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Ebrahimi S, Habibzadeh A, Khojasteh-Kaffash S, Valizadeh P, Samieefar N, Rezaei N. Immune checkpoint inhibitors therapy as the game-changing approach for pediatric lymphoma: A brief landscape. Crit Rev Oncol Hematol 2024; 193:104225. [PMID: 38049077 DOI: 10.1016/j.critrevonc.2023.104225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/06/2023] Open
Abstract
Lymphoma is known as the third most common malignancy in children, and its prevalence and mortality are increasing. Common treatments, including chemotherapy, radiotherapy, and also surgery, despite their efficacy, have many side effects and, have a high chance of disease relapse. Immune Checkpoint Inhibitors (ICIs) offer a promising alternative with potentially fewer risks of relapse and toxicity. This review article aims to investigate the efficacy and safety of ICIs, either as monotherapy or in combination, for pediatric lymphoma patients. ICIs have revolutionized cancer treatment in recent years and have shown remarkable results in several adult cancers. However, their efficacy in treating pediatrics requires further investigation. Nevertheless, some ICIs, including nivolumab, pembrolizumab, and ipilimumab, have demonstrated encouraging outcomes. ICIs therapy is not without risks and can cause side effects, including rash, itching, vitiligo, abdominal pain, diarrhea, dysphagia, epigastric pain, nausea, vomiting, thyroid, and pituitary dysfunction. Overall, this review article highlights the potential benefits and risks of ICIs in treating pediatric lymphoma.
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Affiliation(s)
- Sara Ebrahimi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Adrina Habibzadeh
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Soroush Khojasteh-Kaffash
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Student Research Committee, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Parya Valizadeh
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Noosha Samieefar
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran; USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Science, Tehran, Iran.
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2
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Zijtregtop EAM, Zeal J, Metzger ML, Kelly KM, Mauz-Koerholz C, Voss SD, McCarten K, Flerlage JE, Beishuizen A. Significance of E-lesions in Hodgkin lymphoma and the creation of a new consensus definition: a report from SEARCH. Blood Adv 2023; 7:6303-6319. [PMID: 37522740 PMCID: PMC10589789 DOI: 10.1182/bloodadvances.2023010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/05/2023] [Accepted: 05/25/2023] [Indexed: 08/01/2023] Open
Abstract
The International Staging Evaluation and Response Criteria Harmonization for Childhood, Adolescent, and Young Adult Hodgkin Lymphoma (SEARCH for CAYAHL) seeks to provide an appropriate, universal differentiation between E-lesions and stage IV extranodal disease in Hodgkin lymphoma (HL). A literature search was performed through the PubMed and Google Scholar databases using the terms "Hodgkin disease," and "extranodal," "extralymphatic," "E lesions," "E stage," or "E disease." Publications were reviewed for the number of participants; median age and age range; diagnostic modalities used for staging; and the definition, incidence, and prognostic significance of E-lesions. Thirty-six articles describing 12 640 patients met the inclusion criteria. Most articles reported staging per the Ann Arbor (72%, 26/36) or Cotswolds modification of the Ann Arbor staging criteria (25%, 9/36), and articles rarely defined E-lesions or disambiguated "extranodal disease." The overall incidence of E-lesions for patients with stage I-III HL was 11.5% (1330/11 602 unique patients). Available stage-specific incidence analysis of 3888 patients showed a similar incidence of E-lesions in stage II (21.2%) and stage III (21.9%), with E-lesions rarely seen with stage I disease (1.1%). E-lesions likely remain predictive, but we cannot unequivocally conclude that identifying E-lesions in HL imparts prognostic value in the modern era of the more selective use of targeted radiation therapy. A harmonized E-lesion definition was reached based on the available evidence and the consensus of the SEARCH working group. We recommend that this definition of E-lesion be applied in future clinical trials with explicit reporting to confirm the prognostic value of E-lesions.
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Affiliation(s)
- Eline A. M. Zijtregtop
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Jamie Zeal
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN
- Department of Medicine, University of Tennessee Health Sciences Center, Memphis, TN
| | - Monika L. Metzger
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kara M. Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Christine Mauz-Koerholz
- Department of Pädiatrische Hämatologie und Onkologie, Zentrum für Kinderheilkunde der Justus-Liebig-Universität Giessen, Giessen, Germany
- Medical Faculty, Martin-Luther-University of Halle-Wittenberg, Halle, Germany
| | - Stephan D. Voss
- Department of Radiology, Boston Children’s Hospital Dana-Farber Cancer Institute, Boston, MA
| | | | - Jamie E. Flerlage
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Auke Beishuizen
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Hemato-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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3
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Janssens GO, Mandeville HC, Timmermann B, Maduro JH, Alapetite C, Padovani L, Horan G, Lassen-Ramshad Y, Dieckmann K, Ruebe C, Thorp N, Gandola L, Ajithkumar T, Boterberg T. A rapid review of evidence and recommendations from the SIOPE radiation oncology working group to help mitigate for reduced paediatric radiotherapy capacity during the COVID-19 pandemic or other crises. Radiother Oncol 2020; 148:216-222. [PMID: 32342872 PMCID: PMC7184972 DOI: 10.1016/j.radonc.2020.04.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To derive evidence-based recommendations for the optimal utilisation of resources during unexpected shortage of radiotherapy capacity. METHODS AND MATERIALS We have undertaken a rapid review of published literature on the role of radiotherapy in the multimodality treatment of paediatric cancers governing the European practise of paediatric radiotherapy. The derived data has been discussed with expert paediatric radiation oncologists to derive a hierarchy of recommendations. RESULTS The general recommendations to mitigate the potential detriment of an unexpected shortage of radiotherapy facilities include: (1) maintain current standards of care as long as possible (2) refer to another specialist paediatric radiotherapy department with similar level of expertise (3) prioritise use of existing radiotherapy resources to treat patients with tumours where radiotherapy has the most effect on clinical outcome (4) use chemotherapy to defer the start of radiotherapy where timing of radiotherapy is not expected to be detrimental (5) active surveillance for low-grade tumours if appropriate and (6) consider iso-effective hypofractionated radiotherapy regimens only for selected patients with predicted poor prognosis. The effectiveness of radiotherapy and recommendations for prioritisation of its use for common and challenging paediatric tumours are discussed. CONCLUSION This review provides evidence-based treatment recommendations during unexpected shortage of paediatric radiotherapy facilities. It has wider applications for the optimal utilisation of facilities, to improve clinical outcome in low- and middle-income countries, where limited resources continue to be a challenge.
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Affiliation(s)
- Geert O Janssens
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands; Princess Maxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - Henry C Mandeville
- Department of Radiotherapy, The Royal Marsden Hospital, Sutton, United Kingdom; The Institute of Cancer Research, Sutton, United Kingdom
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ) and German Cancer Consortium (DKTK), Germany
| | - John H Maduro
- Princess Maxima Centre for Paediatric Oncology, Utrecht, The Netherlands; Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Claire Alapetite
- Department of Radiation Oncology & Proton Center, Institut Curie, France
| | - Laetitia Padovani
- Aix-Marseille University, Oncology Radiotherapy Department, CRCM Inserm, UMR1068, CNRS UMR7258, AMU UM105, Genome Instability and Carcinogenesis, APHM, France
| | - Gail Horan
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom
| | | | - Karin Dieckmann
- Department of Radiotherapy Medical University Vienna, Austria
| | - Christian Ruebe
- Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Nicky Thorp
- Department of Radiotherapy, The Clatterbridge Cancer Centre, Wirral, United Kingdom; The Proton Beam Therapy Centre, The Christie Hospital, Manchester, United Kingdom
| | - Lorenza Gandola
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Thankamma Ajithkumar
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom.
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
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Townsend W, Leong S, Hoskin P, Diez P, Patrick P, Linch D, Wong WL, Kayani I, Sanghera B, Lopes A, Daw S, Collins G, Clifton-Hadley L, Ardeshna K. Treatment of classical Hodgkin lymphoma in young adults aged 18-30 years with a modified paediatric Hodgkin lymphoma protocol. Results of a multicentre phase II clinical trial (CRUK/08/012). Br J Haematol 2019; 189:128-132. [PMID: 31710702 PMCID: PMC7154553 DOI: 10.1111/bjh.16296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/30/2019] [Indexed: 11/29/2022]
Abstract
This phase II trial was designed to determine the safety and efficacy of a modified paediatric risk-stratified protocol in young adults (18-30 years) with classical Hodgkin Lymphoma. The primary end-point was neurotoxicity rate. The incidence of grade 3 neurotoxicity was 11% (80% CI, 5-19%); a true rate of neuropathy of >15% cannot be excluded. Neuropathy and associated deterioration in quality of life was largely reversible. The overall response rate was 100% with 40% complete remission (CR) rate. Twelve months disease-free survival (DFS) was 91%. We demonstrate that a risk-stratified paediatric combined modality treatment approach can be delivered to young adults without significant irreversible neuropathy.
