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Ghigna MR, Thomas de Montpreville V. Mediastinal tumours and pseudo-tumours: a comprehensive review with emphasis on multidisciplinary approach. Eur Respir Rev 2021; 30:30/162/200309. [PMID: 34615701 PMCID: PMC9488622 DOI: 10.1183/16000617.0309-2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/08/2021] [Indexed: 12/02/2022] Open
Abstract
The diagnosis of a mediastinal mass may be challenging for clinicians, since lesions arising within the mediastinum include a variety of disease entities, frequently requiring a multidisciplinary approach. Age and sex represent important information, which need to be integrated with imaging and laboratory findings. In addition, the location of the mediastinal lesion is fundamental; indeed, we propose to illustrate mediastinal diseases based on the compartment of origin. We consider that this structured approach may serve as hint to the diagnostic modalities and management of mediastinal diseases. In this review, we present primary mediastinal tumours in the evolving context of new diagnostic and therapeutic tools, with recently described entities, based on our own experience with >900 cases encountered in the past 10 years. Given the mediastinal anatomical heterogeneity, the correct positioning of mediastinal lesions becomes primal, in order to first establish a clinical suspicion and then to assist in planning biopsy and surgical procedurehttps://bit.ly/3p0gsk3
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Affiliation(s)
- Maria-Rosa Ghigna
- Dept of Pathology, Marie Lannelongue Hospital, Le Plessis Robinson, France
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Male and Female Fertility: Prevention and Monitoring Hodgkin' Lymphoma and Diffuse Large B-Cell Lymphoma Adult Survivors. A Systematic Review by the Fondazione Italiana Linfomi. Cancers (Basel) 2021; 13:cancers13122881. [PMID: 34207634 PMCID: PMC8228520 DOI: 10.3390/cancers13122881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Adult patients with Hodgkin lymphoma (HL) and diffuse large B-cell lymphoma (DLBCL) have prolonged survival but face the risk of treatment-induced impaired fertility. This systematic review, conducted by Fondazione Italiana Linfomi (FIL) researchers, aims to evaluate the incidence of treatment-related infertility, fertility preservation options, fertility assessment measures, and the optimal interval between the end of treatment and conception. METHODS MEDLINE, the Cochrane Library, and EMBASE were systematically searched up to September 2020 for published cohort, case-control, and cross-sectional studies on fertility issues. RESULTS Forty-five eligible studies were identified. Gonadotoxicity was related to sex, type and dosage of treatment, and, in females, to age. After receiving alkylating-agent-containing regimens, less than 30% of males recovered spermatogenesis, and 45% of females ≥30 years in age retained regular menstrual cycles. Sperm cryopreservation was offered to the majority of patients; sperm utilization resulted in a 33-61% pregnancy rate. After ovarian tissue transplantation, the spontaneous pregnancy and live birth rates were 38% and 23%; after IVF, the live birth rate was 38.4%. No data could be extracted on the utilization rate of cryopreserved mature oocytes. The results of studies on GnRH analogs are controversial; therefore, their use should not be considered an alternative to established cryopreservation techniques. Sperm count, FSH, and inhibin-B levels were appropriate measures to investigate male fertility; serum AMH levels and antral follicle count were the most appropriate markers for ovarian reserve. No data could be found regarding the optimal interval between the end of treatment and conception. CONCLUSIONS The risk of infertility should be discussed with adult lymphoma patients at the time of diagnosis, and fertility preservation options should be proposed before first-line treatment with alkylating-agent-containing regimens.
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Using both clinical research and population-based cancer registry in long-term research- a case study using EORTC trials and the Dutch national cancer registry (IKNL). J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2020.100226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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High burden of subsequent malignant neoplasms and cardiovascular disease in long-term Hodgkin lymphoma survivors. Br J Cancer 2018; 118:887-895. [PMID: 29381685 PMCID: PMC5886118 DOI: 10.1038/bjc.2017.476] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/04/2017] [Accepted: 12/04/2017] [Indexed: 12/11/2022] Open
Abstract
Background: Hodgkin lymphoma (HL) patients are at an increased risk of late adverse treatment effects. While published studies focussed on the risk of either subsequent malignant neoplasms (SMNs) or cardiovascular disease (CVD), we examined the combined burden from SMN and CVD. Methods: In 2908 5-year HL survivors treated between 1965 and 2000, the burden from SMN and/or CVD was assessed using cumulative incidences (CIs) and the mean cumulative count (MCC). Results: We identified 888 SMNs and 1153 CVDs in 1247 patients (median follow-up 22 years). At 40 years, the CI for developing either SMN or CVD was 68% and the CI for developing both SMN and CVD was 17%, and an average of 1.2 events per patient (MCC) was observed. HL patients who developed a solid malignancy had similar 15-year risks to develop another subsequent malignancy or CVD (15%), whereas patients who developed a CVD after HL had a higher 15-year risk to develop another CVD compared with a subsequent malignancy (46 vs 15%). Radiotherapy was the strongest risk factor for developing both SMN and CVD in multivariable Cox regression models. Conclusions: Treating physicians should be aware of the increased risk of both SMN and CVD in patients treated for HL until 2000.
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Radiation Therapy in Hodgkin’s Lymphoma. Radiat Oncol 2017. [DOI: 10.1007/978-3-319-52619-5_19-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Liu L, Giusti F, Schaapveld M, Aleman B, Lugtenburg P, Meijnders P, Hutchings M, Lemmens V, Bogaerts J, Visser O. Survival differences between patients with Hodgkin lymphoma treated inside and outside clinical trials. A study based on the EORTC-Netherlands Cancer Registry linked data with 20 years of follow-up. Br J Haematol 2016; 176:65-75. [DOI: 10.1111/bjh.14379] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/20/2016] [Indexed: 01/07/2023]
Affiliation(s)
- Lifang Liu
- Department of Statistics; The European Organisation for Research and Treatment of Cancer (EORTC); Brussels Belgium
| | - Francesco Giusti
- Department of Statistics; The European Organisation for Research and Treatment of Cancer (EORTC); Brussels Belgium
| | - Michael Schaapveld
- Netherlands Comprehensive Cancer Organisation (IKNL); Utrecht the Netherlands
- Division of Psychosocial Research and Epidemiology; the Netherlands Cancer Institute (NKI); Amsterdam the Netherlands
| | - Berthe Aleman
- Department of Radiation Oncology; the Netherlands Cancer Institute (NKI); Amsterdam the Netherlands
| | | | - Paul Meijnders
- Department of Radiation Oncology; ZNA Middelheim and University of Antwerp; Antwerp Belgium
| | - Martin Hutchings
- Department of Haematology; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - Valery Lemmens
- Netherlands Comprehensive Cancer Organisation (IKNL); Utrecht the Netherlands
| | - Jan Bogaerts
- Department of Statistics; The European Organisation for Research and Treatment of Cancer (EORTC); Brussels Belgium
| | - Otto Visser
- Netherlands Comprehensive Cancer Organisation (IKNL); Utrecht the Netherlands
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van Nimwegen FA, Cutter DJ, Schaapveld M, Rutten A, Kooijman K, Krol AD, Janus CP, Darby SC, van Leeuwen FE, Aleman BM. Simple Method to Estimate Mean Heart Dose From Hodgkin Lymphoma Radiation Therapy According to Simulation X-Rays. Int J Radiat Oncol Biol Phys 2015; 92:153-60. [DOI: 10.1016/j.ijrobp.2015.02.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/23/2015] [Accepted: 02/09/2015] [Indexed: 01/08/2023]
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van Nimwegen FA, Schaapveld M, Janus CPM, Krol ADG, Raemaekers JMM, Kremer LCM, Stovall M, Aleman BMP, van Leeuwen FE. Risk of diabetes mellitus in long-term survivors of Hodgkin lymphoma. J Clin Oncol 2014; 32:3257-63. [PMID: 25154821 DOI: 10.1200/jco.2013.54.4379] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Recently, an increased risk of diabetes mellitus (DM) was observed after abdominal irradiation for childhood cancer. Because many Hodgkin lymphoma (HL) survivors have also been treated with infradiaphragmatic radiotherapy, we evaluated the association between HL treatment and DM risk. PATIENTS AND METHODS Our study cohort comprised 2,264 5-year HL survivors, diagnosed before age 51 years and treated between 1965 and 1995. Treatment and follow-up information was collected from medical records and general practitioners. Radiation dosimetry was performed to estimate radiation dose to the pancreas. Cumulative incidence of DM was estimated, and risk factors for DM were evaluated by using Cox regression. RESULTS After a median follow-up of 21.5 years, 157 patients developed DM. Overall cumulative incidence of DM after 30 years was 8.3% (95% CI, 6.9% to 9.8%). After para-aortic radiation with ≥ 36 Gy, the 30-year cumulative incidence of DM was 14.2% (95% CI, 10.7% to 18.3%). Irradiation with ≥ 36 Gy to the para-aortic lymph nodes and spleen was associated with a 2.30-fold increased risk of DM (95% CI, 1.54- to 3.44-fold) whereas para-aortic radiation alone with ≥ 36 Gy was associated with a 1.82-fold increased risk (95% CI, 1.02- to 3.25-fold). Lower doses (10 to 35 Gy) did not significantly increase risk of DM. The risk of DM significantly increased with higher mean radiation doses to the pancreatic tail (P < .001). CONCLUSION Radiation to the para-aortic lymph nodes increases the risk of developing DM in 5-year HL survivors. Screening for DM should be considered in follow-up guidelines for HL survivors, and treating physicians should be alert to this increased risk.
