEMENT Survivors of hematopoietic stem cell transplant (HSCT) are at significant risk for cardiac disease and cardiac complications. While there may be cardiac complications during the acute period of HSCT, long-term survivors remain at risk for cardiovascular disease at a rate at least fourfold higher than the general population. Aggressive screening for cardiac risk factors such as diabetes, hypertension, and arrhythmias is warranted pretransplant. For those with risk factors, particularly a history of cardiovascular disease or atrial fibrillation, cardiology consultation is warranted in the pretransplantation period. Aggressive screening for cardiac risk factors such as diabetes, hypertension, and hyperlipidemia is warranted in HSCT survivors as well; early and aggressive treatment of left ventricular dysfunction is warranted. Collaboration between hematology/oncology and cardiology through a cardio-oncology clinic is an optimal way to help manage these patients.
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Affiliation(s)
- Anne Blaes
- Division of Hematology/Oncology/Transplantion, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA.
| | - Suma Konety
- Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Peter Hurley
- Division of Hematology/Oncology/Transplantion, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA
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Parikh RR, Grossbard ML, Harrison LB, Yahalom J. Early-stage nodular lymphocyte-predominant Hodgkin lymphoma: the impact of radiotherapy on overall survival. Leuk Lymphoma 2016; 57:320-327. [PMID: 26110882 PMCID: PMC5593757 DOI: 10.3109/10428194.2015.1065978] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study was to use the National Cancer Database to examine the association between radiation therapy (RT) and overall survival (OS) in early-stage nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) using standard and propensity score (PS)-adjusted Cox proportional hazards models. From 1998-2011, 1915 patients with stage I/II NLPHL were studied, with a median follow-up of 6.6 years (median age = 44). Of the cohort, 1224(64%) received RT (alone or with chemotherapy) to a median dose of 30.6 Gy. Patients were more likely to receive RT if male, younger age, lower stage, no "B"-symptoms, favorably insured, and treatment at comprehensive centers (all p < 0.05). Patients administered RT had an improved 5-year OS (HR = 0.62; 95%CI, 0.43-0.89, p = 0.01). After PS-matching (n = 868) based on all known co-variates, RT use trended towards improved OS (HR = 0.49; 95%CI, 0.23-1.05, p = 0.06). This study represents one of the largest prospective datasets examining the role of RT for stage I/II NLPHL and inclusion of RT may be considered.
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Affiliation(s)
- Rahul R. Parikh
- Mount Sinai Beth Israel Medical Center & Mount Sinai St. Luke’s-Roosevelt Hospitals, Mount Sinai Health System, Department of Radiation Oncology, New York, NY
| | - Michael. L. Grossbard
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, Division of Hematology and Oncology, New York, NY
| | - Louis. B. Harrison
- Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL
| | - Joachim Yahalom
- Memorial Sloan-Kettering Cancer Center, Department of Radiation Oncology, New York, NY
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Parikh RR, Grossbard ML, Harrison LB, Yahalom J. Association of intensity-modulated radiation therapy on overall survival for patients with Hodgkin lymphoma. Radiother Oncol 2015; 118:52-9. [PMID: 26522061 DOI: 10.1016/j.radonc.2015.10.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to compare outcomes with Hodgkin lymphoma (HL) patients receiving IMRT (intensity-modulated radiation therapy), versus those receiving 2D/3D-CRT (3-dimensional conformal RT) in a large observational cohort. PATIENTS AND METHODS We evaluated patients diagnosed with stage I-IV HL from 1998 to 2011 from the National Cancer Database (NCDB). The association between IMRT use vs. 2D/3D-CRT, co-variables, and outcome was assessed in a Cox proportional hazards model. Propensity score (PS) matching was performed to balance known confounding factors. Survival was estimated using the Kaplan-Meier method. RESULTS Of the 76,672 patients with HL within the NCDB, 12,393 patients with stage I-IV HL received RT (median dose=30.6 Gy) and were eligible for this study, and 6013 patients analyzed for overall survival. The cohort had a median follow-up of 6.2 years and median age of 37 years (range: 18-90). The RT modalities used were: 2D/3D-CRT (n=11,491, 92.7%) or IMRT (n=902, 7.3%). Patients were more likely to receive IMRT if they were of male gender, early stage, no "B" symptoms, and treated at comprehensive cancer programs (all p<0.05). During this time period, there was a significant decrease in use of 2D/3D-CRT from 100% to 81.5%, with a subsequent increase in IMRT utilization from 0% to 18.5%. Five-year overall survival for patients receiving 2D/3D-CRT (n=5844) was 89.9% versus 95.2% for those receiving IMRT (n=169; HR=0.45; 95% CI, 0.23-0.91, p=0.02). After PS-matching based on clinicopathologic characteristics, IMRT use remained associated with improved overall survival (HR=0.40; 95% CI, 0.16-0.97, p=0.04). CONCLUSIONS Our study reveals that HL patients receiving modern RT techniques were associated with an improvement in overall survival. This may have been related to patient selection, access to improved staging and management, or improvements in treatment technology. This represents the only study examining survival outcomes of advanced RT modalities, which may be considered on a case-by-case basis for highly selected patients with HL.