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Affiliation(s)
- William Townsend
- Department of Haematology, University College London Hospitals NHS Foundation trust, London, UK.,Cancer Research UK and University College London Cancer Trials Centre, London, UK
| | - Sarah Leong
- Department of Haematology, University College London Hospitals NHS Foundation trust, London, UK
| | - Peter Hoskin
- Marie Curie Research Wing, Mount Vernon Cancer Centre, Northwood, UK
| | - Patricia Diez
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Northwood, UK
| | - Pip Patrick
- Cancer Research UK and University College London Cancer Trials Centre, London, UK
| | - David Linch
- Department of Haematology, University College London Hospitals NHS Foundation trust, London, UK.,Cancer Research UK and University College London Cancer Trials Centre, London, UK
| | - Wai-Lup Wong
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Irfan Kayani
- Department of Nuclear Medicine, University College Hospitals NHS Foundation Trust, London, UK
| | - Bal Sanghera
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Andre Lopes
- Cancer Research UK and University College London Cancer Trials Centre, London, UK
| | - Stephen Daw
- Department of Paediatric Oncology, University College Hospitals NHS Foundation Trust, London, UK
| | - Graham Collins
- Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford, UK
| | - Laura Clifton-Hadley
- Cancer Research UK and University College London Cancer Trials Centre, London, UK
| | - Kirit Ardeshna
- Department of Haematology, University College London Hospitals NHS Foundation trust, London, UK.,Cancer Research UK and University College London Cancer Trials Centre, London, UK
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5
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Prasad M, Narula G, Chinnaswamy G, Arora B, Shet T, Panjwani P, Sengar M, Laskar S, Khanna N, Banavali S. Unfavorable presentation but comparable outcome: Presentation and outcome of children with nodular lymphocyte predominant Hodgkin lymphoma from India. Pediatr Blood Cancer 2018; 65:e27288. [PMID: 29893471 DOI: 10.1002/pbc.27288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is an uncommon subtype of Hodgkin lymphoma (HL) with few published studies in children, entirely from North America and Europe. We analyzed clinical features and treatment outcome of pediatric NLPHL. PROCEDURE Children less than 18 years of age diagnosed after histopathology review to have NLPHL between June 1998 and August 2016 were retrospectively analyzed. Descriptive details of clinical presentation and treatment were collected, and outcomes analyzed using Kaplan-Meier survival analysis. RESULTS Of the 42 patients with a confirmed diagnosis of NLPHL during this period, there was complete information on 35. Median age was 11 years (range 6-16 years), male:female ratio was 4.8:1, there were 15, 11, 6, and 3 patients with Stage I, Stage II, Stage III, and Stage IV disease, respectively. Six patients had B symptoms, 10 had bulky disease, and 3 had bone marrow as well as extranodal involvement. Histology was typical NLPHL in 23 and variant in 12. Twenty-nine received chemotherapy, 10 with additional radiation, 3 patients with early stage disease received only radiotherapy and three others underwent complete node resection alone. Median follow-up was 55 months (range 7-165 months), 5 year event-free survival (EFS) was 83.3%, and overall survival 97.1%. Variant NLPHL histology was associated with higher incidence of unfavorable presentation and lower EFS. CONCLUSIONS NLPHL in India has an excellent outcome, despite a higher incidence of unfavorable presentations such as advanced stage disease, B symptoms, and bulky disease. Variant histology is an adverse prognostic factor.
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Affiliation(s)
- Maya Prasad
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Gaurav Narula
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Girish Chinnaswamy
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Brijesh Arora
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Tanuja Shet
- Homi Bhabha National Institute, Mumbai, India.,Pathology, Tata Memorial Hospital, Mumbai, India
| | | | - Manju Sengar
- Homi Bhabha National Institute, Mumbai, India.,Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Siddharth Laskar
- Homi Bhabha National Institute, Mumbai, India.,Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Nehal Khanna
- Homi Bhabha National Institute, Mumbai, India.,Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Shripad Banavali
- Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
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6
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Peignaux K, Gonzague-Casabianca L. Radiothérapie « involved node » et « involved site » des lymphomes hodgkiniens : quels volumes cible ? Cancer Radiother 2018; 22:401-403. [DOI: 10.1016/j.canrad.2018.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
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7
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Burnelli R, Rinieri S, Rondelli R, Todesco A, Bianchi M, Garaventa A, Zecca M, Indolfi P, Conter V, Santoro N, Aricò M, Cesaro S, D’amico S, Farruggia P, De Santis R, Locatelli F, Pileri SA, Scarzello G, Mascarin M, Vecchi V. Long-term results of the AIEOP MH’96 childhood Hodgkin’s lymphoma trial and focus on significance of response to chemotherapy and its implication in low risk patients to avoid radiotherapy. Leuk Lymphoma 2018; 59:2612-2621. [DOI: 10.1080/10428194.2018.1435872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Roberta Burnelli
- Pediatric Oncology Hematology “Lalla Seragnoli”, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Simona Rinieri
- Pediatric Onco-Hematology Unit, Azienda Ospedaliero-Universitaria Sant’Anna di Ferrara, Ferrara, Italy
| | - Roberto Rondelli
- Pediatric Oncology Hematology “Lalla Seragnoli”, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Alessandra Todesco
- Clinic of Pediatric Hemato-Oncology, Department of Women’s and Children’s Health, University of Padova, Padova, Italy
| | - Maurizio Bianchi
- Division of Pediatric Onco-Hematology, Regina Margherita Children’s Hospital, Torino, Italy
| | | | - Marco Zecca
- Pediatric Haematology/Oncology, Fondazione IRCCS Policlinico “San Matteo”, Pavia, Italy
| | - Paolo Indolfi
- Pediatric Oncology Service, Pediatric Department, Second University of Naples, Napoli, Italy
| | - Valentino Conter
- Clinica Pediatrica, Università di Milano-Bicocca, Azienda Ospedaliera San Gerardo, Monza, Italy
| | - Nicola Santoro
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Bari, Italy
| | - Maurizio Aricò
- Department of Pediatric Hematology Oncology, Azienda Ospedaliero Universitaria A. Meyer Children Hospital, Firenze, Italy
| | - Simone Cesaro
- Pediatric Hematology-Oncology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Salvatore D’amico
- Pediatric Hematology-Oncology, - Azienda Ospedaliera Universitaria Policlinico Vittorio Emanuele, Catania, Italy
| | - Piero Farruggia
- Department of Oncology, Pediatric Hematology and Oncology Unit, A.R.N.A.S. Ospedali Civico Di Cristina e Benfratelli, Palermo, Italy
| | - Raffaela De Santis
- Unit of Pediatrics, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Franco Locatelli
- Dipartimento di Oncoematologia Pediatrica, Ospedale Bambino Gesù, IRCCS Roma, Rome, Italy
| | - Stefano A. Pileri
- Chair of Pathology and Unit of Haematopathology, Department of Haematology and Oncological Sciences “L. and A. Seràgnoli”, Bologna University, Bologna, Italy
| | | | - Maurizio Mascarin
- S.S. Radioterapia Pediatrica e Area Giovani, IRCCS, Centro di Riferimento Oncologico Aviano, Pordenone, Italy
| | - Vico Vecchi
- Department of Pediatrics, Pediatric Oncology Unit, “Infermi” Hospital, Rimini, Italy
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9
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Cardiovascular effects of Hodgkin’s lymphoma: a review of literature. J Cancer Res Clin Oncol 2017; 144:99-107. [DOI: 10.1007/s00432-017-2560-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/11/2017] [Indexed: 01/09/2023]
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10
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Kamel MG, El-Qushayri AE, Thach TQ, Huy NT. Cardiovascular mortality trends in non-Hodgkin's lymphoma: a population-based cohort study. Expert Rev Anticancer Ther 2017; 18:91-100. [PMID: 29192533 DOI: 10.1080/14737140.2018.1409626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Non-Hodgkin's lymphoma (NHL) survivors are at a higher risk of cardiovascular diseases (CVDs). METHODS A population-based study was conducted to investigate the cardiovascular mortality trends to identify NHL survivors at the highest risk. RESULTS The CVDs mortality was the second most common cause of death (13.07%) after NHL. There were more patients ≥ 60 years old in the cardiovascular group (87.2%), P < 0.001. Patients who died from CVDs had the best survival while patients who died from NHL had a significantly lower mean survival. The overall survival rate was 92.4%. Consistently, older age, unmarried, male patients, not recently diagnosed with NHL and not receiving radiation and/or surgery were associated with a worse survival across all models. The black race and stage IV only had a worse cardiovascular specific survival (CVSS). CONCLUSIONS Although the CVSS improved over time, the mortality from the CVDs is still the second most common cause of death after NHL. Older age, not married, black, male patients, not recently diagnosed with NHL, with an advanced stage and not receiving radiation and/or surgery were associated with a worse survival. Risk factor modification along with CVDs screening should be intensified in NHL patients with these mortality predictors.
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Affiliation(s)
| | | | - Tran Quang Thach
- b University of Medicine and Pharmacy , Ho Chi Minh City , Vietnam
| | - Nguyen Tien Huy
- c Evidence Based Medicine Research Group & Faculty of Applied Sciences , Ton Duc Thang University , Ho Chi Minh City , Vietnam.,d Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences , Nagasaki University , Nagasaki , Japan
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11
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Kesik V, Ataş E, Karakükcü M, Aksoylar S, Erbey F, Taçyıldız N, Küpesiz A, Öniz H, Ünal E, Kansoy S, Öztürk G, Elli M, Kaya Z, Ünal E, Hazar V, Yılmaz Bengoa Ş, Karasu G, Atay D, Dağdemir A, Ören H, Koçak Ü, Yeşilipek MA. Prognostic Factors and a New Prognostic Index Model for Children and Adolescents with Hodgkin's Lymphoma Who Underwent Autologous Hematopoietic Stem Cell Transplantation: A Multicenter Study of the Turkish Pediatric Bone Marrow Transplantation Study Group. Turk J Haematol 2016; 33:265-272. [PMID: 27094103 PMCID: PMC5204179 DOI: 10.4274/tjh.2015.0280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: The prognostic factors and a new childhood prognostic index after autologous hematopoietic stem cell transplantation (AHSCT) in patients with relapsed/refractory Hodgkin’s lymphoma (HL) were evaluated. Materials and Methods: The prognostic factors of 61 patients who underwent AHSCT between January 1990 and December 2014 were evaluated. In addition, the Age-Adjusted International Prognostic Index and the Childhood International Prognostic Index (CIPI) were evaluated for their impact on prognosis. Results: The median age of the 61 patients was 14.8 years (minimum-maximum: 5-20 years) at the time of AHSCT. There were single relapses in 28 patients, ≥2 relapses in eight patients, and refractory disease in 25 patients. The chemosensitivity/chemorefractory ratio was 36/25. No pretransplant radiotherapy, no remission at the time of transplantation, posttransplant white blood cell count over 10x103/µL, posttransplant positron emission tomography positivity at day 100, and serum albumin of <2.5 g/dL at diagnosis were correlated with progression-free survival. No remission at the time of transplantation, bone marrow positivity at diagnosis, and relapse after AHSCT were significant parameters for overall survival. Conclusion: The major factors affecting the progression-free and overall survival were clearly demonstrated. A CIPI that uses a lactate dehydrogenase level of 500 IU/L worked well for estimating the prognosis. We recommend AHSCT at first complete remission for relapsed cases, and it should also be taken into consideration for patients with high prognostic scores at diagnosis.