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Affiliation(s)
- Frederika A van Nimwegen
- Frederika A. van Nimwegen, Michael Schaapveld, Berthe M.P. Aleman, and Flora E. van Leeuwen, The Netherlands Cancer Institute; Michael Schaapveld, Comprehensive Cancer Centre the Netherlands; Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam; Cecile P.M. Janus, Erasmus Medical Center Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; John M.M. Raemaekers, Radboud University Medical Center, Nijmegen, and Rijnstate Hospital, Arnhem, the Netherlands; and Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Schaapveld
- Frederika A. van Nimwegen, Michael Schaapveld, Berthe M.P. Aleman, and Flora E. van Leeuwen, The Netherlands Cancer Institute; Michael Schaapveld, Comprehensive Cancer Centre the Netherlands; Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam; Cecile P.M. Janus, Erasmus Medical Center Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; John M.M. Raemaekers, Radboud University Medical Center, Nijmegen, and Rijnstate Hospital, Arnhem, the Netherlands; and Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cecile P M Janus
- Frederika A. van Nimwegen, Michael Schaapveld, Berthe M.P. Aleman, and Flora E. van Leeuwen, The Netherlands Cancer Institute; Michael Schaapveld, Comprehensive Cancer Centre the Netherlands; Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam; Cecile P.M. Janus, Erasmus Medical Center Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; John M.M. Raemaekers, Radboud University Medical Center, Nijmegen, and Rijnstate Hospital, Arnhem, the Netherlands; and Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Augustinus D G Krol
- Frederika A. van Nimwegen, Michael Schaapveld, Berthe M.P. Aleman, and Flora E. van Leeuwen, The Netherlands Cancer Institute; Michael Schaapveld, Comprehensive Cancer Centre the Netherlands; Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam; Cecile P.M. Janus, Erasmus Medical Center Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; John M.M. Raemaekers, Radboud University Medical Center, Nijmegen, and Rijnstate Hospital, Arnhem, the Netherlands; and Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John M M Raemaekers
- Frederika A. van Nimwegen, Michael Schaapveld, Berthe M.P. Aleman, and Flora E. van Leeuwen, The Netherlands Cancer Institute; Michael Schaapveld, Comprehensive Cancer Centre the Netherlands; Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam; Cecile P.M. Janus, Erasmus Medical Center Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; John M.M. Raemaekers, Radboud University Medical Center, Nijmegen, and Rijnstate Hospital, Arnhem, the Netherlands; and Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Leontien C M Kremer
- Frederika A. van Nimwegen, Michael Schaapveld, Berthe M.P. Aleman, and Flora E. van Leeuwen, The Netherlands Cancer Institute; Michael Schaapveld, Comprehensive Cancer Centre the Netherlands; Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam; Cecile P.M. Janus, Erasmus Medical Center Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; John M.M. Raemaekers, Radboud University Medical Center, Nijmegen, and Rijnstate Hospital, Arnhem, the Netherlands; and Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marilyn Stovall
- Frederika A. van Nimwegen, Michael Schaapveld, Berthe M.P. Aleman, and Flora E. van Leeuwen, The Netherlands Cancer Institute; Michael Schaapveld, Comprehensive Cancer Centre the Netherlands; Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam; Cecile P.M. Janus, Erasmus Medical Center Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; John M.M. Raemaekers, Radboud University Medical Center, Nijmegen, and Rijnstate Hospital, Arnhem, the Netherlands; and Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Berthe M P Aleman
- Frederika A. van Nimwegen, Michael Schaapveld, Berthe M.P. Aleman, and Flora E. van Leeuwen, The Netherlands Cancer Institute; Michael Schaapveld, Comprehensive Cancer Centre the Netherlands; Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam; Cecile P.M. Janus, Erasmus Medical Center Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; John M.M. Raemaekers, Radboud University Medical Center, Nijmegen, and Rijnstate Hospital, Arnhem, the Netherlands; and Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Flora E van Leeuwen
- Frederika A. van Nimwegen, Michael Schaapveld, Berthe M.P. Aleman, and Flora E. van Leeuwen, The Netherlands Cancer Institute; Michael Schaapveld, Comprehensive Cancer Centre the Netherlands; Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam; Cecile P.M. Janus, Erasmus Medical Center Cancer Institute, Rotterdam; Augustinus D.G. Krol, Leiden University Medical Center, Leiden; John M.M. Raemaekers, Radboud University Medical Center, Nijmegen, and Rijnstate Hospital, Arnhem, the Netherlands; and Marilyn Stovall, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Abstract
Key Points
Hodgkin lymphoma survivors who developed a second malignancy remain at high risk of developing subsequent malignancies. Treatment options for these malignancies may be more restricted making early detection especially important to improving outcome.
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van der Kaaij M, van Echten-Arends J, Heutte N, Meijnders P, Abeilard-Lemoisson E, Spina M, Moser E, Allgeier A, Meulemans B, Lugtenburg P, Aleman B, Noordijk E, Fermé C, Thomas J, Stamatoullas A, Fruchart C, Eghbali H, Brice P, Smit W, Sebban C, Doorduijn J, Roesink J, Gaillard I, Coiffier B, Lybeert M, Casasnovas O, André M, Raemaekers J, Henry-Amar M, Kluin-Nelemans J. Cryopreservation, semen use and the likelihood of fatherhood in male Hodgkin lymphoma survivors: an EORTC-GELA Lymphoma Group cohort study. Hum Reprod 2013; 29:525-33. [DOI: 10.1093/humrep/det430] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Hodgkin lymphoma (HL), a B cell-derived cancer, is one of the most common lymphomas. In HL, the tumor cells--Hodgkin and Reed-Sternberg (HRS) cells--are usually very rare in the tissue. Although HRS cells are derived from mature B cells, they have largely lost their B cell phenotype and show a very unusual co-expression of markers of various hematopoietic cell types. HRS cells show deregulated activation of multiple signaling pathways and transcription factors. The activation of these pathways and factors is partly mediated through interactions of HRS cells with various other types of cells in the microenvironment, but also through genetic lesions. The transforming events involved in the pathogenesis of HL are only partly understood, but mutations affecting the NF-κB and JAK/STAT pathways are frequent. The dependency of HRS cells on microenvironmental interactions and deregulated signaling pathways may offer novel strategies for targeted therapies.
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Affiliation(s)
- Ralf Küppers
- Institute of Cell Biology (Cancer Research), Medical School, University of Duisburg-Essen, Essen, Germany.
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van der Kaaij MAE, Heutte N, Meijnders P, Abeilard-Lemoisson E, Spina M, Moser LC, Allgeier A, Meulemans B, Dubois B, Simons AHM, Lugtenburg PJ, Aleman BMP, Noordijk EM, Fermé C, Thomas J, Stamatoullas A, Fruchart C, Brice P, Gaillard I, Doorduijn JK, Sebban C, Smit WGJM, Bologna S, Roesink JM, Ong F, André MPE, Raemaekers JMM, Henry-Amar M, Kluin-Nelemans HC. Parenthood in survivors of Hodgkin lymphoma: an EORTC-GELA general population case-control study. J Clin Oncol 2012; 30:3854-63. [PMID: 23008303 DOI: 10.1200/jco.2011.40.8906] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We investigated the impact of Hodgkin lymphoma (HL) on parenthood, including factors influencing parenthood probability, by comparing long-term HL survivors with matched general population controls. PATIENTS AND METHODS A Life Situation Questionnaire was sent to 3,604 survivors treated from 1964 to 2004 in successive clinical trials. Responders were matched with controls (1:3 or 4) for sex, country, education, and year of birth (10-year groups). Controls were given an artificial date of start of treatment equal to that of their matched case. The main end point was presence of biologic children after treatment, which was evaluated by using conditional logistic regression analysis. Logistic regression analysis was used to analyze factors influencing spontaneous post-treatment parenthood. RESULTS In all, 1,654 French and Dutch survivors were matched with 6,414 controls. Median follow-up was 14 years (range, 5 to 44 years). After treatment, the odds ratio (OR) for having children was 0.77 (95% CI, 0.68 to 0.87; P < .001) for survivors compared with controls. Of 898 survivors who were childless before treatment, 46.7% achieved post-treatment parenthood compared with 49.3% of 3,196 childless controls (OR, 0.87; P = .08). Among 756 survivors with children before treatment, 12.4% became parents after HL treatment compared with 22.2% of 3,218 controls with children before treatment (OR, 0.49; P < .001). Treatment with alkylating agents, second-line therapy, and age older than 35 years at treatment appeared to reduce the chances of spontaneous post-treatment parenthood. CONCLUSION Survivors of HL had slightly but significantly fewer children after treatment than matched general population controls. The difference concerned only survivors who had children before treatment and appears to have more personal than biologic reasons. The chance of successful post-treatment parenthood was 76%.
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Abstract
Hodgkin lymphoma (HL) has become one of the most easily curable malignancies in oncology. More than 80% of patients can be cured with risk-adapted treatment that includes chemotherapy and radiotherapy. This progress is mainly due to the development of multi-agent chemotherapy and improved radiation techniques; however, severe, life-threatening treatment-related side effects occur, which include organ toxicity and secondary malignancies. Thus, the treatment approaches must be carefully balanced between optimal disease control and the risk of long-term sequelae. Although this article is meant to provide an overview of the current treatment approaches for patients with HL, in many instances conflicting results from various clinical trials are available, and a personal judgment is inevitable. Here, we focus on evidence from large clinical trials with solid conclusions.