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Affiliation(s)
- Rahul R Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, United States.
| | - Michael L Grossbard
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, Division of Hematology-Oncology, United States
| | - Louis B Harrison
- Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, United States
| | - Joachim Yahalom
- Memorial Sloan-Kettering Cancer Center, Department of Radiation Oncology, New York, United States
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Albright CM, Wenstrom KD. Malignancies in pregnancy. Best Pract Res Clin Obstet Gynaecol 2015; 33:2-18. [PMID: 26542928 DOI: 10.1016/j.bpobgyn.2015.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/09/2015] [Indexed: 12/13/2022]
Abstract
Malignancy complicating pregnancy is fortunately rare, affecting one in 1000 to one in 1500 pregnancies. Optimal treatment involves balancing the benefit of treatment for the mother while minimizing harm to the fetus. This balance is dependent on the extent of the disease, the recommended course of treatment, and the gestational age at which treatment is considered. Both surgery and chemotherapy are generally safe in pregnancy, whereas radiation therapy is relatively contraindicated. Iatrogenic prematurity is the most common pregnancy complication, as infants are often delivered for maternal benefit. In general, however, survival does not differ from the nonpregnant population. These patients require a multidisciplinary approach for management with providers having experience in caring for these complex patients. The aim of this review was to provide an overview for obstetricians of the diagnosis and management of malignancy in pregnancy.
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Affiliation(s)
- Catherine M Albright
- Division of Maternal Fetal Medicine, Brown University, Women and Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA.
| | - Katharine D Wenstrom
- Division of Maternal Fetal Medicine, Brown University, Women and Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA.
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36
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Parikh RR, Grossbard ML, Harrison LB, Yahalom J. Impact of delays in definitive treatment on overall survival: a National Cancer Database study of patients with Hodgkin lymphoma. Leuk Lymphoma 2015; 57:1074-82. [PMID: 26374099 DOI: 10.3109/10428194.2015.1094696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this large observational study was to examine outcomes in patients with Hodgkin lymphoma (HL) by timing to definitive chemotherapy (TTC) using standard and propensity score (PS)-adjusted Cox proportional hazards models. From 1998-2011, 56,457 patients with stage I-IV HL were studied, with a median follow-up of 6.0 years (median age=39). Median TTC was 26 days from diagnosis. The cohort of "early" (<60 days from diagnosis) TTC patients included 45,307 (80.3%) patients and "late" (≥60 days) TTC was 11,150 (19.7%). Patients were more likely to experience early TTC if they were of a younger age, at an advanced stage, with "B" symptoms, favorably insured, favorable socioeconomic status, and treated at comprehensive cancer center (all p<0.05). Ten-year overall survival for patients with early TTC was 73.2% vs. 70.0% for those with late TTC (HR=0.87; 95%CI, 0.83-0.92, p<0.0001). After PS-matching for co-variates, early TTC was not associated with overall survival (HR=0.96; 95%CI, 0.85-1.08, p=0.51). This represents the only study to evaluate overall survival by time to definitive treatment for HL.