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Affiliation(s)
- Vural Kesik
- Gülhane Training and Research Hospital Clinic of Pediatric Oncology, Ankara, Turkey Phone: +90 312 304 43 94 E-mail:
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12
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Seror E, Donadieu J, Pacquement H, Abbou S, Lambilliotte A, Schell M, Curtillet C, Gandemer V, Pasquet M, Aladjidi N, Lutz P, Schmitt C, Deville A, Minckes O, Vanier JP, Armari-Alla C, Thomas C, Gorde-Grosjean S, Millot F, Blouin P, Garnier N, Coze C, Devoldere C, Reguerre Y, Helfre S, Claude L, Clavel J, Oberlin O, Landman-Parker J, Leblanc T. Combined therapy in children and adolescents with classical Hodgkin's lymphoma: A report from the SFCE on MDH-03 national guidelines. Pediatr Hematol Oncol 2016; 33:423-437. [PMID: 27960645 DOI: 10.1080/08880018.2016.1247393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hodgkin's lymphoma (HL) in children and adolescents is highly curable, but children are at risk of long-term toxicity. The MDH-03 guidelines were established in order to decrease the burden of treatment in good-responder patients, and this report should be considered a step toward further optimization of treatment within large collaborative trials. We report the therapy and long-term outcomes of 417 children and adolescents treated according to the national guidelines, which were applied between 2003 and 2007 in France. The patients were stratified into three groups according to disease extension. Chemotherapy consisted of four cycles of VBVP (vinblastine, bleomycin, VP16, prednisone) in localized stages (G1/95 pts/23%), four cycles of COPP/ABV (cyclophosphamide, vincristine, procarbazine, prednisone, adriamycin, bleomycin, vinblastine) cycles in intermediate stages (G2/184 pts/44%) and three cycles of OPPA (vincristine, procarbazine, prednisone, adriamycin) plus three cycles of COPP in advanced stages (G3/138 pts/33%). Radiation therapy of the involved field was given to 97% of the patients, with the dose limited to 20 Gy in good responders (88%). With a median follow-up of 6.6 years, the 5-year event-free survival (EFS) and overall survival (OS) were 86.7% (83.1-89.7%) and 97% (94.5-98.1%), respectively. EFS and OS for G1, G2, and G3 were 98% and 100%, 81% and 97%, and 87% and 95%, respectively. Low-risk patients treated without alkylating agents and anthracycline had excellent outcomes and a low expected incidence of late effects. Intensification with a third OPPA cycle in high-risk group patients, including stage IV patients, allowed for very good outcomes, without increased toxicity.
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Affiliation(s)
- E Seror
- a Department of Pediatric Hematology , Robert-Debré Hospital , Paris , France
| | - J Donadieu
- b Armand-Trousseau Hospital , Paris , France
| | | | - S Abbou
- d Institut Gustave Roussy , Villejuif , France
| | | | - M Schell
- f CAC Centre Léon Bérard , Lyon , France
| | | | | | | | | | - P Lutz
- k CHU Strasbourg , Strasbourg , France
| | | | | | | | | | | | | | | | - F Millot
- s CHU Poitiers , Poitiers , France
| | | | | | - C Coze
- g CHU La Timone , Marseille , France
| | | | - Y Reguerre
- w CHU St Denis, La Réunion , Saint-Denis , France
| | - S Helfre
- c Institut Curie , Paris , France
| | - L Claude
- f CAC Centre Léon Bérard , Lyon , France
| | - J Clavel
- x Unité INSERM UMRS 1153 , Université Paris Descartes , Paris , France
| | - O Oberlin
- d Institut Gustave Roussy , Villejuif , France
| | | | - T Leblanc
- a Department of Pediatric Hematology , Robert-Debré Hospital , Paris , France
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Abstract
PURPOSE Our objective was to determine the risk factors for inpatient mortality of pediatric patients diagnosed with lymphoma through the utilization of a large national pediatric database. METHODS This cross-sectional study uses data from the Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP KID) for the year of 2012 to estimate the risk factors for inpatient mortality for pediatric patients diagnosed with lymphoma. All patients diagnosed with lymphoma between the ages of one and 18 years were included. Chi-square test was used to analyze categorical variables. Independent t-test was used to analyze continuous variables. RESULTS A total of 2,908 study subjects with lymphoma were analyzed. Of those, 56.1% were male and the average age was three years old. Total inpatient mortality was 1.2% or 34 patients. We found that patients with four or more chronic conditions were much more likely to die while hospitalized (p < 0.0001). In addition, we also saw that patients with median household incomes below $47,999 dollars (p = 0.05) having a need for a major procedure (p = 0.008) were associated with inpatient mortality. Congestive heart failure, renal failure, coagulopathy, metastatic disease, and electrolyte abnormalities were all found to be associated with inpatient mortality. CONCLUSIONS Pediatric lymphoma mortality in children is not only influenced by their medical condition but also by their socioeconomic condition as well.
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Affiliation(s)
- Yana Puckett
- Surgery, Texas Tech University Health Sciences Center
| | - Anh Ta
- School of Medicine, Saint Louis University
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14
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Fredman E, Mansur DB, Russo S. The evolving role of radiation therapy in pediatric Hodgkin's disease. Expert Rev Anticancer Ther 2016; 16:605-13. [PMID: 27137877 DOI: 10.1080/14737140.2016.1182428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Identifying the optimal treatment of pediatric Hodgkin's disease has been at the forefront of clinical investigation in recent years. Results of a number of large clinical trials have driven paradigm shifts in how physicians approach this often curable disease. In an effort to balance the goals of maximizing survival while minimizing acute toxicities and late complications, the recommended indications, targets, doses and schedules of chemotherapy and radiation have and continue to evolve. Recent attempts to decrease the total volume of tissue receiving radiation without requiring a significant escalation in cytotoxic chemotherapy have shown promise in low, intermediate and high risk patients. Utilizing risk-adapted, response-based treatment, researchers hope to uncover a subpopulation that may not require previously considered standard treatment modalities.
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Affiliation(s)
- Elisha Fredman
- a Department of Radiation Oncology, Seidman Cancer Center , University Hospitals, Case Medical Center , Cleveland , OH , USA
| | - David B Mansur
- a Department of Radiation Oncology, Seidman Cancer Center , University Hospitals, Case Medical Center , Cleveland , OH , USA
| | - Suzanne Russo
- a Department of Radiation Oncology, Seidman Cancer Center , University Hospitals, Case Medical Center , Cleveland , OH , USA
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15
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Al-Kindi SG, Abu-Zeinah GF, Kim CH, Hejjaji V, William BM, Caimi PF, Oliveira GH. Trends and Disparities in Cardiovascular Mortality Among Survivors of Hodgkin Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:748-52. [PMID: 26324747 DOI: 10.1016/j.clml.2015.07.638] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/28/2015] [Accepted: 07/28/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Over the past decades, survival of patients with Hodgkin lymphoma (HL) has increased but remains curtailed by cardiovascular mortality (CVM). HL survivors at greatest risk for cardiovascular death have not been clearly identified. We sought to report trends of CVM identify HL survivors at highest risk. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was queried for all adult patients diagnosed with HL (age 20-49 years) between 1990 and 2011. The trend of CVM and disparities are presented. RESULTS Of 19,781 HL patients, 53% were male and 83% were white; patients had a mean age of 33 ± 8.3 years at diagnosis. Eighteen percent had stage I disease, 45% stage II, 18% stage III, and 15% stage IV. The risk for CVM was higher in blacks (adjusted hazard ratio [HR], 1.97; P = .002), men (adjusted HR, 2.2; P < .001), and patients with older age at diagnosis (adjusted HR, 1.073 per year; P < .001). CVM has decreased, with 5-year cumulative incidence decreasing from 1.17% in 1990 to 0.18% in 2006, averaging 7% per year (adjusted HR, 0.927; P < .001). This trend was seen only in patients with early disease (P < .001) but not with advanced disease (P = NS). CVM as a proportion of all-cause mortality increases sharply at 50 years of age, constituting more than 30% of all causes of death. CONCLUSION Despite an overall decrease in CVM in HL survivors over the last decades, older patients, black patients, and men, especially those who have advanced-stage disease at diagnosis, are at the highest risk of cardiovascular death. Cardiovascular screening and risk modification should be intensified in HL patients with these characteristics.
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Affiliation(s)
- Sadeer G Al-Kindi
- Onco-cardiology program, Harrington Heart and Vascular Institute, and Seidman Cancer Center, University Hospitals, Cleveland, OH; School of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Chang H Kim
- Onco-cardiology program, Harrington Heart and Vascular Institute, and Seidman Cancer Center, University Hospitals, Cleveland, OH; School of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Vittal Hejjaji
- Onco-cardiology program, Harrington Heart and Vascular Institute, and Seidman Cancer Center, University Hospitals, Cleveland, OH
| | - Basem M William
- School of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Paolo F Caimi
- School of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Seidman Cancer Center, Cleveland, OH
| | - Guilherme H Oliveira
- Onco-cardiology program, Harrington Heart and Vascular Institute, and Seidman Cancer Center, University Hospitals, Cleveland, OH; School of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Seidman Cancer Center, Cleveland, OH.