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Meijnders P, Carde P, Girinsky T, Kluin-Nelemans J, Henry-Amar M, Raemaekers J, Karrasch M, van der Maazen R. Clinical achievements of the EORTC Lymphoma Group and aspects of future group strategy. EJC Suppl 2012. [DOI: 10.1016/s1359-6349(12)70019-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Orlacchio A, Schillaci O, Gaspari E, Della Gatta F, Danieli R, Bolacchi F, Ragano Caracciolo C, Mancini A, Simonetti G. Role of [18F]-FDG-PET/MDCT in evaluating early response in patients with Hodgkin's lymphoma. Radiol Med 2012; 117:1250-63. [PMID: 22327919 DOI: 10.1007/s11547-012-0792-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 06/10/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE The authors evaluated the prognostic role of 18-fluoro-fluorodeoxyglucose positron emission tomography/multidetector computed tomography ([(18)F]-FDG PET/MDCT) in treating patients with Hodgkin's lymphoma (HL). MATERIALS AND METHODS We retrospectively evaluated 132 patients with HL studied with PET/MDCT before the start of chemotherapy (CTX) for staging purposes and again after two CTX cycles with [doxorubicin (Adriblastin), bleomycin, vinblastine, dacarbazine (ABVD_] (interim PET/MDCT), at least 30 days after the end of the last CTX cycle and/or 3 months after the end of radiotherapy, if delivered (final PET-MDCT). RESULTS Interim PET-MDCT was negative in 104/132 patients (79%), and their final PET-MDCT showed complete remission in 102/104 (98%) of cases, with disease recurrence/persistence in two (2%). In the remaining 28 (21%) patients, interim PET-MDCT revealed an early response in 68% of cases and chemoresistance with disease progression in 32% of cases; in these 28 patients, final PET-MDCT showed a lack of response to treatment in 43% of cases (43%) and complete remission in 57% of cases. Statistical analysis of these data showed that interim PET-MDCT had a negative predictive value of 98% and a positive predictive value of 42%, with values of sensitivity, specificity and diagnostic accuracy of 85.7%, 86.4% and 86.4%, respectively. CONCLUSIONS Interim PET-MDCT has a reliable prognostic role in diagnosis and treatment of patients with HL, as it helps predict which patients are more likely to achieve a complete response at the end of treatment. PET/MDCT may also lead to a change in treatment, with reduced treatment-related toxic effects and significantly reduced total costs.
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Affiliation(s)
- A Orlacchio
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Policlinico Universitario Tor Vergata, Via Oxford 81, 00133, Roma, Italy.
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van der Kaaij MA, Heutte N, Meijnders P, Abeilard-Lemoisson E, Spina M, Moser EC, Allgeier A, Meulemans B, Simons AH, Lugtenburg PJ, Aleman BM, Noordijk EM, Fermé C, Thomas J, Stamatoullas A, Fruchart C, Brice P, Gaillard I, Bologna S, Ong F, Eghbali H, Doorduijn JK, Morschhauser F, Sebban C, Roesink JM, Bouteloup M, Van Hoof A, Raemaekers JM, Henry-Amar M, Kluin-Nelemans HC. Premature Ovarian Failure and Fertility in Long-Term Survivors of Hodgkin's Lymphoma: A European Organisation for Research and Treatment of Cancer Lymphoma Group and Groupe d'Étude des Lymphomes de l'Adulte Cohort Study. J Clin Oncol 2012; 30:291-9. [DOI: 10.1200/jco.2011.37.1989] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose In this large cohort of Hodgkin's lymphoma survivors with long follow-up, we estimated the impact of treatment regimens on premature ovarian failure (POF) occurrence and motherhood, including safety of nonalkylating chemotherapy and dose-response relationships for alkylating chemotherapy and age at treatment. Patients and Methods The Life Situation Questionnaire was sent to 1,700 women treated in European Organisation for Research and Treatment of Cancer and Groupe d'Étude des Lymphomes de l'Adulte trials between 1964 and 2004. Women treated between ages 15 and 40 years and currently not using hormonal contraceptives (n = 460) were selected to assess occurrence of POF. Cumulative POF risk was estimated using the life-table method. Predictive factors were assessed by Cox regression analysis. Results Median follow-up was 16 years (range, 5 to 45 years). Cumulative risk of POF after alkylating chemotherapy was 60% (95% CI, 41% to 79%) and only 3% (95% CI, 1% to 7%) after nonalkylating chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine; epirubicin, bleomycin, vinblastine, and prednisone). Dose relationship between alkylating chemotherapy and POF occurrence was linear. POF risk increased by 23% per year of age at treatment. In women treated without alkylating chemotherapy at age younger than 32 years and age 32 years or older, cumulative POF risks were 3% (95% CI, 1% to 16%) and 9% (95% CI, 4% to 18%), respectively. If menstruation returned after treatment, cumulative POF risk was independent of age at treatment. Among women who ultimately developed POF, 22% had one or more children after treatment, compared with 41% of women without POF. Conclusion Nonalkylating chemotherapy carries little to no excess risk of POF. Dose-response relationships for alkylating chemotherapy and age at treatment are both linear. Timely family planning is important for women at risk of POF.
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Affiliation(s)
- Marleen A.E. van der Kaaij
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Natacha Heutte
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Paul Meijnders
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Edwige Abeilard-Lemoisson
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Michele Spina
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Elizabeth C. Moser
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Anouk Allgeier
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Bart Meulemans
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Arnold H.M. Simons
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Pieternella J. Lugtenburg
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Berthe M.P. Aleman
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Evert M. Noordijk
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Christophe Fermé
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - José Thomas
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Aspasia Stamatoullas
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Christophe Fruchart
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Pauline Brice
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Isabelle Gaillard
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Serge Bologna
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Francisca Ong
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Houchingue Eghbali
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Jeanette K. Doorduijn
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Franck Morschhauser
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Catherine Sebban
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Judith M. Roesink
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Marie Bouteloup
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Achiel Van Hoof
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - John M.M. Raemaekers
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Michel Henry-Amar
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
| | - Hanneke C. Kluin-Nelemans
- Affiliations Marleen A.E. van der Kaaij, Arnold H.M. Simons, and Hanneke C. Kluin-Nelemans, University Medical Center Groningen, University of Groningen, Groningen; Pieternella J. Lugtenburg and Jeanette K. Doorduijn, Erasmus University Medical Center, Rotterdam; Berthe M.P. Aleman, the Netherlands Cancer Institute, Amsterdam; Evert M. Noordijk, Leiden University Medical Center, Leiden; Francisca Ong, Medisch Spectrum Twente, Enschede; Judith M. Roesink, University Medical Center Utrecht, Utrecht; John M
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ABVD as the Treatment Option in Advanced Hodgkin’s Lymphoma Patients Older than 45 Years. Pathol Oncol Res 2012; 18:675-80. [DOI: 10.1007/s12253-011-9494-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 09/06/2011] [Indexed: 10/14/2022]
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Advani RH, Hoppe RT, Maeda LS, Baer DM, Mason J, Rosenberg SA, Horning SJ. Stage I-IIA non-bulky Hodgkin's lymphoma. Is further distinction based on prognostic factors useful? The Stanford experience. Int J Radiat Oncol Biol Phys 2011; 81:1374-9. [PMID: 20934280 PMCID: PMC3020265 DOI: 10.1016/j.ijrobp.2010.07.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 07/13/2010] [Accepted: 07/14/2010] [Indexed: 11/16/2022]
Abstract
PURPOSE In the United States, early-stage Hodgkin's lymphoma (HL) is defined as asymptomatic stage I/II non-bulky disease. European groups stratify patients to more intense treatment by considering additional unfavorable factors, such as age, number of nodal sites, sedimentation rate, extranodal disease, and elements of the international prognostic score for advanced HL. We sought to determine the prognostic significance of these factors in patients with early-stage disease treated at Stanford University Medical Center. METHODS AND MATERIALS This study was a retrospective analysis of 101 patients treated with abbreviated Stanford V chemotherapy (8 weeks) and 30-Gy (n=84 patients) or 20-Gy (n=17 patients) radiotherapy to involved sites. Outcomes were assessed after applying European risk factors. RESULTS At a median follow-up of 8.5 years, freedom from progression (FFP) and overall survival (OS) rates were 94% and 97%, respectively. From 33% to 60% of our patients were unfavorable per European criteria (i.e., German Hodgkin Study Group [GHSG], n=55%; European Organization for Research and Treatment of Cancer, n=33%; and Groupe d'Etudes des Lymphomes de l'Adulte, n=61%). Differences in FFP rates between favorable and unfavorable patients were significant only for GHSG criteria (p=0.02) with there were no differences in OS rates for any criteria. Five of 6 patients who relapsed were successfully salvaged. CONCLUSIONS The majority of our patients deemed unfavorable had an excellent outcome despite undergoing a significantly abbreviated regimen. Application of factors used by the GHSG defined a less favorable subset for FFP but with no impact on OS. As therapy for early-stage disease moves to further reductions in therapy, these factors take on added importance in the interpretation of current trial results and design of future studies.
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Affiliation(s)
- Ranjana H Advani
- Department of Medicine, Division of Medical Oncology, Stanford University Medical Center, Stanford, California 94305, USA.
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Eichenauer DA, Fuchs M, Borchmann P, Engert A. Hodgkin's lymphoma: current treatment strategies and novel approaches. Expert Rev Hematol 2011; 1:63-73. [PMID: 21083007 DOI: 10.1586/17474086.1.1.63] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Approximately 80% of Hodgkin's lymphoma (HL) patients achieve long-term remission after primary chemotherapy or chemo/radiotherapy. Despite these excellent results, further treatment improvement is necessary. HL therapy is associated with severe acute and long-term toxicities. Thus, a major aim of clinical HL research is to evaluate novel schemes that are less toxic than current standard regimens without being less effective. Another focus is the treatment of patients with multiple relapses. Standard treatment for these patients has not yet been defined, and their prognosis is still poor. Reduced-intensity conditioning allogeneic stem cell transplantation was recently shown to be effective in carefully selected young chemosensitive patients. Furthermore, new strategies such as antibody- and small-molecule-based therapy have demonstrated encouraging results in preclinical studies and the first clinical trials.
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Affiliation(s)
- Dennis A Eichenauer
- First Department of Internal Medicine, University Hospital of Cologne, Kerpener Str. 62, 50924 Cologne, Germany.