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Affiliation(s)
- Rahul R Parikh
- a Mount Sinai Beth Israel Medical Center & Mount Sinai St. Luke's-Roosevelt Hospitals, Mount Sinai Health System , Department of Radiation Oncology , New York
| | - Michael L Grossbard
- b Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center , Division of Hematology-Oncology , New York
| | - Louis B Harrison
- c Moffitt Cancer Center and Research Institute , Department of Radiation Oncology , Tampa , FL , and
| | - Joachim Yahalom
- d Memorial Sloan-Kettering Cancer Center , Department of Radiation Oncology , New York , NY , USA
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Seith F, Gatidis S, Bisdas S, la Fougère C, Schäfer J, Nikolaou K, Schwenzer N. PET/MR in Oncology. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Eichenauer DA, Plütschow A, Fuchs M, von Tresckow B, Böll B, Behringer K, Diehl V, Eich HT, Borchmann P, Engert A. Long-Term Course of Patients With Stage IA Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Report From the German Hodgkin Study Group. J Clin Oncol 2015; 33:2857-62. [DOI: 10.1200/jco.2014.60.4363] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The optimal treatment of stage IA nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is not well defined. Thus, we performed an analysis using the database of the German Hodgkin Study Group. Patients and Methods The long-term outcome of 256 patients with stage IA NLPHL was evaluated. Patients had received combined-modality treatment (CMT; n = 72), extended-field radiotherapy (EF-RT; n = 49), involved-field radiotherapy (IF-RT; n = 108), or four weekly standard doses of rituximab (n = 27) within German Hodgkin Study Group clinical trial protocols between 1988 and 2009. Results The median age at NLPHL diagnosis was 39 years (range, 16 to 75 years). Most patients were male (76%). The whole patient group had a median follow-up of 91 months (CMT: 95 months; EF-RT: 110 months; IF-RT: 87 months; rituximab: 49 months). At 8 years, progression-free survival and overall survival rates were 88.5% and 98.6% for CMT, 84.3% and 95.7% for EF-RT, and 91.9% and 99.0% for IF-RT, respectively. Patients treated with rituximab had 4-year progression-free and overall survival rates of 81.0% and 100%, respectively. A second malignancy during the course of follow-up was diagnosed in 17 (6.6%) of 256 patients. A total of 12 deaths occurred. However, only one patient died from NLPHL. Conclusion Tumor control in this analysis was equivalent with CMT, EF-RT, and IF-RT. Therefore, IF-RT, which is associated with the lowest risk for the development of toxic effects, should be considered as standard of care for patients with stage IA NLPHL. Rituximab alone is associated with an increased risk of relapse in this patient population.
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Affiliation(s)
- Dennis A. Eichenauer
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Annette Plütschow
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Michael Fuchs
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Bastian von Tresckow
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Boris Böll
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Karolin Behringer
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Volker Diehl
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Hans Theodor Eich
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Peter Borchmann
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
| | - Andreas Engert
- All authors: University Hospital Cologne, Cologne; and Hans Theodor Eich, University Hospital Münster, Münster, Germany
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Reddy JP, Akhtari M, Smith GL, Pinnix C, Osborne EM, Gunther JR, Allen PK, Yehia ZA, Fanale M, Rodriguez MA, Fowler N, Milgrom SA, Wogan CF, Dabaja BS. Outcomes After Chemotherapy Followed by Radiation for Stage IIB Hodgkin Lymphoma With Bulky Disease. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:664-670.e2. [PMID: 26321471 DOI: 10.1016/j.clml.2015.07.633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 07/09/2015] [Accepted: 07/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Treatment of stage IIB bulky Hodgkin lymphoma (HL) is controversial, with treatment varying by institution. We evaluated patients with IIB bulky disease treated with combined-modality therapy at our institution by describing their long-term outcomes. PATIENTS AND METHODS We identified 149 consecutive patients with stage IIB bulky HL treated between 1971 and 2012. Clinical, pathologic, and treatment characteristics were extracted from medical records. Actuarial overall survival (OS) and relapse-free survival (RFS) were calculated by the Kaplan-Meier method. Independent factors associated with these outcomes were identified by a multivariate Cox regression model. Outcomes were further compared against comparison groups of both advanced-stage and stage IIB patients treated between 1971 and 2009. RESULTS The 8-year OS rate for patients with stage IIB bulky disease who received combined-modality ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and radiation was 88.8%; the 8-year RFS rate was 76.8%. On multivariate analysis, age < 40 years (hazard ratio [HR], 0.28; 95% confidence interval [CI], 0.14-0.57; P = .001), receipt of ABVD (vs. MOPP [mechlorethamine, vincristine, procarbazine, prednisone]; HR, 0.32; 95% CI, 0.10-0.88; P = .028), and radiation dose ≥ 30.1 Gy (HR, 0.25; 95% CI, 0.11-0.65; P = .006) were associated with improved OS. Cardiac events (n = 11) and secondary malignancies (n = 11) only occurred in patients treated before 1995. A subgroup analysis demonstrated significantly improved survival in IIB bulky versus advanced-stage patients (8-year OS, 73.4% vs. 57.4%; P = .008). Improved outcomes in patients with in IIB bulky disease were especially evident in the modern era (> 1995; P = .004). CONCLUSION Patients with stage IIB bulky HL had excellent outcomes after combined-modality therapy. Treatment strategies have changed substantially over time, with concomitant improvements in disease outcomes and long-term toxicities.