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16
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Kobayashi R, Sunami S, Mitsui T, Nakazawa A, Koga Y, Mori T, Tanaka F, Ueyama JI, Osumi T, Fukano R, Ohki K, Sekimizu M, Mori T. Treatment of pediatric lymphoma in Japan: Current status and plans for the future. Pediatr Int 2015; 57:523-34. [PMID: 26096060 DOI: 10.1111/ped.12725] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/18/2015] [Accepted: 05/28/2015] [Indexed: 11/30/2022]
Abstract
Results of pediatric lymphoma treatment have improved markedly over the past 30 years. In Hodgkin's lymphoma, the 5 year event-free survival (EFS) was 81.5% in a retrospective study. In the ALB-NHL03 study, the 5 year EFS according to clinical stage in patients with lymphoblastic T-cell lymphoma (T-LBL) was 70.6% for stage III and 88.9% for stage IV. In mature B-cell lymphoma, the B-NHL03 study indicated that the 4 year EFS according to treatment group was 94% for group 1, 98% for group 2, 84% for group 3, and 78% for group 4. Moreover, the 2 year EFS rate was 81% in Japanese advanced stage patients based on the international ALCL99 study. Thus, EFS >80% was achieved in any subtype of pediatric lymphoma. With regard to refractory or recurrent lymphoma, however, treatment methods for improvement of the survival rate in these patients still need to be developed. Also the difference between child, and adolescent and young adult patients still needs to be clarified, and treatment protocols developed. Although lymphoma treatment does not greatly change according to country, it does differ between other countries and Japan for some subtypes of lymphoma. In particular, the results of treatment of stage III T-LBL in Japan are worse than those in the USA and Europe. The priority in future studies will be to collect data on these differences, and the reasons for these differences.
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Affiliation(s)
- Ryoji Kobayashi
- Department of Pediatrics, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Shosuke Sunami
- Department of Pediatrics, Narita Red Cross Hospital, Narita, Japan
| | - Tetsuo Mitsui
- Department of Pediatrics, Yamagata University School of Medicine, Yamagata, Japan
| | - Atsuko Nakazawa
- Department of Pathology, Children's Cancer Cente, National Center for Child Health and Development, Tokyo, Japan
| | - Yuhki Koga
- Department of Pediatrics, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Takeshi Mori
- Department of Pediatrics, Kobe University School of Medicine, Kobe, Japan
| | - Fumiko Tanaka
- Department of Pediatrics, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Jun-ichi Ueyama
- Department of Multidisciplinary Internal Medicine, Division of Pediatrics and Perinatology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Tomoo Osumi
- Division of Leukemia and Lymphoma, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Reiji Fukano
- Department of Pediatrics, National Hospital Organization Kyusyu Cancer Center, Fukuoka, Japan
| | - Kentaro Ohki
- Department of Hematology and Oncology, Gunma Children's Medical Center, Shibukawa, Japan
| | - Masahiro Sekimizu
- Department of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Tetsuya Mori
- Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
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Bayoumi Y, Al-Homaidi A, Zaidi S, Tailor I, Motiabi I, Alshehri N, Al-Ghazali A, Almudaibigh S. The benefit of consolidation radiotherapy to initial disease bulk in patients with advanced Hodgkin's disease who achieved complete remission after standard chemotherapy. J Blood Med 2015; 6:87-92. [PMID: 25848329 PMCID: PMC4374789 DOI: 10.2147/jbm.s69267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background/purpose The aim of this study was to evaluate the role of consolidation radiotherapy (RT) in advanced-stage Hodgkin’s disease (HD) with initial bulky sites after radiological complete remission (CR) or partial response (PR) with positron emission tomography-negative (metabolic CR) following standard chemotherapy (ABVD [Adriamycin, bleomycin, vinblastine, and dacarbazine]) six to eight cycles. Patients and methods Adult patients with advanced-stage HD treated at our institute during the period 2006 to 2012 were retrospectively evaluated. One hundred and ninety-two patients with initial bulky disease size (>7 cm) who attained radiological CR/PR and metabolic CR were included in the analysis. One hundred and thirteen patients who received radiotherapy (RT) as consolidation postchemotherapy (RT group) were compared to 79 patients who did not receive RT (non-RT group). Disease-free (DFS) and overall survival (OS) rates were estimated using the Kaplan–Meier method and were compared according to treatment group by the log-rank tests at P ≤0.05 significance level. Results The mean age of the cohort was 33 (range: 14 to 81) years. Eighty-four patients received involved-field radiation and 29 patients received involved-site RT. The RT group had worse prognostic factors compared to the non-RT group. Thirteen (12%) relapses occurred in the RT group, and 19 (24%) relapses occurred in the non-RT group. Nine patients (8%) in the RT group died, compared to eleven patients (14%) in the non-RT group. Second malignancies were seen in only five patients: three patients in the RT group compared to two patients in the non-RT group. At 5 years, overall DFS was 79%±9% and OS was 85%±9%. There was significant statistical difference between the RT group and the non-RT group regarding 5-year DFS: 86%±7% and 74%±9%, respectively (P ≤0.02). However, the 5-year OS was 90%±5% for the RT group and 83%±8% for the non-RT group, with no statistical difference (P ≤0.3). Conclusion: The results of our study suggest that consolidation RT in patients with advanced-stage HD with initial bulky disease who had postchemotherapy radiologic CR or PR with metabolic CR improved the DFS.
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Affiliation(s)
- Yasser Bayoumi
- Radiation Oncology, National Cancer Institute, Cairo University, Egypt ; Radiation Oncology Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Al-Homaidi
- Department of Haematology and Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Syed Zaidi
- Department of Haematology and Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Imran Tailor
- Department of Haematology and Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ibrahiem Motiabi
- Department of Haematology and Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nawal Alshehri
- Department of Haematology and Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Assem Al-Ghazali
- Department of Haematology and Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Samer Almudaibigh
- Department of Haematology and Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Hodgson DC, Dieckmann K, Terezakis S, Constine L. Implementation of contemporary radiation therapy planning concepts for pediatric Hodgkin lymphoma: Guidelines from the International Lymphoma Radiation Oncology Group. Pract Radiat Oncol 2015; 5:85-92. [DOI: 10.1016/j.prro.2014.05.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/12/2014] [Accepted: 05/16/2014] [Indexed: 11/16/2022]
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19
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Ballas L. Modern radiotherapeutic strategies in the management of lymphoma. Future Oncol 2015; 11:1011-20. [DOI: 10.2217/fon.14.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The history of radiation therapy in the treatment of malignancies is closely linked to its use in Hodgkin lymphoma. It was less than a decade after the first publication on x-rays that radiotherapy was used in the treatment of a Hodgkin lymphoma. Over time, radiotherapy has evolved with newer technology and better understanding of radiobiology. During this same time frame, the treatment of Hodgkin and non-Hodgkin lymphomas has also seen great progress. This review will provide detail on modern radiotherapy techniques, indications for utilization, and modern radiation field sizes and doses.
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20
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FDG-PET Response Prediction in Pediatric Hodgkin's Lymphoma: Impact of Metabolically Defined Tumor Volumes and Individualized SUV Measurements on the Positive Predictive Value. Cancers (Basel) 2015; 7:287-304. [PMID: 25635760 PMCID: PMC4381259 DOI: 10.3390/cancers7010287] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 01/21/2015] [Indexed: 12/22/2022] Open
Abstract
Background: In pediatric Hodgkin’s lymphoma (pHL) early response-to-therapy prediction is metabolically assessed by (18)F-FDG PET carrying an excellent negative predictive value (NPV) but an impaired positive predictive value (PPV). Aim of this study was to improve the PPV while keeping the optimal NPV. A comparison of different PET data analyses was performed applying individualized standardized uptake values (SUV), PET-derived metabolic tumor volume (MTV) and the product of both parameters, termed total lesion glycolysis (TLG); Methods: One-hundred-eight PET datasets (PET1, n = 54; PET2, n = 54) of 54 children were analysed by visual and semi-quantitative means. SUVmax, SUVmean, MTV and TLG were obtained the results of both PETs and the relative change from PET1 to PET2 (Δ in %) were compared for their capability of identifying responders and non-responders using receiver operating characteristics (ROC)-curves. In consideration of individual variations in noise and contrasts levels all parameters were additionally obtained after threshold correction to lean body mass and background; Results: All semi-quantitative SUV estimates obtained at PET2 were significantly superior to the visual PET2 analysis. However, ΔSUVmax revealed the best results (area under the curve, 0.92; p < 0.001; sensitivity 100%; specificity 85.4%; PPV 46.2%; NPV 100%; accuracy, 87.0%) but was not significantly superior to SUVmax-estimation at PET2 and ΔTLGmax. Likewise, the lean body mass and background individualization of the datasets did not impove the results of the ROC analyses; Conclusions: Sophisticated semi-quantitative PET measures in early response assessment of pHL patients do not perform significantly better than the previously proposed ΔSUVmax. All analytical strategies failed to improve the impaired PPV to a clinically acceptable level while preserving the excellent NPV.