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20
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Yamaguchi K, Fujisawa M. Anticancer chemotherapeutic agents and testicular dysfunction. Reprod Med Biol 2011; 10:81-87. [PMID: 29699084 DOI: 10.1007/s12522-011-0080-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 02/27/2011] [Indexed: 01/15/2023] Open
Abstract
The improvement of the survival rates of various cancer patients has resulted in increased focus on the long-term complications of treatment. Most anticancer chemotherapeutic agents are gonadotoxic, and sterility is therefore one of the most common complications for cancer survivors. The degree of gonadal dysfunction induced by anticancer chemotherapeutic agents seems to be drug specific and dose related. Following the development of new chemotherapeutic agents that have high benefit-to-risk ratios, sufficient sperm can be acquired by collection of ejaculated semen after the treatment in relatively many cases, and assisted reproductive techniques enable conceptions with even severe spermatogenesis dysfunction. However, anticancer chemotherapeutic agents have consistently exhibited the potential to induce permanent azoospermia. Cryopreservation of semen, which is currently the only proven successful option for future fertility preservation in male cancer patients, should certainly be recommended before cancer therapy. However, to date, no established effective methods have shown the capability to protect gonadal function from anticancer treatment in prepubertal cancer patients.
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Affiliation(s)
- Kohei Yamaguchi
- Division of Urology, Department of Organs Therapeutics, Faculty of Medicine Kobe University Graduate School of Medicine 7-5-1 Kusunoki-Cho, Chuo-Ku 650-0017 Kobe Japan
| | - Masato Fujisawa
- Division of Urology, Department of Organs Therapeutics, Faculty of Medicine Kobe University Graduate School of Medicine 7-5-1 Kusunoki-Cho, Chuo-Ku 650-0017 Kobe Japan
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Abstract
Substantial clinical progress over the last decades has made Hodgkin's lymphoma into one of the most curable human cancers in adults. About 80% of patients in all stages and of all histologic subtypes experience long-term disease-free survival. Modern treatment strategies aim to improve chemotherapy and radiotherapy, while minimizing therapy-related toxicities. Ongoing trials investigate a reduction of chemotherapy doses or cycles and the application of lower radiation doses and smaller radiation field sizes. For patients with a specific high-risk profile, novel approaches with more intense drug combinations are currently being investigated in clinical trials. This review discusses recent approaches to the first-line treatment of early-favorable, early-unfavorable, and advanced-stage Hodgkin's lymphoma.
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van der Kaaij MAE, Heutte N, van Echten-Arends J, Raemaekers JMM, Carde P, Noordijk EM, Fermé C, Thomas J, Eghbali H, Brice P, Bonmati C, Henry-Amar M, Kluin-Nelemans HC. Sperm quality before treatment in patients with early stage Hodgkin's lymphoma enrolled in EORTC-GELA Lymphoma Group trials. Haematologica 2009; 94:1691-7. [PMID: 19850901 DOI: 10.3324/haematol.2009.009696] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Although widely recommended, cryopreservation of sperm is sometimes not performed for patients with Hodgkin's lymphoma because of presumed poor sperm quality related to the disease. We investigated sperm quality and factors determining it in untreated patients with early stage Hodgkin's lymphoma. DESIGN AND METHODS Of 2362 males who participated in EORTC H6-H9 trials, 474 (20%) had data available. Sperm quality was defined according to World Health Organization guidelines. Determining factors were studied by logistic regression analysis. RESULTS The median sperm concentration was 40x10(6)/mL (range, 0-345x10(6)/mL) and the median motility 50% (range, 0-90%). Sperm quality was good (concentration >or=20x10(6)/mL and motility >or=50%), intermediate (concentration >or=5x10(6)/mL) and poor (concentration <5x10(6)/mL but >0) in 41%, 49% and 7% of patients, respectively. Three percent of the patients were azoospermic. No relation was found between sperm quality and age or clinical stage of the Hodgkin's lymphoma, but B-symptoms and elevated erythrocyte sedimentation rate predicted poor sperm quality. The odds ratios for the association of poor sperm quality with the variables examined were: presence of B-symptoms, 2.77 (95% CI, 1.50-5.12; p=0.001); erythrocyte sedimentation rate of 50 mm/h or greater, 2.35 (95% CI, 1.24-4.43; p=0.009); fever, 3.22 (95% CI, 1.41-7.33; p=0.005), and night sweats, 3.78 (95% CI, 1.97-7.26; p<0.001). There was no relation between sperm quality and pre-treatment follicle stimulating hormone level. CONCLUSIONS In this large study of males with Hodgkin's lymphoma, 90% had good or intermediate sperm quality. Three percent were azoospermic. There was an association between sperm quality and the presence or absence of B-symptoms, in particular fever and night sweats. With modern fertilization techniques, in most patients with early-stage Hodgkin's lymphoma sperm quality before treatment is good enough for future fatherhood.
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Affiliation(s)
- Marleen A E van der Kaaij
- Department of Hematology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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Yung L, Smith P, Hancock BW, Hoskin P, Gilson D, Vernon C, Linch DC. Long Term Outcome in Adolescents with Hodgkin's Lymphoma: Poor Results using Regimens Designed for Adults. Leuk Lymphoma 2009; 45:1579-85. [PMID: 15370209 DOI: 10.1080/1042819042000209404] [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] [Indexed: 10/26/2022]
Abstract
It is unclear whether the outcome in adolescents with Hodgkin's lymphoma is as good as that in children and there are no prospective randomized trials comparing regimes used in children and adults in this setting. We have therefore performed an analysis of 210 adolescent patients diagnosed with Hodgkin's lymphoma between 1970-1997 and registered on the database held by the British National Lymphoma Investigation. Patients were treated according to adult regimens current at the time of their diagnosis. The complete response rate recorded in 209 patients was 76%. This was highly dependent on disease stage being 95% in patients with localized disease but 63% in those with advanced disease. The 5 year event free survival for the whole cohort was 50% falling to 41% at 20 years with overall survival of 81% falling to 68% at 5 and 20 years respectively. There is no significant difference in the 3 decades pertaining to this analysis. Of the 62 deaths in this cohort, 70% were due to Hodgkin's lymphoma but of the 13 deaths occurring beyond 10 years, only 3 were due to Hodgkin's lymphoma, the reminder being attributable to the late effects of therapy. Results from paediatric groups have been much more encouraging than those presented from this cohort. It seems the use of risk-adjusted combined modality therapy with minimization of radiation fields and doses and reduction of anthracycline and alkylator exposure has been successful in children and should be used in adolescents.
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Affiliation(s)
- L Yung
- Royal Free and University College Medical School, London WC1E 6HX
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De Bruin ML, Sparidans J, van't Veer MB, Noordijk EM, Louwman MWJ, Zijlstra JM, van den Berg H, Russell NS, Broeks A, Baaijens MHA, Aleman BMP, van Leeuwen FE. Breast cancer risk in female survivors of Hodgkin's lymphoma: lower risk after smaller radiation volumes. J Clin Oncol 2009; 27:4239-46. [PMID: 19667275 DOI: 10.1200/jco.2008.19.9174] [Citation(s) in RCA: 260] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE We assessed the long-term risk of breast cancer (BC) after treatment for Hodgkin's lymphoma (HL). We focused on the volume of breast tissue exposed to radiation and the influence of gonadotoxic chemotherapy (CT). PATIENTS AND METHODS We performed a cohort study among 1,122 female 5-year survivors treated for HL before the age of 51 years between 1965 and 1995. We compared the incidence of BC with that in the general population. To assess the risk according to radiation volume and hormone factors, we performed multivariate Cox regression analyses. RESULTS After a median follow-up of 17.8 years, 120 women developed BC (standardized incidence ratio [SIR], 5.6; 95% CI, 4.6 to 6.8), absolute excess risk 57 per 10,000 patients per year. The overall cumulative incidence 30 years after treatment was 19% (95% CI, 16% to 23%); for those treated before age 21 years, it was 26% (95% CI, 19% to 33%). The relative risk remained high after prolonged follow-up (> 30 years after treatment: SIR, 9.5; 95% CI, 4.9 to 16.6). Mantle field irradiation (involving the axillary, mediastinal, and neck nodes) was associated with a 2.7-fold increased risk (95% CI, 1.1 to 6.9) compared with similarly dosed (36 to 44 Gy) mediastinal irradiation alone. Women with >or= 20 years of intact ovarian function after radiotherapy at young ages (< 31 years) experienced significantly higher risks for BC than those with fewer than 10 years of intact ovarian function. CONCLUSION Reduction of radiation volume appears to decrease the risk for BC after HL. In addition, shorter duration of intact ovarian function after irradiation is associated with a significant reduction of the risk for BC.