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Affiliation(s)
- Jay P Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mani Akhtari
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Grace L Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chelsea Pinnix
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eleanor M Osborne
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jillian R Gunther
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Pamela K Allen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Zeinab Abou Yehia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michelle Fanale
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - M Alma Rodriguez
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nathan Fowler
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sarah A Milgrom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christine F Wogan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bouthaina S Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Salvino MA, Ruiz J. Hematopoietic progenitor cell mobilization for autologous transplantation - a literature review. Rev Bras Hematol Hemoter 2015; 38:28-36. [PMID: 26969772 PMCID: PMC4786760 DOI: 10.1016/j.bjhh.2015.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/30/2015] [Accepted: 07/17/2015] [Indexed: 12/27/2022] Open
Abstract
The use of high-dose chemotherapy with autologous support of hematopoietic progenitor cells is an effective strategy to treat various hematologic neoplasms, such as non-Hodgkin lymphomas and multiple myeloma. Mobilized peripheral blood progenitor cells are the main source of support for autologous transplants, and collection of an adequate number of hematopoietic progenitor cells is a critical step in the autologous transplant procedure. Traditional strategies, based on the use of growth factors with or without chemotherapy, have limitations even when remobilizations are performed. Granulocyte colony-stimulating factor is the most widely used agent for progenitor cell mobilization. The association of plerixafor, a C-X-C Chemokine receptor type 4 (CXCR4) inhibitor, to granulocyte colony stimulating factor generates rapid mobilization of hematopoietic progenitor cells. A literature review was performed of randomized studies comparing different mobilization schemes in the treatment of multiple myeloma and lymphomas to analyze their limitations and effectiveness in hematopoietic progenitor cell mobilization for autologous transplant. This analysis showed that the addition of plerixafor to granulocyte colony stimulating factor is well tolerated and results in a greater proportion of patients with non-Hodgkin lymphomas or multiple myeloma reaching optimal CD34+ cell collections with a smaller number of apheresis compared the use of granulocyte colony stimulating factor alone.