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21
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Mauz-Körholz C, Hasenclever D, Holzendorf V, Bernstädt M, Jürgens H, Burdach S, Eggert A, Berthold F, Müller HL, Frühwald MC, Klingebiel T, Metzler M, Körholz D. Feasibility of VECOPA, a dose-intensive chemotherapy regimen for children and adolescents with intermediate and advanced stage Hodgkin lymphoma: results of the GPOH-HD-2002/VECOPA pilot trial. Leuk Lymphoma 2014; 56:1308-14. [PMID: 25204374 DOI: 10.3109/10428194.2014.961011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The GPOH-HD (Gesellschaft für Pädiatrische Onkologie und Hämatologie-Hodgkin Disease) strategy for children and adolescents with intermediate and advanced stage Hodgkin lymphoma is based on two induction cycles of OEPA (vincristine, etoposide, prednisone, doxorubicin) followed by COPP (cyclophosphamide, vincristine, procarbazine, prednisone) or COPDAC (cyclophosphamide, vincristine, prednisone, dacarbazine) consolidation. The feasibility and efficacy of an intensified procarbazine-free consolidation regimen VECOPA (vinblastine, etoposide, cyclophosphamide, vincristine, prednisone, doxorubicin) were investigated. Following two OEPA and one or two VECOPA cycles, involved field radiotherapy was applied. The main endpoint was feasibility. Secondary endpoints were toxicity, proportion of delayed cycles, granulocyte-colony stimulating factor use, and event-free and overall survival. The regimen was well tolerated with mostly hematotoxicity exceeding Common Toxicity Criteria grade 2. In most patients with advanced stage the second VECOPA cycle was delayed despite hematopoietic recovery and absence of serious adverse events. Event-free survival at 36 months was 0.86 (95% confidence interval 0.70-1). The VECOPA regimen is effective and tolerable. However, its time-intensification was not fully exploited within this trial.
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22
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Mulvihill DJ, McMichael K, Goyal S, Drachtman R, Weiss A, Khan AJ. Involved-nodal radiation therapy leads to lower doses to critical organs-at-risk compared to involved-field radiation therapy. Radiother Oncol 2014; 112:279-83. [PMID: 25082095 DOI: 10.1016/j.radonc.2014.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 06/25/2014] [Accepted: 06/30/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Involved field radiotherapy (IFRT) after cytotoxic chemotherapy has become the standard of care in treating pediatric patients with Hodgkin lymphoma. However, recent interest in shrinking the treatment volume to involved node radiotherapy (INRT) may allow lower doses to critical organ structures. We dosimetrically compared IFRT and INRT treatment approaches. METHODS INRT treatment plans were retrospectively constructed from 17 consecutively treated pediatric patients identified with Hodgkin lymphoma who had been previously treated with conventional IFRT. The radiation doses delivered to organs-at-risk (OARs) with virtual INRT treatment plans based on INRT field design were then compared to the original IFRT treatment plans. Metrics for comparison included mean doses to organs and volumes of organ receiving at least 50% of the original prescription dose (V50%). A one-tailed, paired t-test was then performed to verify statistical significance at an alpha level of 0.05. RESULTS All organs at risk compared in this investigation (kidneys, heart, thyroid, parotids, and lungs) had significantly lower doses of radiation with INRT when compared to IFRT (p<0.05). Furthermore, the volume of the breast receiving at least 50% of the initial prescription dose was statistically lower in the INRT plans. CONCLUSIONS Utilizing the concept of INRT results in a reduction of radiation dose to critical organ structures in pediatric patients with Hodgkin lymphoma when compared to the more traditional method of IFRT.
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Affiliation(s)
- David J Mulvihill
- Dept of Radiation Oncology, Rutgers Cancer Institute of NJ, New Brunswick, United States
| | - Kevin McMichael
- Dept of Radiation Oncology, Rutgers Cancer Institute of NJ, New Brunswick, United States
| | - Sharad Goyal
- Dept of Radiation Oncology, Rutgers Cancer Institute of NJ, New Brunswick, United States
| | - Richard Drachtman
- Dept of Pediatric Oncology, Rutgers Cancer Institute of NJ, New Brunswick, United States
| | - Aaron Weiss
- Dept of Pediatric Oncology, Rutgers Cancer Institute of NJ, New Brunswick, United States
| | - Atif J Khan
- Dept of Radiation Oncology, Rutgers Cancer Institute of NJ, New Brunswick, United States.
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Harker-Murray PD, Drachtman RA, Hodgson DC, Chauvenet AR, Kelly KM, Cole PD. Stratification of treatment intensity in relapsed pediatric Hodgkin lymphoma. Pediatr Blood Cancer 2014; 61:579-86. [PMID: 24504790 DOI: 10.1002/pbc.24851] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/15/2013] [Indexed: 11/12/2022]
Abstract
Risk-adapted, response-based therapies for pediatric Hodgkin lymphoma have resulted in 5-year survival exceeding 90%. Although high-dose chemotherapy and autologous hematopoietic stem cell transplantation (AHSCT) are considered standard for most patients with relapsed or refractory Hodgkin lymphoma, a subset of children with low risk relapse do not require AHSCT for cure. Currently there are no widely accepted criteria defining who should receive standard dose chemotherapy and/or radiotherapy, nor is there a standardized treatment regimen. We propose a risk-stratified, response-based algorithm for children with relapsed or refractory Hodgkin lymphoma that is based on a critical appraisal of published outcomes and prognostic factors.
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Affiliation(s)
- Paul D Harker-Murray
- Division of Pediatric Hematology and Oncology, Midwest Children's Cancer Center, Milwaukee, Wisconsin
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24
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Khafaga YM, Belgaumi AF. Pediatric Hodgkin's lymphoma: changing concepts and moving points in radiation therapy. Transfus Apher Sci 2013; 49:56-62. [PMID: 23769169 DOI: 10.1016/j.transci.2013.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The classic treatment of Hodgkin's lymphoma (HL) in children resulted in significant late toxicity in long-term survivors. Late treatment effects included skeletal, cardio- pulmonary, gonadal toxicities, and second malignant tumor (SMN). This has driven pediatric HL groups to adopt treatment strategies using less intense chemotherapy, less alkylating agents, reduced radiation dose and volume, and omission of radiation therapy in selected group of patients. In limited disease, the aim is to maintain a high cure rate with minimal side effects. Patients with advanced-stage HL have a lower outcome, and need treatment intensification. Dose-dense, risk and response-adapted treatment strategies are evolving aiming at improving outcome and reducing toxicity.
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Affiliation(s)
- Yasser M Khafaga
- Department of Radiation Oncology, King Faisal Specialist Hospital and Research Center, PO Box 3354, MBC34, Riyadh 11211, Saudi Arabia.
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25
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Risk-adapted chemotherapy without procarbazine in treatment of children with Hodgkin lymphoma. World J Pediatr 2013; 9:32-5. [PMID: 23275102 DOI: 10.1007/s12519-012-0390-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 02/08/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Because procarbazine is not available in the mainland of China, a risk-adapted chemotherapy without the drug was adopted for children with Hodgkin lymphoma (HL) in two tertiary referral centers for childhood cancer in Shanghai. The objective of the present study was to obtain the results comparable with those of previous studies. METHODS From January 1998 to December 2009, patients below 18 years with newly diagnosed, untreated HL were enrolled in the study. The patients were stratified into risk groups R1 (early stage), R2 (intermediate stage) and R3 (advanced stage). All the patients who had attained a complete remission were not given involved field radiotherapy. RESULTS Fifty-six patients were eligible for the study. The 4-year event-free survival (EFS) rate was 100%, 80.3%±7.2%, and 62.5%±12.1% for the risk groups R1, R2, and R3, respectively. There was statistically significant difference in EFS between patients with and those without B symptoms (P<0.001). In group R2, the EFS rate was higher for patients treated with chemotherapy combined with radiation (100% vs. 75%±8.8%). But no statistical difference was observed (P=0.177). At the time of evaluation (December 31, 2010), secondary malignancy was not observed. CONCLUSIONS A significant fraction of children with early stage or intermediate stage HL can be cured with a chemotherapy regimen without procarbazine. Complete response to chemotherapy seems not to be a determinant to omit radiotherapy.
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Are We Ready for Positron Emission Tomography/Computed Tomography-based Target Volume Definition in Lymphoma Radiation Therapy? Int J Radiat Oncol Biol Phys 2013; 85:14-20. [DOI: 10.1016/j.ijrobp.2012.02.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 01/28/2012] [Accepted: 02/10/2012] [Indexed: 11/18/2022]
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Tebbi CK, Mendenhall NP, London WB, Williams JL, Hutchison RE, FitzGerald TJ, de Alarcón PA, Schwartz C, Chauvenet A. Response-dependent and reduced treatment in lower risk Hodgkin lymphoma in children and adolescents, results of P9426: a report from the Children's Oncology Group. Pediatr Blood Cancer 2012; 59:1259-65. [PMID: 22911615 PMCID: PMC3468662 DOI: 10.1002/pbc.24279] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 07/11/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hodgkin lymphoma is highly curable but associated with significant late effects. Reduction of total treatment would be anticipated to reduce late effects. This aim of this study was to demonstrate that a reduction in treatment was possible without compromising survival outcomes. METHODS Protocol P9426, a response-dependent and reduced treatment for low risk Hodgkin lymphoma (stages I, IIA, and IIIA(1) ) was designed in 1994 based on a previous pilot project. Patients were enrolled from October 15, 1996 to September 19, 2000. Patients were randomized to receive or not receive dexrazoxane and received two cycles of chemotherapy consisting of doxorubicin, bleomycin, vincristine, and etoposide. After two cycles, patients were evaluated for response. Those in complete response (CR) received 2,550 cGy of involved field radiation therapy (IFRT). Patient with partial response or stable disease, received two more cycles of chemotherapy and IFRT at 2,550 cGy. RESULTS There were 294 patients enrolled, with 255 eligible for analysis. The 8-year event free survival (EFS) between the dexrazoxane randomized groups did not differ (EFS 86.8 ± 3.1% with DRZ, and 85.7 ± 3.3% without DRZ (P = 0.70). Forty-five percent of patients demonstrated CR after two cycles of chemotherapy. There was no difference in EFS by histology, rapidity of response, or number of cycles of chemotherapy. Six of the eight secondary malignancies in this study have been previously reported. CONCLUSIONS Despite reduced therapy and exclusion of most patients with lymphocyte predominant histology, EFS and overall survival are similar to other reported studies. The protocol documents that it is safe and effective to reduce therapy in low-risk Hodgkin lymphoma based on early response to chemotherapy with rapid responding patients having the same outcome as slower-responding patients when given 50% of the chemotherapy.