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Affiliation(s)
- Marie L De Bruin
- Department of Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
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De Bruin ML, Dorresteijn LDA, van't Veer MB, Krol ADG, van der Pal HJ, Kappelle AC, Boogerd W, Aleman BMP, van Leeuwen FE. Increased risk of stroke and transient ischemic attack in 5-year survivors of Hodgkin lymphoma. J Natl Cancer Inst 2009; 101:928-37. [PMID: 19535773 DOI: 10.1093/jnci/djp147] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Information on clinically verified stroke and transient ischemic attack (TIA) following Hodgkin lymphoma is scarce. We quantified the long-term risk of cerebrovascular disease associated with the use of radiotherapy and chemotherapy in survivors of Hodgkin lymphoma and explored potential pathogenic mechanisms. METHODS We performed a retrospective cohort study among 2201 five-year survivors of Hodgkin lymphoma treated before age 51 between 1965 and 1995. We compared incidence rates of clinically verified stroke and TIA with those in the general population. We used multivariable Cox regression techniques to study treatment-related factors and other risk factors. All statistical tests were two-sided. RESULTS After a median follow-up of 17.5 years, 96 patients developed cerebrovascular disease (55 strokes, 31 TIAs, and 10 with both TIA and stroke; median age = 52 years). Most ischemic events were from large-artery atherosclerosis (36%) or cardioembolisms (24%). The standardized incidence ratio for stroke was 2.2 (95% confidence interval [CI] = 1.7 to 2.8), and for TIA, it was 3.1 (95% CI = 2.2 to 4.2). The risks remained elevated, compared with those in the general population, after prolonged follow-up. The cumulative incidence of ischemic stroke or TIA 30 years after Hodgkin lymphoma treatment was 7% (95% CI = 5% to 8%). Radiation to the neck and mediastinum was an independent risk factor for ischemic cerebrovascular disease (hazard ratio = 2.5, 95% CI = 1.1 to 5.6 vs without radiotherapy). Treatment with chemotherapy was not associated with an increased risk. Hypertension, diabetes mellitus, and hypercholesterolemia were associated with the occurrence of ischemic cerebrovascular disease, whereas smoking and overweight were not. CONCLUSIONS Patients treated for Hodgkin lymphoma experience a substantially increased risk of stroke and TIA, associated with radiation to the neck and mediastinum. Physicians should consider appropriate risk-reducing strategies.
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Affiliation(s)
- Marie L De Bruin
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Diehl V, Behringer K. Could BEACOPP Be the New Standard for the Treatment of Advanced Hodgkin's Lymphoma? Cancer Invest 2009; 24:461-5. [PMID: 16777701 DOI: 10.1080/07357900600705789] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In 1992, the German Hodgkin Study Group (GHSG) developed the BEACOPP regimen for further improving the outcome of patients with advanced Hodgkin's lymphoma (HL). Since then, BEACOPP has been introduced in 3 different prospective randomized clinical trials of the GHSG to find an equilibrium between maximal efficacy and least toxicity with the BEACOPP principle for the treatment of advanced stage HL. In the HD9 trial of the GHSG, with 1,186 patients, after a median observation time of 7 years, the rates for FFTF are 85 percent and for overall survival 90 percent for dose-escalated BEACOPP, and for COPP/ABVD (C/ABVD comparable to ABVD) the rate for FFTF is 67 percent and for overall survival it is 79 percent. These superior BEACOPP results are obtained inspite of a higher rate of secondary AML/MDS in the escalated BEACOPP arm. The number of toxic deaths during treatment, however, was lower for escalated BEACOPP (1.6 percent) than for C/ABVD (1.8 percent). The majority of patients were treated in an outpatient setting, in a multicenter study with more than 400 centers, including 120 private doctors, located in Germany and 9 other European countries. To reduce acute and long-term toxicity, the GHSG started in the consecutive studies HD12 and HD15 for advanced stage HL to de-escalate BEACOPP by reducing the number of escalated BEACOPP cycles and by applying the baseline dose BEACOPP, a time dense regimen, called BEACOPP-14. The excellent results obtained with the BEACOPP principle challenge the seemingly global consensus that ABVD is the gold standard treatment strategy for advanced stage HL.
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Affiliation(s)
- V Diehl
- First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany.
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Diehl V, Behringer K. Could BEACOPP Be the New Standard for the Treatment of Advanced Hodgkin's Lymphoma (HL)? Cancer Invest 2009; 24:713-7. [PMID: 17118782 DOI: 10.1080/07357900600981380] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In 1992, the German Hodgkin Study Group (GHSG) developed the BEACOPP regimen for further improving the outcome of patients with advanced Hodgkin's lymphoma (HL). Since then, BEACOPP has been introduced in 3 different prospective randomized clinical trials of the GHSG to find an equilibrium between maximal efficacy and least toxicity with the BEACOPP principle for the treatment of advanced stage HL. In the HD9 trial of the GHSG, with 1,186 patients, after a median observation time (mot) of 7 years, the rates for freedom from treatment failure (FFTF) are 85 percent, and for overall survival (OS) 90 percent for dose-escalated BEACOPP, and for COPP/ABVD (C/ABVD comparable to ABVD) the rate for FFTF is 67 percent, and for OS it is 79 percent. These superior BEACOPP results are obtained inspite of a higher rate of secondary AML/MDS in the esc. BEACOPP arm. The number of toxic deaths during treatment, however, was lower for esc. BEACOPP (1.6 percent) than for C/ABVD (1.8 percent). The majority of patients were treated in outpatient setting, in a multicenter study with more than 400 centers, including 120 private doctors, in Germany and 9 other European countries. The reduce acute and longterm toxicity, the GHSG started in the consecutive studies HD12 and HD15 for advanced stage HL to de-escalate BEACOPP by reducing the number of escalated BEACOPP cycles and by applying the baseline-dose BEACOPP, a time-dense regimen, called BEACOPP-14. The excellent results obtained with the BEACOPP principle challenge the seemingly global consensus that ABVD is the gold standard treatment strategy for advanced stage HL.
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Affiliation(s)
- V Diehl
- German Hodgkin's Study Group (GHSG), First Department of Internal Medicine, University Hospital, Cologne, Cologne, Germany.
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Favier O, Heutte N, Stamatoullas-Bastard A, Carde P, van't Veer MB, Aleman BMP, Noordijk EM, Thomas J, Fermé C, Henry-Amar M. Survival after Hodgkin lymphoma. Cancer 2009; 115:1680-91. [DOI: 10.1002/cncr.24178] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Fuchs M, Eichenauer DA, Nogová L, Diehl V, Engert A. Nodular lymphocyte-predominant Hodgkin lymphoma. Curr Hematol Malig Rep 2008; 3:126-31. [PMID: 20425457 DOI: 10.1007/s11899-008-0019-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare subtype of Hodgkin lymphoma that differs from classic Hodgkin lymphoma (cHL) with respect to histologic and clinical presentation. Because the prognosis of NLPHL in early unfavorable and advanced stages is similar to that of cHL, treatment is similar. In contrast, early favorable-stage NLPHL has a better prognosis than cHL. Thus, NLPHL in early favorable stages might be treated with reduced-intensity programs without compromising cure rates. Because involved-field radiotherapy alone seems to be as effective as extended-field radiotherapy or combined modalities, it has been adopted by the German Hodgkin Study Group and the European Organisation for Research and Treatment of Cancer as the treatment of choice for stage IA NLPHL. Now that efficacy of the monoclonal antibody rituximab has been shown in relapsed NLPHL, its use in the first-line treatment of NLPHL is under investigation.
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Affiliation(s)
- Michael Fuchs
- First Department of Internal Medicine, University Hospital of Cologne, Kerpener Strasse 62, Cologne, Germany
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31
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Nogová L, Reineke T, Brillant C, Sieniawski M, Rüdiger T, Josting A, Bredenfeld H, Skripnitchenko R, Müller RP, Müller-Hermelink HK, Diehl V, Engert A. Lymphocyte-predominant and classical Hodgkin's lymphoma: a comprehensive analysis from the German Hodgkin Study Group. J Clin Oncol 2008; 26:434-9. [PMID: 18086799 DOI: 10.1200/jco.2007.11.8869] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Lymphocyte-predominant Hodgkin's lymphoma (LPHL) is rare and differs in histologic and clinical presentation from classical Hodgkin's lymphoma (cHL). To shed more light on the prognosis and outcome of LPHL, we reviewed all LPHL patients registered in the German Hodgkin Study Group (GHSG) database, comparing patient characteristics and treatment outcome with cHL patients. PATIENTS AND METHODS We analyzed retrospectively 8,298 HL patients treated within the GHSG trials HD4 to HD12, of whom 394 had LPHL and 7,904 had cHL. RESULTS Complete remission and unconfirmed complete remission after first-line treatment was achieved in 91.6% v 85.9% of patients in early favorable stages, 85.7% v 83.3% of patients in early unfavorable stages, and 76.8% v 77.8% of patients in advanced stages of LPHL compared with cHL, respectively. Tumor control (freedom from treatment failure [FFTF]) for LPHL and cHL patients at a median observation of 50 months was 88% and 82% (P = .0093) and overall survival (OS) was 96% and 92%, respectively (P = .0166). In LPHL patients, negative prognostic factors were advanced stage (P = .0092), Hb less than 10.5 g/dL (P = .0171), and lymphopenia (P = .010) for FFTF. Age >or= 45 years (P = .0125), advanced stage (P = .0153), and Hb less than 10.5 g/dL (P = .0014) were negative prognostic factors for OS. CONCLUSION The better prognosis of LPHL as compared with cHL might allow different treatment strategies, particularly for early-stage LPHL patients.
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Affiliation(s)
- Lucia Nogová
- First Department of Internal Medicine, University Hospital Cologne, Kerpenerstr 62, 50924 Cologne, Germany.