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Olszewski AJ, Shrestha R, Cook NM. Race-specific features and outcomes of nodular lymphocyte-predominant Hodgkin lymphoma: Analysis of the National Cancer Data Base. Cancer 2015; 121:3472-80. [PMID: 26149294 DOI: 10.1002/cncr.29527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/02/2015] [Accepted: 03/20/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The incidence of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is higher among African Americans than among other races, but to the authors' knowledge, the characteristics of NLPHL in this population have not been evaluated. The authors compared clinical features, treatments, and survival of black and white patients with NLPHL using the National Cancer Data Base. METHODS The authors extracted the records of 602 black and 1950 white patients with NLPHL who were diagnosed between 1998 and 2011. Overall survival (OS) was compared using the log-rank test. RESULTS Black patients were on average younger than white patients (median age, 42 years vs 45 years; P =.0001), more often female (49% vs 29%; P<.0001), and more likely to have the axillary lymph nodes as the primary disease site (25% vs 17%; P =.0002). They also had unfavorable socioeconomic characteristics, a higher rate of no treatment in patients with early-stage disease, and a longer time to therapy initiation (median, 53.5 days vs 47 days; P<.0001). Despite this, the authors found no significant difference between the races with regard to stage distribution or survival (P =.39). OS at 7 years was 90.1% in patients with early-stage (American Joint Committee on Cancer stage IA/B, IIA) and 79.4% in patients with advanced stage (American Joint Committee on Cancer stage IIB, III/IV) NLPHL. Survival in the early stage of disease was not found to be significantly different after various treatment strategies (stratified log-rank P = .18), except that the administration of chemotherapy was associated with a better outcome in black patients (log-rank P =.011 vs P =.81 for white patients). CONCLUSIONS Differences in clinical presentation suggest the interaction of race-specific and sex-specific susceptibility factors for NLPHL. Further research is needed to elucidate these factors, and to investigate possible heterogeneous effects of treatments by race. Clinical trials comparing standard treatment strategies are unlikely to detect differences in OS among patients with early-stage NLPHL.
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Affiliation(s)
- Adam J Olszewski
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Medicine, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island
| | - Rajesh Shrestha
- Department of Medicine, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island
| | - Nathaniel M Cook
- Division of Hematology-Oncology, Roger Williams Medical Center, Providence, Rhode Island
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Bonthapally V, Wu E, Macalalad A, Yang H, Shonukan O, Liu Y, Chi A, Huebner D. Brentuximab vedotin in relapsed/refractory Hodgkin lymphoma post-autologous transplant: meta-analysis versus historical data. Curr Med Res Opin 2015; 31:993-1001. [PMID: 25772232 DOI: 10.1185/03007995.2015.1030378] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This meta-analysis evaluated the antitumor activity of brentuximab vedotin versus historical values in patients with relapsed/refractory Hodgkin lymphoma post-autologous stem cell transplantation (ASCT). METHODS A systematic literature review identified studies (1993-February 2013) reporting complete remission (CR) rates in patients with relapsed/refractory Hodgkin lymphoma post-ASCT. Publications reporting CR rates, identified through interrogation of multiple electronic databases and manual searches (with search terms used to capture 'relapsed', 'refractory', 'HL', and 'ASCT'), were included if they reported: ≥20 relapsed/refractory Hodgkin lymphoma patients, where ≥80% were aged ≥12 years and ≥50% had failed prior ASCT. Overall CR rate was determined using a random-effect model, and compared with that reported for brentuximab vedotin in a pivotal phase 2 trial (SG035-0003). MAIN OUTCOME MEASURES Across 17 evaluable studies of historical or experimental agents (n = 812), the estimated overall CR rate was 11.1% (95% confidence interval [CI] 7.0, 17.6; range, 0-38.5%) versus 33.3% (95% CI 25.3, 43.9) for brentuximab vedotin (p < 0.0001). In sensitivity analyses, the estimated overall CR rates for historical/experimental agents were 13.6% (95% CI 8.7, 21.4) when only HL trials that reported a CR rate of >0% were included (13 studies; n = 696; p = 0.0009 vs. brentuximab vedotin), and 9.0% (95% CI 4.9, 16.6) when only HL trials were included where CR definition was reported and was measured using the same criteria as in the SG035-0003 study (12 studies; n = 562; p = 0.0001 vs. brentuximab vedotin). CONCLUSIONS Indirect comparisons against a heterogeneous historical sample population naturally limit our ability to draw comparisons, yet the results from this quantitative meta-analysis suggest that the antitumor activity of brentuximab vedotin may exceed that of other therapies used to treat patients with relapsed/refractory Hodgkin lymphoma post-ASCT.