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Affiliation(s)
- Cameron K Tebbi
- Division of Pediatric Hematology/Oncology, University of South Florida School of Medicine, Tampa General Hospital Children’s Medical Center, Tampa, Florida
| | - Nancy P Mendenhall
- Medical Director of the University of Florida Proton Therapy Institute, University of Florida, Jacksonville, FL
| | - Wendy B London
- Children’s Oncology Group Statistics and Data Center and Dana-Farber Harvard Cancer Center, Harvard Medical School, Boston, MA
| | - Jonathan L. Williams
- Department of Radiology, University of Florida, 1600 SW Archer Rd, Shands Hospital, University of Florida, Gainesville, FL
| | | | - Thomas J. FitzGerald
- Radiation Oncology, UMass Memorial Medical Center - University Campus, Worcester, MA
| | | | - Cindy Schwartz
- Alan G. Hassenfeld Professor and Director of Pediatric Hematology Oncology, Brown University and Hasbro Children’s Hospital, Providence, RI
| | - Allen Chauvenet
- Pediatric Hematology/Oncology West Virginia University, Charleston, WV
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Frew JA, Lewis J, Lucraft HH. The management of children with lymphomas. Clin Oncol (R Coll Radiol) 2012; 25:11-8. [PMID: 23231943 DOI: 10.1016/j.clon.2012.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 08/10/2012] [Accepted: 08/13/2012] [Indexed: 10/27/2022]
Abstract
Lymphomas account for 10-15% of all paediatric malignancies. They are highly curable with 5 year survival rates of up to 95% for Hodgkin lymphoma and 82% for non-Hodgkin lymphoma. These excellent results have focused recent attention on reducing the burden of treatment-related morbidity while maintaining the excellent outcomes. Lymphomas are highly radiosensitive and radiotherapy was used historically in the treatment of both paediatric Hodgkin and non-Hodgkin lymphomas. As the late effects of radiotherapy, including second tumours, were recognised, successive protocols seeking to minimise late effects were developed that reduced the use of radiotherapy. Current treatment protocols for non-Hodgkin lymphoma are chemotherapy based and radiotherapy has been virtually eliminated. In contrast, current paediatric Hodgkin lymphoma protocols continue to use radiotherapy as part of combined modality treatment, targeted according to risk factors and response and at the minimum effective dose. This article reviews the treatment of Hodgkin lymphoma in children with particular emphasis on the role of radiotherapy.
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Affiliation(s)
- J A Frew
- Northern Centre for Cancer Care, The Freeman Hospital, High Heaton, Newcastle-upon-Tyne, UK.
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Hoskin PJ, Díez P, Williams M, Lucraft H, Bayne M. Recommendations for the use of radiotherapy in nodal lymphoma. Clin Oncol (R Coll Radiol) 2012; 25:49-58. [PMID: 22889569 DOI: 10.1016/j.clon.2012.07.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 05/22/2012] [Accepted: 05/29/2012] [Indexed: 12/25/2022]
Abstract
These guidelines have been developed to define the use of radiotherapy for lymphoma in the current era of combined modality treatment taking into account increasing concern over the late side-effects associated with previous radiotherapy. The role of reduced volume and reduced doses is addressed, integrating modern imaging with three-dimensional planning and advanced techniques of treatment delivery. Both wide-field and involved-field techniques have now been supplanted by the use of defined volumes based on node involvement shown on computed tomography (CT) and positron emission tomography (PET) imaging and applying the International Commission on Radiation Units and Measurements concepts of gross tumour volume (GTV), clinical target volume (CTV) and planning target volume (PTV). The planning of lymphoma patients for radical radiotherapy should now be based upon contrast enhanced 3 mm contiguous CT with three-dimensional definition of volumes using the convention of GTV, CTV and PTV. The involved-site radiotherapy concept defines the CTV based on the PET-defined pre-chemotherapy sites of involvement with an expansion in the cranio-caudal direction of lymphatic spread by 1.5 cm, constrained to tissue planes such as bone, muscle and air cavities. The margin allows for uncertainties in PET resolution, image registration and changes in patient positioning and shape. There is increasing evidence in both Hodgkin and non-Hodgkin lymphoma that traditional doses are higher than necessary for disease control and related to the incidence of late effects. No more than 30 Gy for Hodgkin and aggressive non-Hodgkin lymphoma and 24 Gy for indolent lymphomas is recommended; lower doses of 20 Gy in combination therapy for early-stage low-risk Hodgkin lymphoma may be sufficient. As yet there are no large datasets validating the use of involved-site radiotherapy; these will emerge from the current generation of clinical trials. Radiotherapy remains the most effective single modality in the treatment of lymphoma. A reduction in both treatment volume and overall treatment dose should now be considered to minimise the risks of late sequelae. However, it is important that this is not at the expense of the excellent disease control currently achieved.
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Affiliation(s)
- P J Hoskin
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK.
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Smith EC, Ziogas A, Anton-Culver H. Association between insurance and socioeconomic status and risk of advanced stage Hodgkin lymphoma in adolescents and young adults. Cancer 2012; 118:6179-87. [PMID: 22736071 DOI: 10.1002/cncr.27684] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 01/06/2012] [Accepted: 02/01/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Hodgkin lymphoma (HL) is one of the most common types of cancer among adolescents and young adults (AYAs) in the United States. Unfortunately, a greater percentage of AYAs are presenting with an advanced stage of disease at the time of diagnosis compared with their younger counterparts. METHODS The objective of the current study was to examine the association between possible barriers and characteristics (including gender, race, birthplace, marital status, socioeconomic status [SES], and insurance status) that may increase the risk of advanced stage HL at the time of diagnosis in a large cohort of AYA patients with HL from the California Cancer Registry (7343 incident cases of HL diagnosed from 1988-2006, between ages 15 years-40 years). RESULTS AYAs with advanced stage HL were more likely to be male, of Hispanic or black race/ethnicity, foreign born, single, of lower SES, and uninsured or to have only public health insurance (P < .05). Multivariate logistic regression analysis demonstrated that there was a significant increase in the odds of having advanced HL in males (odds ratio [OR], 1.57; 95% confidence interval [95% CI], 1.42-1.74 [P < .0001]), those with the lowest SES (OR, 1.47; 95% CI, 1.23-1.75 [P = .0003]), those without health insurance (OR, 1.76; 95% CI, 1.34-2.31 [P < .0001]), and those with public health insurance (OR, 1.45; 95% CI, 1.23-1.71 [P < .0001]). CONCLUSIONS A strong association was found between male gender, lower SES, and lack of health insurance and advanced stage HL at the time of diagnosis in AYAs (See editorial on pages 000-000, this issue.).
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Affiliation(s)
- Erlyn C Smith
- Department of Pediatric Hematology-Oncology, Children's Hospital of Orange County, Orange, California, USA
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Hudson MM, Constine LS. Refining the role of radiation therapy in pediatric hodgkin lymphoma. Am Soc Clin Oncol Educ Book 2012:616-20. [PMID: 24451806 DOI: 10.14694/edbook_am.2012.32.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The role of radiation therapy in the treatment of pediatric Hodgkin lymphoma has continued to be refined, motivated by the desire to avoid disruption to normal tissue development and function and secondary carcinogenesis. Such progress has occurred in tandem with modifications of the multiagent chemotherapy regimens that have been used in place of or in combination with low-dose involved-field radiation that are also associated with dose-related risks of cardiopulmonary and gonadal dysfunction and leukemogenesis. Consequently, treatment strategies for young patients, who have an excellent prognosis of long-term survival, utilizes a risk-adapted approach that provides optimal efficacy for disease control whereas limiting toxicity associated with both radiation and chemotherapy. Because of the differences in age-related developmental status and gender-related sensitivity to chemotherapy and radiation toxicity, no single treatment approach is ideal for all pediatric patients. This manuscript summarizes results from published clinical trials with the goal of defining optimal treatment strategies for children and adolescents with Hodgkin lymphoma in regards to the use of radiation therapy.
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Affiliation(s)
- Melissa M Hudson
- From the Department of Oncology, Division of Cancer Survivorship, St. Jude's Children's Research Hospital, Memphis, TN; Departments of Radiation Oncology and Pediatrics, Philip Rubin Center for Cancer Survivorship, James P. Wilmot Cancer Center at University of Rochester Medical Center, Rochester, NY
| | - Louis S Constine
- From the Department of Oncology, Division of Cancer Survivorship, St. Jude's Children's Research Hospital, Memphis, TN; Departments of Radiation Oncology and Pediatrics, Philip Rubin Center for Cancer Survivorship, James P. Wilmot Cancer Center at University of Rochester Medical Center, Rochester, NY
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Shankar A, Visaduraki M, Hayward J, Morland B, McCarthy K, Hewitt M. Clinical outcome in children and adolescents with Hodgkin lymphoma after treatment with chemotherapy alone – The results of the United Kingdom HD3 national cohort trial. Eur J Cancer 2012; 48:108-13. [DOI: 10.1016/j.ejca.2011.05.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 05/15/2011] [Accepted: 05/18/2011] [Indexed: 11/16/2022]
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Dosimetric Comparison of Involved-Field Three-Dimensional Conformal Photon Radiotherapy and Breast-Sparing Proton Therapy for the Treatment of Hodgkin’s Lymphoma in Female Pediatric Patients. Int J Radiat Oncol Biol Phys 2011; 81:e667-71. [DOI: 10.1016/j.ijrobp.2011.01.061] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Revised: 01/04/2011] [Accepted: 01/31/2011] [Indexed: 12/25/2022]
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Abstract
Leukemia and lymphoma are the most common and third most common pediatric malignancies, respectively, and share cell lineages, but the clinical and imaging manifestations of these malignancies vary substantially. Along with providing pertinent details on classification, epidemiology, and treatment, this article reviews the current roles of imaging in the management of childhood leukemia and lymphoma, with attention to diagnosis, staging, risk stratification, therapy response assessment, and surveillance for disease relapse and adverse effects of therapy. Advances in functional imaging are also discussed to provide insights into future applications of imaging in the management of pediatric patients with leukemia and lymphoma.