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Wood L, Robinson R, Gavine L, Juritz J, Jacobs P. A single unit lymphoma experience: outcome in a Cape Town academic centre. Transfus Apher Sci 2007; 37:93-102. [PMID: 17931976 DOI: 10.1016/j.transci.2007.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 06/22/2007] [Indexed: 11/26/2022]
Abstract
To document outcome in Hodgkin and other lymphomas from a privately based academic centre the clinical records from 253 consecutive referrals were analysed. Diagnosis was according to World Health Organization criteria, prognosis assigned by the international index and therapy risk-stratified with results subject to appropriate statistical methodology. None of these patients underwent transplantation. For the cohort the median age was 55 years (range 11-94) and 63% were male. Constitutional symptoms were present in 22%; a quarter had previous chemotherapy and a third some form of irradiation prior to referral. Fifty-seven percent were stage I or II and 21% had nodal disease above and below the diaphragm whilst in the remainder cells were present in the circulation and this included the subset of chronic lymphocytic leukaemia -- small lymphocytic lymphoma. Positron emission scanning was not available for these studies. Median survival for the cohort is 3.2 years and reduced to 1.3 years by the presence of unexplained fever, sweating or inappropriate weight loss. Further adverse factors included any prior treatment, intermediate or high-grade histopathology, risk factors defined by the International Prognostic Index as well as late Rai stages. Analysed by disease category Hodgkin lymphoma (n=17) when managed according to the German Study Group protocols and hairy cell leukaemia (n=10) treated with two chlorodeoxyadenosine -- both had a stable plateau in excess of 90%. The corresponding figures for follicular variants (n=31) was 72% in the low risk and 58% in the remainder when treated with cyclophosphamide, vincristine and prednisone. Curves for the aggressive or diffuse large B-cell lymphoma (n=44) fell initially to 48%, but relapse continued in stages III and IV to the current level of 18% when receiving cyclophosphamide, hydroxydaunorubicin, vincristine and prednisone on the 21-day schedule. Chronic lymphocytic leukaemia -- small lymphocytic lymphoma (n=58) were initially given pulsed chlorambucil and sustained response was over 90% with low bulk, but declined to reach 30% as prognostic score rose. The miscellaneous categories (n<5 each) managed variably, but using the same criteria, were pooled and are presently at 62% and 30% for high and low grades. It is concluded that precise diagnosis, accurate staging and therapy on standardised risk-stratified programmes, delivered uniformly by a single multidisciplinary group, creates the all-important centre effect; matching figures are unlikely to apply outside these disciplined circumstances. The expectation from patients and referring physicians alike is that, since lymphomas are potentially curable, such an approach to comprehensive management will be regarded as standard even in an under resourced or Third World country. It follows that late referral and prior therapy will adversely affect performance status and compromise life span: These alternative approaches are inappropriate and strongly discouraged.
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Affiliation(s)
- Lucille Wood
- The Department of Haematology and Bone Marrow Transplant Unit, Incorporating The Searll Research Laboratory for Cellular and Molecular Biology, Constantiaberg Medi-Clinic, Plumstead, Cape Town, South Africa
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Abstract
Early assessment of response to chemotherapy with fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is becoming a routine part of management in patients with Hodgkin lymphoma (HL) and histologically aggressive non-Hodgkin lymphoma (NHL). Changes in FDG uptake can occur soon after the initiation of therapy and they precede changes in tumour volume. Recent studies in uniform populations of aggressive lymphomas (predominantly diffuse large B cell lymphomas) and HL have clarified the value of early response assessment with PET. These trials show that PET imaging after 2-3 chemotherapy cycles is far superior to CT-based imaging in predicting progression-free survival and can be at least as reliable as definitive response assessment at the end of therapy. This information is of great potential value to patients, but oncologists should be cautious in the use of early PET response in determining choice of therapy until some critical questions are answered. These include: When is the best time to use PET for response assessment? What is the best methodology, visual or quantitative? (For HL at least, visual reading appears superior to an SUV-based assessment). Can early responders be cured with less intensive therapy? Will survival be better for patients treated more intensively because they have a poor interim metabolic response? In the future, early PET will be crucial in developing response-adapted therapy but without further carefully designed clinical trials, oncologists will remain uncertain how best to use this new information.
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van der Kaaij MAE, Heutte N, Le Stang N, Raemaekers JMM, Simons AHM, Carde P, Noordijk EM, Fermé C, Thomas J, Eghbali H, Kluin-Nelemans HC, Henry-Amar M. Gonadal Function in Males After Chemotherapy for Early-Stage Hodgkin's Lymphoma Treated in Four Subsequent Trials by the European Organisation for Research and Treatment of Cancer: EORTC Lymphoma Group and the Groupe d'Étude des Lymphomes de l'Adulte. J Clin Oncol 2007; 25:2825-32. [PMID: 17515571 DOI: 10.1200/jco.2006.10.2020] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeTo analyze fertility in male patients treated with various combinations of radiotherapy and chemotherapy, with or without alkylating agents, or with radiotherapy alone for Hodgkin's lymphoma.Patients and MethodsFollicle-stimulating hormone (FSH) levels were measured in patients with early-stage upper-diaphragmatic disease enrolled in four European Organisation for Research and Treatment of Cancer (EORTC) trials (H6-H9). Median follow-up after therapy was 32 months. Patients with FSH measurement at least 12 months after end of treatment (n = 355) were selected to assess post-treatment fertility. Patients with FSH measurement 0 to 9 months after therapy (n = 349) were selected to analyze fertility recovery; of these, patients with elevated FSH (> 10 U/L; n = 101) were followed until recovery. Factors predictive for therapy-related infertility were assessed by logistic regression.ResultsThe proportion of elevated FSH was 3% and 8% in patients treated with radiotherapy only or with nonalkylating chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine [ABVD], epirubicin, bleomycin, vinblastine, prednisone [EBVP]); it was 60% (P < .001) after chemotherapy containing alkylating agents (mechlorethamine, vincristine, procarbazine, prednisone [MOPP], MOPP/doxorubicin, bleomycin, vinblastine [ABV], bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone [BEACOPP]). After a median time of 19 months, recovery of fertility occurred in 82% of patients treated without alkylating chemotherapy. This proportion was 30%, statistically (P < .001) lower in those treated with alkylating chemotherapy, and median time to recovery was 27 months. The post-treatment proportion of elevated FSH increased significantly (P < .001) with the dose of alkylating chemotherapy administered, and recovery was less frequent and slower after higher doses. Age more than 50 years and stage II disease also contributed to poor outcome.ConclusionFertility can be secured after nonalkylating chemotherapy for Hodgkin's lymphoma. In contrast, alkylating chemotherapy has a dismal effect, even after a limited number of cycles.
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Affiliation(s)
- Marleen A E van der Kaaij
- Department of Hematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Klimm B, Eich HT, Haverkamp H, Lohri A, Koch P, Boissevain F, Trenn G, Worst P, Dühmke E, Müller RP, Müller-Hermelink K, Pfistner B, Diehl V, Engert A. Poorer outcome of elderly patients treated with extended-field radiotherapy compared with involved-field radiotherapy after chemotherapy for Hodgkin's lymphoma: an analysis from the German Hodgkin Study Group. Ann Oncol 2007; 18:357-63. [PMID: 17071932 DOI: 10.1093/annonc/mdl379] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The optimal treatment of elderly patients with Hodgkin's lymphoma (HL) is still a matter of debate. Since many of these patients receive combined modality treatment, we evaluated the impact of different radiation field sizes, that is extended-field (EF) or involved-field (IF) technique when given after four cycles of chemotherapy. PATIENTS AND METHODS In the multicenter HD8 study of the German Hodgkin Study Group, 1204 patients with early-stage unfavorable HL were randomized to receive four cycles of chemotherapy followed by either radiotherapy (RT) of 30 Gy EF + 10 Gy to bulky disease (arm A) or 30 Gy IF + 10 Gy to bulky disease (arm B). A total of 1064 patients were assessable for the analysis. Of these, 89 patients (8.4%) were 60 years or older. RESULTS Elderly patients had a poorer risk profile. Acute toxicity from RT was more pronounced in elderly patients receiving EF-RT compared with IF-RT [World Health Organization (WHO) grade 3/4: 26.5% versus 8.6%)]. Freedom from treatment failure (FFTF, 64% versus 87%) and overall survival (OS, 70% versus 94%) after 5 years was lower in elderly patients compared with younger patients. Importantly, elderly patients had poorer outcome when treated with EF-RT compared with IF-RT in terms of FFTF (58% versus 70%; P = 0.034) and OS (59% versus 81%; P = 0.008). CONCLUSION Elderly patients with early-stage unfavorable HL generally have a poorer risk profile and outcome when compared with younger patients. Treatment with EF-RT instead of IF-RT after chemotherapy has a negative impact on survival of elderly patients and should be avoided.
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Affiliation(s)
- B Klimm
- Department I of Internal Medicine, University Hospital Cologne, Germany.
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Affiliation(s)
- Richard W Tsang
- Department of Radiation Oncology, University of Toronto, Princess Margaret Hospital, Toronto, Ontario, Canada
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Abstract
Lymphocyte-predominant Hodgkin's lymphoma (LPHL) differs in histologic and clinical presentation from classical Hodgkin's lymphoma (cHL). Treatment of LPHL patients using standard Hodgkin's lymphoma protocols leads to complete remission in more than 95% of patients. Survival and freedom from treatment failure are substantially worse in advanced-stage patients than for early-stage patients. Thus, patients in advanced stages and those in early stages with unfavorable risk factors should be treated similar to those with cHL. In contrast, patients with early-stage LPHL without risk factors might be sufficiently treated with reduced-intensity programs having less severe adverse effects. As a result, treatment of early LPHL is rather heterogeneous, including radiotherapy using extended-fleld technique, involved-fleld radiotherapy (IF-RT), combined-modality treatment, and, more recently, monoclonal antibodies. Watch-and-wait strategy plays an important role in pediatric oncology, to avoid adverse effects associated with therapy. IF-RT seems to be emerging as a treatment of choice for patients with stage IA LPHL; most larger study groups, such as the German Hodgkin Study Group and the European Organisation for Research and Treatment of Cancer, have adopted IF-RT as the treatment of choice for these patients.
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Affiliation(s)
- Lucia Nogovà
- First Department of Internal Medicine, University Hospital Cologne, Kerpenerstr. 62, 50924 Cologne, Germany.