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Affiliation(s)
- Vijayveer Bonthapally
- Global Outcomes and Epidemiology Research, Millennium: The Takeda Oncology Company , Cambridge, MA , USA
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Oki Y, Neelapu SS, Fanale M, Kwak LW, Fayad L, Rodriguez MA, Wallace M, Klinger M, Carlton V, Kong K, Faham M, Younes A. Detection of classical Hodgkin lymphoma specific sequence in peripheral blood using a next-generation sequencing approach. Br J Haematol 2015; 169:689-93. [PMID: 25818067 DOI: 10.1111/bjh.13349] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 01/20/2015] [Indexed: 11/29/2022]
Abstract
We applied a highly sensitive next-generation sequencing method to identify lymphoma-specific immunoglobulin gene segments in classical Hodgkin lymphoma (CHL) at initial diagnosis or recurrence, and assessed the ability of detecting such lymphoma-specific sequences in peripheral blood (PB). Seventeen CHL cases were tested and lymphoma-specific sequences were identified in 12 of the primary tumour biopsies. In 11 of these patients whose paired PB samples were available, tumour-specific clonotypes were detected in PB in eight patients. This data demonstrates the feasibility of detecting circulating tumour-specific sequences, creating an unprecedented opportunity to optimize the future treatment and monitoring strategies for patients with CHL.
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Affiliation(s)
- Yasuhiro Oki
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Sattva S Neelapu
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Michelle Fanale
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Larry W Kwak
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Luis Fayad
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Maria A Rodriguez
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Michael Wallace
- Department of Interventional Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Malek Faham
- Sequenta, Inc., South San Francisco, CA, USA
| | - Anas Younes
- Department of Lymphoma and Myeloma, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Li WS, Wang RC, Wang J, Chang KC. Primary nodular lymphocyte-predominant Hodgkin lymphoma of uterine cervix mimicking leiomyoma. Clin Case Rep 2015; 3:349-52. [PMID: 26185626 PMCID: PMC4498840 DOI: 10.1002/ccr3.246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/18/2014] [Accepted: 02/20/2015] [Indexed: 11/06/2022] Open
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) accounts for about 5% of all Hodgkin lymphomas and predominantly involves peripheral lymph nodes. Primary NLPHL of uterine cervix is very rare. Here, we report cervical NLPHL with CD21 expression in a 43-year-old woman, who presented with abnormal vaginal bleeding for 1 year.
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Affiliation(s)
- Wan-Shan Li
- Department of pathology and laboratory medicine, Taichung Veterans General Hospital Taichung, Taiwan
| | - Ren-Ching Wang
- Department of pathology and laboratory medicine, Taichung Veterans General Hospital Taichung, Taiwan
| | - John Wang
- Department of pathology and laboratory medicine, Taichung Veterans General Hospital Taichung, Taiwan
| | - Kung-Chao Chang
- Department of Pathology, College of Medicine, National Cheng Kung University and Hospital Tainan, Taiwan
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Gandikota N, Hartridge-Lambert S, Migliacci JC, Yahalom J, Portlock CS, Schöder H. Very low utility of surveillance imaging in early-stage classic Hodgkin lymphoma treated with a combination of doxorubicin, bleomycin, vinblastine, and dacarbazine and radiation therapy. Cancer 2015; 121:1985-92. [PMID: 25739719 DOI: 10.1002/cncr.29277] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 12/17/2014] [Accepted: 01/06/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study evaluated the need for surveillance imaging in early-stage classic Hodgkin lymphoma (cHL) after planned combined-modality therapy (CMT). METHODS Primary early-stage cHL patients who underwent CMT were included. Positron emission tomography (PET)/computed tomography (CT), CT, or both were performed at the initial staging, during or after chemotherapy, and for at least 2 years during follow-up. Imaging studies and medical records were reviewed to determine if and when relapse had occurred. Radiation doses and costs were also calculated from follow-up imaging. RESULTS The study included 78 patients with a median follow-up of 46 months; 85% of the patients had stage II disease (32% with bulky disease). Four of 77 interim PET scans were positive; none of these patients relapsed during follow-up, which ranged from 24 to 80 months. After a total of 466 follow-up imaging studies (91% with CT and 9% with PET/CT), no cHL relapse was detected. Eleven abnormal findings were noted on surveillance imaging: 9 were false-positives, and 2 were second primary malignancies. The average cumulative dose per patient from follow-up imaging was 107 mSv, which translated into an estimated lifetime excess cancer risk of 0.5%; the estimated total costs were $296,817 according to Medicare reimbursements. CONCLUSIONS Surveillance imaging with either CT or PET/CT can be omitted safely for early-stage cHL treated with a combination of doxorubicin, bleomycin, vinblastine, and dacarbazine and radiation therapy because the risk of relapse is extremely low. This observation also applies to patients with bulky disease. The elimination of surveillance imaging will also reduce healthcare expenses and cumulative radiation doses in these predominantly young patients.