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Affiliation(s)
- R Paul Guillerman
- Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin Street, Suite 470, Houston, TX 77030, USA.
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Abstract
Adolescents and young adults (AYA) with cancer have been designated as a vulnerable population by the National Cancer Institute. This group, defined by the ages of 16-39 years, has not enjoyed the same survival improvements over the past several decades as older and younger cohorts. Several barriers prevent the optimal delivery of oncologic care in this subpopulation. This review will describe these challenges in the context of the major hematologic malignancies affecting this population (acute lymphoblastic leukemia [ALL], acute myeloid leukemia [AML], Hodgkin lymphoma [HL], and non-Hodgkin lymphoma [NHL]). For example, historical differences in care delivery between pediatric and adult health care systems have created confusion about optimal treatment planning for AYAs, a population that spans the pediatric-adult divide. In the case of ALL, retrospective studies have demonstrated significantly better outcomes when AYAs are treated according to pediatric and not adult protocols. Additional challenges more specific to AYAs include increased treatment-related toxicity relative to younger patients; less access to care and, specifically, access to clinical trials; lower adherence to medications and treatment plans; and psychosocial stressors relevant to individuals at this stage of life. Recognizing and responding to these challenges in AYAs may create opportunities to improve the cancer outcomes of this group.
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Carbone A, Spina M, Gloghini A, Tirelli U. Classical Hodgkin's lymphoma arising in different host's conditions: pathobiology parameters, therapeutic options, and outcome. Am J Hematol 2011; 86:170-9. [PMID: 21264899 DOI: 10.1002/ajh.21910] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Epidemiologic and molecular findings suggest that classical Hodgkin's lymphoma (CHL) is not a single disease but consists of more than one entity and may occur in different clinical settings. This review analyzes similarities and disparities among CHL entities arising in different host's conditions with respect to pathobiology parameters, therapeutic options, and outcome. For the purpose of this analysis, CHL entities have been subdivided according to the immune status of the host. In nonimmunosuppressed hosts, according to the age, CHL include pediatric, adult, and elderly forms, whereas, in immunosuppressed hosts, according to the type of immunosuppression, CHL include human immunodeficiency virus (HIV)-associated, iatrogenic, and post-transplant types. CHL entities in different settings are similar in morphology of neoplastic cells, expression of activation markers, and aberrations/activation of NFKB, JAK/STAT, and P13K/AKT pathways, but differ in the association with Epstein-Barr virus (EBV) infection, persistent B-cell phenotype, and cellular background composition. Large B-cell lymphomas resembling CHL may also be observed in the same clinical settings. These lesions, however, do not fulfill the diagnostic criteria of CHL and clinically display a very aggressive behavior. In this article, current treatment options for the CHL entities, especially for elderly CHL and HIV-associated CHL, are specifically reviewed. ABVD remains the gold standard both in nonimmunosuppressed or immunosuppressed hosts even if there are several data suggesting a possible improvement in outcome using the aggressive BEACOPP regimen in advanced stages. Refractory CHL, a clinical condition that may occur throughout the entire spectrum of CHL, is discussed separately.
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Affiliation(s)
- Antonino Carbone
- Division of Pathology, Centro di Riferimento Oncologico Aviano, Istituto Nazionale Tumori, Aviano, Italy
| | - Michele Spina
- Department of Medical Oncology, Centro di Riferimento Oncologico Aviano, Istituto Nazionale Tumori, Aviano, Italy
| | - Annunziata Gloghini
- Department of Diagnostic Pathology and Laboratory Medicine, Istituto Nazionale Tumori, Milano, Italy
| | - Umberto Tirelli
- Department of Medical Oncology, Centro di Riferimento Oncologico Aviano, Istituto Nazionale Tumori, Aviano, Italy
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Ali A, Sayed H, Farrag A, El-Sayed M. Risk-based combined-modality therapy of pediatric Hodgkin's lymphoma: A retrospective study. Leuk Res 2010; 34:1447-52. [DOI: 10.1016/j.leukres.2010.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 06/12/2010] [Accepted: 06/13/2010] [Indexed: 11/29/2022]
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Hines-Thomas MR, Howard SC, Hudson MM, Krasin MJ, Kaste SC, Shulkin BL, Metzger ML. Utility of bone marrow biopsy at diagnosis in pediatric Hodgkin's lymphoma. Haematologica 2010; 95:1691-6. [PMID: 20494933 DOI: 10.3324/haematol.2010.025072] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Bone marrow biopsy is considered essential for the staging and risk-adapted treatment of Hodgkin's lymphoma with unfavorable risk features. We reviewed the cases of pediatric Hodgkin's lymphoma in our institution to determine the impact of bone marrow involvement on treatment, relapse, and survival. DESIGN AND METHODS We reviewed the clinical characteristics and outcome of 383 patients treated for Hodgkin's lymphoma at St. Jude Children's Research Hospital between August 1990 and August 2008. The 5-year survival estimates for patients with and without bone marrow involvement were compared. RESULTS Of 228 patients who had a bone marrow biopsy at diagnosis, 21 had bone marrow involvement. Bone marrow findings changed the disease stage in only seven patients (3.1%): from IB to IVB (n=1), from IIA (with bulky disease) to IVA (n=1), from IIB to IVB (n=1), and from IIIB to IVB (n=4). One patient's risk assignment changed from intermediate to unfavorable risk without his chemotherapy being altered. No statistically significant difference was observed between patients with stage IV Hodgkin's lymphoma who did (n=21) and did not (n=61) have bone marrow involvement in 5-year relapse-free survival (89.6± 7% versus 73.9±6.1%; P=0.25) or 5-year overall survival (95.2±8.2% versus 87.3±4.9%; P=0.82). CONCLUSIONS Although bone marrow involvement changed the stage in 3.1% of pediatric Hodgkin's lymphoma patients, it did not change risk-adapted treatment or prognosis. We conclude that bone marrow biopsy need not be performed at diagnosis in patients who have unfavorable risk features, although this finding should be confirmed by larger prospective studies.
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Affiliation(s)
- Melissa R Hines-Thomas
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA
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Abstract
Hodgkin lymphoma is one of the few cancers that affect both adults and children. Cure rates for Hodgkin lymphoma remain among the best for pediatric cancers. However, cure is often associated with significant delayed effects of therapy, including an elevated risk for second malignancies, cardiotoxicity, pulmonary toxicity, and gonadal and non-gonadal endocrine dysfunction. Therefore, the aim of current treatment strategies is to further improve outcomes while minimizing therapy-related complications. At diagnosis, patients are classified into risk groups based on disease stage, and the presence of clinical, biologic, and serologic risk factors. In general, the most recent trials have intensified therapy in those patients with high-risk disease to improve disease control, and have limited therapy in those patients with low-risk disease to avoid secondary effects. In low-risk patients, multiple studies have been conducted to investigate limiting either radiation therapy or chemotherapy to prevent long-term side effects without affecting the excellent cure rate. In intermediate- and high-risk patients, many studies have examined intensifying therapy to improve event-free survival rates. In addition, response assessment by fluorine-18-2-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) may be particularly important in pediatric Hodgkin lymphoma; it may allow modification of treatment to maximize treatment efficacy and minimize late effects of chemotherapy and radiation therapy. Despite the improvements in treatment for all stages of Hodgkin lymphoma, there is still a subgroup of patients who do not enter remission with initial therapy or relapse after initial response to therapy. Unfortunately, standard-dose salvage chemotherapy for relapsed disease has disappointing results in terms of overall survival since patients have typically already received intensive therapy. While there is no standard of care in terms of salvage chemotherapy, high-dose chemotherapy with autologous stem cell transplant (ASCT) rescue has become the standard of care for the majority of children with relapsed Hodgkin lymphoma. The use of allogeneic transplantation is controversial in relapsed or refractory Hodgkin lymphoma; because of the high transplant-related mortality, allogeneic transplant has not been associated with improved overall survival over ASCT. As more has been learned about the biologic mechanisms involved in Hodgkin lymphoma, biologically-based therapies are being investigated for use in this disease, both at initial diagnosis and relapse. Both immunotherapy and small molecules are being studied as possible therapeutic agents in Hodgkin lymphoma. Unfortunately, the vast majority of investigations of novel agents have occurred exclusively in adult patients. However, since pediatric Hodgkin lymphoma and adult Hodgkin lymphoma are similar, these results may potentially be extrapolated to pediatric Hodgkin lymphoma.
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Affiliation(s)
- Jennifer Freed
- Division of Pediatric Hematology/Oncology, The Brooklyn Hospital Center, Brooklyn, New York 11201, USA.