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Nørgaard M, Larsson H, Pedersen G, Schønheyder HC, Sørensen HT. Risk of bacteraemia and mortality in patients with haematological malignancies. Clin Microbiol Infect 2006; 12:217-23. [PMID: 16451407 DOI: 10.1111/j.1469-0691.2005.01298.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined the association between type of haematological malignancy, risk of bacteraemia and risk of mortality, with emphasis on the impact of bacteraemia type on mortality. A population-based cohort design was used, and all patients aged > or = 15 years with an incident haematological malignancy who were living in North Jutland County, Denmark, during 1992-2002 were included in the study. Among 1666 patients with an incident haematological malignancy, 358 (21%) suffered an episode of bacteraemia during a median follow-up period of 1.1 years (quartile 0.2-3.4) from the date of cancer diagnosis (overall incidence rate of 96/1000 person-years). In comparison to Hodgkin's disease, adjusted incidence rate ratios (IRRs) were 23.3 (95% CI, 10.0-54.5) for acute myeloid leukaemia, 3.8 (95% CI, 1.5-9.3) for multiple myeloma, and 2.2 (95% CI, 0.9-5.1) for non-Hodgkin's lymphoma or chronic lymphatic leukaemia. Overall cumulative 30-day mortality was 32% (95% CI, 27-37), and 90-day mortality was 50% (95% CI, 44-55). In comparison with acute myeloid leukaemia, adjusted mortality rate ratios (MRRs) were close to 1.0 for other haematological malignancies. In comparison to bacteraemia caused by Gram-positive bacteria, adjusted MRRs were 1.0 (95% CI, 0.6-1.5) for Gram-negative bacteraemia, and 1.9 (95% CI, 1.1-3.3) for polymicrobial bacteraemia or fungaemia. Thus, the risk of bacteraemia varied greatly according to the type of malignancy, while mortality rates were similar for these diseases, although dependent on the type of bacteraemia. Polymicrobial bacteraemia or fungaemia was associated with higher mortality.
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Affiliation(s)
- M Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
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Moser EC, Noordijk EM, Carde P, Tirelli U, Baars JW, Thomas J, Bron D, Meerwaldt JH, van Glabbeke M, Raemaekers JMM, Kluin-Nelemans HC. Late non-neoplastic events in patients with aggressive non-Hodgkin's lymphoma in four randomized European Organisation for Research and Treatment of Cancer trials. ACTA ACUST UNITED AC 2006; 6:122-30. [PMID: 16231850 DOI: 10.3816/clm.2005.n.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND A significant proportion of patients with aggressive non-Hodgkin's lymphoma (NHL) become long-term survivors. A European Organisation for Research and Treatment of Cancer database of patients with aggressive NHL, consistently treated with doxorubicin-based chemotherapy since 1980, afforded the possibility to explore late complications in this patient group. PATIENTS AND METHODS Of 951 randomized patients, complete data on late complications could be collected in 757 patients who were alive > or = 2 years after the start of therapy and were seen at yearly follow-ups (median follow-up, 9.4 years; range, 2.1-20.4 years). We computed cumulative incidences of late events in a competing risk model by Gray (death being the competing event) to avoid bias caused by the high percentage of NHL-related deaths. Risk factors were estimated in a Cox proportional-hazards model and also evaluated with the Gray test. RESULTS Late non-neoplastic events were found in 46% of the 757 patients. At 15 years, the cumulative incidences of cardiac disease and infertility were 20% and 29%, respectively. Renal insufficiency (11%), acquired hypertension (8%), and disabling neuropathy (13%) were also frequent. Salvage treatment was a risk factor in most cases. Smoking, age > 50 years during treatment, and preexistent hypertension were the main risk factors for cardiovascular disease. In-field radiation therapy (RT) was related to hypothyroidism, lung fibrosis, hypertension, gastrointestinal toxicity, and renal insufficiency but not to cardiovascular events. Autologous stem cell transplantation and cisplatin- and MOPP (mechlorethamine/vincristine/procarbazine/prednisone)-containing therapies were associated with infertility and renal insufficiency. CONCLUSION Altogether, almost half the patients with aggressive NHL experienced events addressed as late non-neoplastic complications. Salvage therapy, smoking, age > 50 years, and in-field RT are important risk factors.
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Affiliation(s)
- Elizabeth C Moser
- European Organisation for the Research and Treatment of Cancer Data Center, Brussels, Belgium
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Nogová L, Rudiger T, Engert A. Biology, Clinical Course and Management of Nodular Lymphocyte-Predominant Hodgkin Lymphoma. Hematology 2006:266-72. [PMID: 17124071 DOI: 10.1182/asheducation-2006.1.266] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) differs in histological and clinical presentation from classical Hodgkin lymphoma (cHL). The typical morphologic signs of NLPHL are atypical “lymphocytic and histiocytic” (L&H) cells, which are surrounded by a non-neoplastic nodular background of small lymphocytes of B-cell origin. The NLPHL cells are positive for CD45, CD19, CD20, CD22 and CD79a, but lack expression of CD15 and CD30, the typical markers for cHL. NLPHL patients are predominantly of male gender with a median age of 37 years. Patients often present in early stages (63%) and rarely have B-symptoms (9%). Treatment of NLPHL patients using standard Hodgkin lymphoma (HL) protocols leads to complete remission (CR) in more than 95% of patients. Survival and freedom from treatment failure (FFTF) are worse in advanced-stage patients than in early-stage patients. Thus, patients in advanced and in early stages with unfavorable risk factors are treated similarly to cHL patients. In contrast, patients with early-stage NLPHL without risk factors can be sufficiently treated with reduced intensity programs having less severe adverse effects. As a result, treatment of early NLPHL is less clearly defined, including radiotherapy in extended field (EF) or involved field (IF) technique, combined modality treatment, and, more recently, monoclonal antibody rituximab. Watch and wait strategy plays an important role in pediatric oncology to avoid adverse effects associated with therapy.
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Affiliation(s)
- Lucia Nogová
- German Hodgkin Study Group, Clinic I for Internal Medicine, University Hospital Cologne, Kerpenerstr. 62, 50924 Cologne, Germany
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Klimm B, Engert A, Diehl V. Axillary swelling and a reduced general condition in a middle-aged man. ACTA ACUST UNITED AC 2005; 1:51-4; quiz 1 p following 54. [PMID: 16264800 DOI: 10.1038/ncponc0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2004] [Accepted: 09/17/2004] [Indexed: 11/09/2022]
Abstract
BACKGROUND A 48-year-old man presented to his GP with an indolent swelling in his left axillary region. He also complained of a cough, a feeling of pressure in his chest, general poor health, and had increasingly suffered from night-time sweating and fever. Physical examination and an ultrasound revealed an enlarged lymph node of almost 4 cm in the left axillary region and several smaller lymph nodes of 1.5-2.0 cm in the left cervical region. Laboratory tests were unremarkable, except for an elevated erythrocyte sedimentation rate. INVESTIGATIONS Excisional biopsy, radiography, ultrasound, CT scan, bone marrow biopsy, radionuclide imaging, echocardiography and lung function tests. DIAGNOSIS Early-stage unfavorable (intermediate) lymphocyte-rich classical Hodgkin's lymphoma. MANAGEMENT Chemotherapy (treatment with doxorubicin, bleomycin, vinblastine and dacarbazine) and involved-field radiotherapy.
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Affiliation(s)
- Beate Klimm
- Department I of Internal Medicine/GHSG, University of Cologne, Cologne, Germany.
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Nogová L, Reineke T, Eich HT, Josting A, Müller-Hermelink HK, Wingbermühle K, Brillant C, Gossmann A, Oertel J, Bollen MV, Müller RP, Diehl V, Engert A. Extended field radiotherapy, combined modality treatment or involved field radiotherapy for patients with stage IA lymphocyte-predominant Hodgkin's lymphoma: a retrospective analysis from the German Hodgkin Study Group (GHSG). Ann Oncol 2005; 16:1683-7. [PMID: 16093276 DOI: 10.1093/annonc/mdi323] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Since there are no randomized studies, the treatment of choice for patients with early stage lymphocyte-predominant Hodgkin's lymphoma (LPHL) remains unclear. We thus reviewed all LPHL cases registered in the database of the German Hodgkin Study Group (GHSG) and compared the different treatment approaches, such as extended field (EF), involved field (IF) radiation and combined modality (CM) treatment for LPHL stage IA patients. PATIENTS AND METHODS One hundred and thirty-one patients with LPHL in clinical stage IA without risk factors were analyzed. Forty-five patients were treated with EF radiotherapy, 45 patients with IF radiation and 41 patients received CM treatment. The median follow-up was 78 months in the EF group, 40 months after CM and 17 months after IF, respectively. RESULTS A total of 129 patients achieved complete remission (CR and CRu): 98% after EF radiotherapy, 100% after IF radiation and 95% after CM. With a median follow-up of 43 months there were 5% relapses and only three patients died. Toxicity of treatment was generally mild with most events observed after CM. CONCLUSION In terms of remission induction IF radiotherapy for stage IA LPHL patients is as effective as EF or CM treatment. However, longer follow-up is needed before final conclusion as the optimal therapy.
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Affiliation(s)
- L Nogová
- Clinic I for Internal Medicine, Clinic of Radiotherapy and Department of Radiology of University Hospital Cologne
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Klimm B, Diehl V, Pfistner B, Engert A. Current treatment strategies of the German Hodgkin Study Group (GHSG). Eur J Haematol 2005:125-34. [PMID: 16007881 DOI: 10.1111/j.1600-0609.2005.00466.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hodgkin's Lymphoma (HL) has developed to one of the best curable human cancers and overall about 80% of patients experience long-term disease free survival. Therefore, current treatment strategies aim at further improving treatment outcome, thereby trying to by minimize therapy-induced complications, such as infertility, cardiopulmonary toxicity, and secondary malignancies. Ongoing trials investigate a reduction of chemotherapy in terms of dose or cycles given, and the application of lower radiation doses and smaller radiation fields. For patients with a specific high-risk profile, new approaches with more intense drug combinations are currently being investigated. Moreover, the advent of effective salvage high-dose therapy for relapsed disease and a better understanding of prognostic factors have further improved the management of HL. Here, we summarize current strategies of the German Hodgkin Study Group (GHSG) in diagnostics and treatment of primary and relapsed HL, together with recent approaches for specific subgroups of HL patients.