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Affiliation(s)
- Neetha Gandikota
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sidonie Hartridge-Lambert
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jocelyn C Migliacci
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carol S Portlock
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Heiko Schöder
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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Liu S, Ma J, Yue Y, Li Q, Yang H, Zhao H, Zhao W, Yu Y, Wang X, Zhao Z, Wang Y, Zhang Y. [The clinical and pathological characteristics of 14 patients' nodular lymphocyte predominant Hodgkin's lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2015; 36:20-3. [PMID: 25641140 PMCID: PMC7343041 DOI: 10.3760/cma.j.issn.0253-2727.2015.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
目的 探讨结节性淋巴细胞为主型霍奇金淋巴瘤(NLPHL)患者的临床病理特征及疗效。 方法 收集14例NLPHL患者的临床资料,对其临床病理特征及近、远期疗效进行相关性分析。 结果 14例患者均为初治者,男、女各7例,中位发病年龄38(13~54)岁,中位随访时间为55.5(23~189)个月。发病率占同期霍奇金淋巴瘤(HL)的6.3%(14/223)。免疫组织化学检查结果示14例患者CD20均呈(+)/弱(+),CD30均(−),仅1例患者呈CD15弱(+)。14例患者中13例因自觉浅表淋巴结肿大就诊,所有患者惰性起病,病情进展缓慢。7例患者采用单纯化疗,7例患者采用放、化疗联合治疗。14例患者均有效,其中完全缓解(CR)+未证实的CR(CRu)12例。5年无疾病生存率为85.7%,5年总生存率为100.0%。单纯化疗与放、化疗联合治疗相比,不同的化疗方案相比,其近、远期疗效差异均无统计学意义(P值均>0.05)。 结论 NLPHL患者瘤细胞呈CD20(+)/弱(+),CD30(−),极少数患者呈CD15弱(+)。NLPHL在HL患者中所占比例低,以中青年患者多见,起病缓慢,与经典型HL患者相比疗效较好。
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Affiliation(s)
- Su Liu
- Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital. National Clinical Research Center for Cancer. Tianjin Key Laboratory of Cancer Prevention and Therapy. Tianjin 300060, China
| | - Jing Ma
- Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital. National Clinical Research Center for Cancer. Tianjin Key Laboratory of Cancer Prevention and Therapy. Tianjin 300060, China
| | - Yuanfang Yue
- Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital. National Clinical Research Center for Cancer. Tianjin Key Laboratory of Cancer Prevention and Therapy. Tianjin 300060, China
| | - Qian Li
- Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital. National Clinical Research Center for Cancer. Tianjin Key Laboratory of Cancer Prevention and Therapy. Tianjin 300060, China
| | - Hongliang Yang
- Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital. National Clinical Research Center for Cancer. Tianjin Key Laboratory of Cancer Prevention and Therapy. Tianjin 300060, China
| | - Haifeng Zhao
- Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital. National Clinical Research Center for Cancer. Tianjin Key Laboratory of Cancer Prevention and Therapy. Tianjin 300060, China
| | - Weipeng Zhao
- Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital. National Clinical Research Center for Cancer. Tianjin Key Laboratory of Cancer Prevention and Therapy. Tianjin 300060, China
| | - Yong Yu
- Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital. National Clinical Research Center for Cancer. Tianjin Key Laboratory of Cancer Prevention and Therapy. Tianjin 300060, China
| | - Xiaofang Wang
- Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital. National Clinical Research Center for Cancer. Tianjin Key Laboratory of Cancer Prevention and Therapy. Tianjin 300060, China
| | - Zhigang Zhao
- Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital. National Clinical Research Center for Cancer. Tianjin Key Laboratory of Cancer Prevention and Therapy. Tianjin 300060, China
| | - Yafei Wang
- Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital. National Clinical Research Center for Cancer. Tianjin Key Laboratory of Cancer Prevention and Therapy. Tianjin 300060, China
| | - Yizhuo Zhang
- Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital. National Clinical Research Center for Cancer. Tianjin Key Laboratory of Cancer Prevention and Therapy. Tianjin 300060, China
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Cohen JB, Kurtz DM, Staton AD, Flowers CR. Next-generation surveillance strategies for patients with lymphoma. Future Oncol 2015; 11:1977-91. [PMID: 26161931 PMCID: PMC4519355 DOI: 10.2217/fon.15.92] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