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Metzger ML, Hudson MM. Balancing Efficacy and Safety in the Treatment of Adolescents With Hodgkin's Lymphoma. J Clin Oncol 2009; 27:6071-3. [DOI: 10.1200/jco.2009.25.3765] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Monika L. Metzger
- Department of Oncology, St Jude Children's Research Hospital; and University of Tennessee, College of Medicine, Memphis, TN
| | - Melissa M. Hudson
- Department of Oncology, St Jude Children's Research Hospital; and University of Tennessee, College of Medicine, Memphis, TN
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Bien E, Balcerska A. Serum Soluble Interleukin-2 Receptor, Beta2-Microglobulin, Lactate Dehydrogenase and Erythrocyte Sedimentation Rate in Children with Hodgkin’s Lymphoma. Scand J Immunol 2009; 70:490-500. [DOI: 10.1111/j.1365-3083.2009.02313.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Goda JS, Tsang RW. Involved field radiotherapy for limited stage Hodgkin lymphoma: balancing treatment efficacy against long-term toxicities. Hematol Oncol 2009; 27:115-22. [DOI: 10.1002/hon.890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Furth C, Steffen IG, Amthauer H, Ruf J, Misch D, Schönberger S, Kobe C, Denecke T, Stöver B, Hautzel H, Henze G, Hundsdoerfer P. Early and late therapy response assessment with [18F]fluorodeoxyglucose positron emission tomography in pediatric Hodgkin's lymphoma: analysis of a prospective multicenter trial. J Clin Oncol 2009; 27:4385-91. [PMID: 19667276 DOI: 10.1200/jco.2008.19.7814] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In adult Hodgkin's lymphoma (HL) risk stratification after early therapy response assessment with [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) seems to allow tailoring therapy with less toxicity for patients with adequate metabolic response. This study delivers the first prospective data on the potential of FDG-PET for response assessment in pediatric HL. PATIENTS AND METHODS FDG-PET was performed in 40 pediatric HL patients before polychemotherapy (PET-1), after two cycles of polychemotherapy (PET-2), and after completion of polychemotherapy (PET-3). Mean follow-up was 46 months (range, 26 to 72 months). RESULTS At early and late response assessment, the proportion of PET-negative patients was significantly higher compared with those patients with negative findings in conventional imaging methods (CIMs; PET-2, 26 of 40 v CIM-2, one of 40; P < .001; PET-3, 21 of 29 v CIM-3, four of 29; P < .001). Sensitivity and negative predictive value were 100% for early and late therapy response assessment by PET. Both patients suffering a relapse during follow-up were identified by PET-2/3, whereas one of these patients was not detected by CIM-3. PET was superior to CIMs with regard to specificity in early and late therapy response assessment (68% v 3%, and 78% v 11%, respectively; both P < .001). Specificity of early therapy response assessment by PET was improved to 97% by quantitative analysis of maximal standardized uptake value reduction using a cutoff value of 58%. CONCLUSION Pediatric HL patients with a negative PET in response assessment have an excellent prognosis while PET-positive patients have an increased risk for relapse.
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Affiliation(s)
- Christian Furth
- Klinik für Radiologie und Nuklearmedizin, Otto-von-Guericke Universität, Universitätsklinikum Magdeburg A.ö.R., Leipziger Strasse 44, 39120 Magdeburg, Germany.
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Keller FG, Castellino SM, Nachman JB. What is the best treatment for children with limited-stage Hodgkin lymphoma? Curr Hematol Malig Rep 2009; 4:129-35. [DOI: 10.1007/s11899-009-0019-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Constine LS, Tarbell N, Hudson MM, Schwartz C, Fisher SG, Muhs AG, Basu SK, Kun LE, Ng A, Mauch P, Sandhu A, Culakova E, Lyman G, Mendenhall N. Subsequent malignancies in children treated for Hodgkin's disease: associations with gender and radiation dose. Int J Radiat Oncol Biol Phys 2008; 72:24-33. [PMID: 18722263 DOI: 10.1016/j.ijrobp.2008.04.067] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 04/02/2008] [Accepted: 04/08/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE Subsequent malignant neoplasms (SMNs) are a dominant cause of morbidity and mortality in children treated for Hodgkin's disease (HD). We evaluated select demographic and therapeutic factors associated with SMNs, specifically gender and radiation dose. METHODS AND MATERIALS A total of 930 children treated for HD at five institutions between 1960 and 1990 were studied. Mean age at diagnosis was 13.6 years, and mean follow-up was 16.8 years (maximum, 39.4 years). Treatment included radiation alone (43%), chemotherapy alone (9%), or both (48%). RESULTS We found that SMNs occurred in 102 (11%) patients, with a 25-year actuarial rate of 19%. With 15,154 patient years of follow-up, only 7.18 cancers were expected (standardized incidence ratio [SIR] = 14.2; absolute excess risk [AER] = 63 cases/10,000 years). The SIR for female subjects, 19.93, was significantly greater than for males, 8.41 (p < 0.0001). After excluding breast cancer, the SIR for female patients was 15.4, still significantly greater than for male patients (p = 0.0012). Increasing radiation dose was associated with an increasing SIR (p = 0.0085). On univariate analysis, an increased risk was associated with female gender, increasing radiation dose, and age at treatment (12-16 years). Using logistic regression, mantle radiation dose increased risk, and this was 2.5-fold for female patients treated with more than 35 Gy primarily because of breast cancer. CONCLUSIONS Survivors of childhood HD are at risk for SMNs, and this risk is greater for female individuals even after accounting for breast cancer. Although SMNs occur in the absence of radiation therapy, the risk increases with RT dose.
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Affiliation(s)
- Louis S Constine
- Department of Radiation Oncology, University of Rochester, Rochester, NY 14642, USA.
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Olson MR, Donaldson SS. Treatment of pediatric hodgkin lymphoma. Curr Treat Options Oncol 2008; 9:81-94. [PMID: 18461462 DOI: 10.1007/s11864-008-0058-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 04/17/2008] [Indexed: 11/30/2022]
Abstract
OPINION STATEMENT We are increasingly successful in the treatment of Hodgkin lymphoma. Current risk adapted trials seek to maintain the excellent efficacy of older therapies, while simultaneously limiting their late toxicities. Current management of early stage/favorable disease involves the use of two to four cycles of tailored chemotherapy, often followed by low-dose, involved field radiation. Those with intermediate and advanced stage disease require more intense chemotherapy and radiation regimens. Functional imaging using [(18)F]-2 fluoro-D-2-deoxyglucose is increasingly used to determine complete vs. partial response and to detect relapse. Given the success of primary therapy, retrieval of patients remains a highly individualized challenge. The majority of children failing combined-modality treatment undergo high-dose chemotherapy followed by autologous hematopoietic stem cell rescue, oftentimes with consolidative radiotherapy.
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Affiliation(s)
- Michael R Olson
- Department of Radiation Oncology, Stanford Cancer Center, 875 Blake Wilbur Drive, Stanford, CA 94305-5847, USA
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Girinsky T, Ghalibafian M. Radiotherapy of hodgkin lymphoma: indications, new fields, and techniques. Semin Radiat Oncol 2007; 17:206-22. [PMID: 17591568 DOI: 10.1016/j.semradonc.2007.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In recent years, radiotherapy in patients with Hodgkin lymphoma has evolved considerably because of sophisticated imaging technologies and radiation delivery techniques. Even more recently, a new radiation field concept has emerged to ensure better normal tissue protection while preserving an excellent clinical outcome. The role of radiation therapy is also rapidly changing because the concept of a risk-adapted treatment strategy, in which combined-modality treatments were the order of the day, is now expanding into a concept of response-adapted treatments.
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Affiliation(s)
- Theodore Girinsky
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France.
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Hodgson DC, Hudson MM, Constine LS. Pediatric Hodgkin Lymphoma: Maximizing Efficacy and Minimizing Toxicity. Semin Radiat Oncol 2007; 17:230-42. [PMID: 17591570 DOI: 10.1016/j.semradonc.2007.02.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Historically, both adult and childhood Hodgkin lymphoma (HL) were treated with full-dose (35-45 Gy) extended-field radiation therapy (RT). Although this treatment was the first to produce reliable disease control, the resulting late toxicity led pediatric oncologists to pioneer the use of combined chemotherapy and low-dose (15-25 Gy) involved-field RT for all stages of HL. Currently, standard treatment of childhood HL is risk adapted; those with favorable risk disease typically receive 2 to 4 cycles of multi-agent chemotherapy with low-dose IFRT, whereas those with higher-risk disease receive more intensive chemotherapy before IFRT. This approach produces long-term survival rates >90% while limiting exposure to anthracyclines, alkylators, and radiation to normal tissues. In contrast to adult HL, IFRT remains an important component of the treatment of advanced-stage HL in pediatric patients. Current clinical trials for children with HL aim to further segregate patients into risk strata such that those who are highly curable can receive less toxic therapy, whereas high-risk patients can receive augmented therapy. Response-adapted therapy, in which overall treatment intensity is modified according to the initial response to chemotherapy, is emerging as a potential means of further reducing therapy for some while maintaining high cure rates. The challenge is to refine therapy in a rare disease in which long-time intervals are necessary to observe an adequate number of events (treatment failure or late effects) to answer judicious questions.
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Affiliation(s)
- David C Hodgson
- Radiation Medicine Program, Princess Margaret Hospital, University Health Network, and Department of Radiation Oncology, University of Toronto, Toronto, Canada.
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Capra M, Hewitt M, Radford M, Hayward J, Weston CL, Machin D. Long-term outcome in children with Hodgkin’s lymphoma: The United Kingdom Children’s Cancer Study Group HD82 trial. Eur J Cancer 2007; 43:1171-9. [PMID: 17379506 DOI: 10.1016/j.ejca.2007.01.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Revised: 01/15/2007] [Accepted: 01/19/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND The aim of United Kingdom Children's Cancer Study Group (UKCCSG) HD82 was to establish the efficacy of chlorambucil/vinblastine/procarbazine/prednisolone (ChlVPP) in the treatment of childhood Hodgkin's lymphoma stages II-IV and radiotherapy (RT) alone in stage I patients. We report on the status of these patients to a follow-up of 20 years. METHODS Treatment consisted of 35Gy involved-field RT for stage I and ChlVPP alone for stages II-IV. Adjuvant RT (35Gy) was administered to those with bulky mediastinal disease. RESULTS Of the 358 patients, the 10-year EFS/OS per stage is I (65.4%/92.6%), II (80.0%/93.3%), III (68.8%/85.0%), IV (45.5%/72.7%). The corresponding 20-year OS rates are similar with a combined (all stage) rate dropping from 89.3% to 89.0% over the decade. The cumulative 20-year malignancy rate is 7.29%. CONCLUSION Single modality treatment provided relatively low EFS at 10-years but comparable long-term OS, relative to contemporary published combined modality regimens, for stages I-III but not for stage IV patients.
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Affiliation(s)
- Michael Capra
- Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
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