While remission and cure rates for Hodgkin and non-Hodgkin lymphoma continue to improve, surveillance approaches remain controversial, especially in light of recent reports suggesting limited benefit for routine radiologic assessment. Routine cross-sectional imaging results in considerable patient expense and anxiety, and this approach does not clearly improve patient outcomes. Next-generation approaches including minimal residual disease detection may provide an opportunity to identify relapse early and intervene prior to progression of clinical disease. This review discusses the role of surveillance imaging in Hodgkin and non-Hodgkin lymphoma and provides an introduction to serologic assessment of minimal residual disease. Future studies will need to focus on the clinical application of minimal residual disease surveillance and its ability to predict relapse, treatment response and survival.
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Affiliation(s)
- Jonathon B Cohen
- Department of Hematology & Medical Oncology, Emory University, 1365 Clifton Road NE, Atlanta, GA 30322, USA
| | - David M Kurtz
- Division of Oncology, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA
| | - Ashley D Staton
- Department of Hematology & Medical Oncology, Emory University, 1365 Clifton Road NE, Atlanta, GA 30322, USA
| | - Christopher R Flowers
- Department of Hematology & Medical Oncology, Emory University, 1365 Clifton Road NE, Atlanta, GA 30322, USA
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Swinburn P, Shingler S, Acaster S, Lloyd A, Bonthapally V. Health utilities in relation to treatment response and adverse events in relapsed/refractory Hodgkin lymphoma and systemic anaplastic large cell lymphoma. Leuk Lymphoma 2014; 56:1839-45. [PMID: 25284490 DOI: 10.3109/10428194.2014.970542] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
New therapies for relapsing/refractory Hodgkin lymphoma (R/R HL) and R/R systemic anaplastic large-cell lymphoma (sALCL) have emerged. This study captured utility values for R/R HL and sALCL to support economic evaluation. Health state "vignettes" were developed describing states associated with R/R HL and sALCL: treatment response (complete or partial response), stable and progressive disease and treatment-related adverse events (B-symptoms, acute/chronic graft-versus-host disease [GVHD] and peripheral neuropathy). Vignettes were evaluated by members of the public in the UK, Australia, Taiwan, Thailand, South Korea, Brazil and Mexico using the time trade-off method. Mean utilities varied substantially. Complete response utility scores were UK: 0.906, Australia: 0.889, Taiwan: 0.597, Thailand: 0.728, South Korea: 0.827, Brazil: 0.764, Mexico: 0.728. Adverse events were associated with disutility: acute GVHD, lowest mean utility value: Thailand 0.124; highest value: Mexico 0.467. Societal evaluation of health states for R/R HL and sALCL revealed a marked perceived benefit of a treatment response.
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Abstract
Patients with Hodgkin lymphoma (HL) who relapse following effective front-line therapy are offered salvage second-line chemotherapy regimens followed by high-dose therapy and autologous stem cell transplantation (HDT/ASCT). Randomized studies comparing HDT/ASCT with conventional chemotherapy in patients with relapsed refractory HL have shown significant improvement in progression-free survival and freedom from treatment failure but were not powered to show improvements in overall survival. For patients who relapse after salvage HDT/ASCT, novel therapies exist as a bridge to allogeneic SCT. In this article, we review indications and results of autologous and allogeneic SCT in HL.
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Affiliation(s)
- Nishitha M Reddy
- Division of Hematology/Oncology, Vanderbilt University Medical Center, 3927 The Vanderbilt Clinic, Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA
| | - Miguel-Angel Perales
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 298, New York, NY 10065, USA.
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