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Affiliation(s)
- Beate Klimm
- Department I of Internal Medicine and German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany.
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Moser EC, Noordijk EM, van Glabbeke M, Teodorovic I, de Wolf-Peeters C, Carde P, Baars JW, Tirelli U, Raemaekers JMM, Kluin-Nelemans JC. Long-term efficacy of the CHVmP/BV regimen used for aggressive non-Hodgkin’s lymphoma in three randomised EORTC trials. Eur J Cancer 2004; 40:474-80. [PMID: 14962711 DOI: 10.1016/j.ejca.2003.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2003] [Revised: 09/30/2003] [Accepted: 11/04/2003] [Indexed: 10/26/2022]
Abstract
We analysed data from 936 newly-diagnosed patients with advanced, aggressive non-Hodgkin's lymphoma (NHL) treated in three randomised European Organisation for Research and Treatment of Cancer (EORTC) trials performed between 1980 and 1999 (median follow-up of 8.7 (0.2-20.4) years). The CHOP-like regimen CHVmP/BV (cyclophosphamide, doxorubicin, teniposide and prednisone with bleomycin and vincristine at mid-interval), was compared with CHVmP (CHVmP/BV without bleomycin and vincristine), ProMACE-MOPP (methotrexate, doxorubicin, cyclophosphamide, etoposide, mechlorethamide, vincristine, procarbazine and prednisone) and CHVmp/BV with additional, autologous stem-cell transplantation, respectively. Overall, treatment with CHVmP/BV resulted in a better long-term outcome with 63% complete responses being observed and an overall survival (OS) of 59 and 43% at 5 and 10 years, respectively. Remarkably, OS after CHVmP/BV improved across the trials, even after stratifying for the International Prognostic Index (IPI). This finding could not be directly related to better salvage treatments during the last decade. Selection bias appears to be responsible: stepwise corrections for small differences in inclusion criteria eliminated the difference in OS, especially when histological subgroups were studied. This systemic review underlines the difficulties encountered in retrospective sub-set analyses and the biases that can be introduced when recent studies are compared with older ones.
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Affiliation(s)
- E C Moser
- Department of Radiotherapy, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Abstract
Hodgkin lymphoma (HL) is characterised histologically by a minority of malignant Hodgkin and Reed-Sternberg (HRS) cells surrounded by benign cells, and clinically by a relatively good prognosis. The treatment, however, leads to a risk of serious side effects. Knowledge about the biology of the disease, particularly the interaction between the HRS cells and the surrounding cells, is essential in order to improve diagnosis and treatment. HL patients with abundant eosinophils in the tumours have a poor prognosis, therefore the eosinophil derived protein eosinophil cationic protein (ECP) was studied. Serum-ECP (S-ECP) was elevated in most HL patients. It correlated to number of tumour eosinophils, nodular sclerosis (NS) histology, and the negative prognostic factors high erythrocyte sedimentation rate (ESR) and blood leukocyte count (WBC). A polymorphism in the ECP gene (434(G>C)) was identified and the 434GG genotype correlated to NS histology and high ESR. The poor prognosis in patients with abundant eosinophils in the tumours has been proposed to depend on HRS cell stimulation by the eosinophils via a CD30 ligand (CD30L)-CD30 interaction. However, CD30L mRNA and protein were detected in mast cells and the predominant CD30L expressing cell in HL is the mast cell. Mast cells were shown to stimulate HRS cell lines via CD30L-CD30 interaction. The number of mast cells in HL tumours correlated to worse relapse-free survival, NS histology, high WBC, and low blood haemoglobin. Survival in patients with early and intermediate stage HL, diagnosed between 1985 and 1992, was generally favourable and comparatively limited treatment was sufficient to produce acceptable results for most stages. The majority of relapses could be salvaged. Patients treated with a short course of chemotherapy and radiotherapy had an excellent outcome. In conclusion prognosis is favourable in early and intermediate stages and there are possibilities for further improvements based on the fact that mast cells and eosinophils affect the biology and prognosis of HL.
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Affiliation(s)
- Daniel Molin
- Department of Oncology, Radiology, and Clinical Immunology, Uppsala University.
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Diehl V. Chemotherapy or combined modality treatment: the optimal treatment for Hodgkin's disease. J Clin Oncol 2003; 22:15-8. [PMID: 14657229 DOI: 10.1200/jco.2004.10.910] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hodgson DC, Tsang RW, Pintilie M, Sun A, Wells W, Crump M, Gospodarowicz MK. Impact of chest wall and lung invasion on outcome of stage I–II Hodgkin's lymphoma after combined modality therapy. Int J Radiat Oncol Biol Phys 2003; 57:1374-81. [PMID: 14630276 DOI: 10.1016/s0360-3016(03)00765-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the impact of extranodal chest wall and lung invasion on the prognosis of patients with clinical Stage I-II Hodgkin's lymphoma treated with combined modality therapy. MATERIALS AND METHODS The outcome of 324 patients with clinical Stage I-II Hodgkin's lymphoma treated with combined modality therapy between 1981 and 1996 was analyzed. Twenty-two patients had chest wall invasion and 40 had invasion of lung parenchyma. The chemotherapy regimens used were ABVD in 182 patients (56%), MOPP/ABV(D) in 45 (14%), MOPP in 86 (27%), and other chemotherapy regimens in 11 patients (3%). This was followed by mantle/mediastinal radiotherapy (RT) in 163 patients (50%), extended-field RT in 135 patients (42%), and infradiaphragmatic RT in 26 patients (8%). The impact of chest wall and lung invasion on local relapse, disease-free survival, cause-specific survival, and overall survival was examined. RESULTS After a median follow-up of 8.3 years, the 5-year cause-specific and overall survival rate of the entire cohort was 93% and 90%, respectively. Compared with patients with no extranodal involvement, patients with chest wall invasion had significantly worse local control (89% vs. 68%, p = 0.005), disease-free survival (84% vs. 59%, p = 0.016), and cause-specific survival (94% vs. 86%, p = 0.009). Overall survival was also worse among patients with chest wall invasion, but not significantly so (90% vs. 82%, p = 0.10). Among the 16 patients with chest wall invasion but without lung invasion, 7 progressed during treatment or relapsed, 6 with local failure (crude relapse rate 44%, 95% confidence interval [CI] 19-68%), and 5 died (crude death rate 31%, 95% CI 9-54%). After adjusting for other significant prognostic factors, patients with chest wall invasion had significantly worse local control (hazard ratio 2.8, 95% CI 1.2-6.3), disease-free survival (hazard ratio 2.3, 95% CI 1.1-4.8), and cause-specific survival (hazard ratio 2.8, 95% CI 1.1-6.8). Lung invasion was not significantly associated with any of the outcomes assessed. CONCLUSIONS Chest wall invasion is an adverse prognostic factor among clinical Stage I-II Hodgkin's lymphoma patients treated with combined modality therapy, although we did not find a worse outcome for patients with lung invasion. Efforts to reduce treatment intensity in these patients should be undertaken with caution, recognizing their increased risk of local relapse.
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Affiliation(s)
- David C Hodgson
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada.
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Molin D, Enblad G, Gustavsson A, Ekman T, Erlanson M, Haapaniemi E, Glimelius B. Early and intermediate stage Hodgkin's lymphoma--report from the Swedish National Care Programme. Eur J Haematol 2003; 70:172-80. [PMID: 12605661 DOI: 10.1034/j.1600-0609.2003.00030.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In Sweden a National Care Programme provides treatment principles for Hodgkin's lymphoma (HL) since 1985, for early and intermediate stages often less extensive than international recommendations. The purpose is to evaluate long-term results of these principles. A total of 308 patients (167 men and 141 women), 17-59 yr old (median 31), diagnosed during 1985-92, pathological stage (PS) I-III1A and I-IIB and clinical stage (CS) I-IIA, mean follow-up 8.8 yr, were studied. Staging laparotomy was recommended in CS IIA. Recommended treatment was mantle or mini-mantle radiotherapy (RT) alone in CS IA, and PS I-IIA and subtotal nodal irradiation in PS III1A if the disease was not bulky. Patients in PS I-IIA and III1A with bulky disease, and PS I-IIB received one cycle of mechlorethamine, vincristine, prednisone, procarbazine/doxorubicin, bleomycin, vinblastine, lacarbazine (MOPP/ABVD) before irradiation. The remaining patients received three to four cycles of MOPP/ABVD with RT to bulky disease. Relapse-free (RFS), Hodgkin specific (HLS), and overall survival (OS) at 10 yr were 74%, 92% and 85%. In the individual stages, RFS ranged from 53% (PSIII1A) to 90% (PS IA). RFS (P = 0.006), HLS, and OS were significantly better in patients treated with chemotherapy compared with those treated with RT alone, especially in patients with bulky disease (P = 0.0005). The international prognostic score did not provide any prognostic information. The OS rates are in agreement with results from international centres during that time. The recommended treatment was sufficient to produce the desired results of <20-30% recurrences, except in PS III1A. Most relapses could be salvaged. Patients with risk factors treated with one MOPP/ABVD and RT had an excellent outcome, superior to those without risk factors treated with RT alone. These results favour the trend to treat early and intermediate stages with a short course of chemotherapy followed by limited RT.
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Affiliation(s)
- Daniel Molin
- Department of Oncology, Radiology, and Clinical Immunology, University Hospital, Uppsala, Sweden.
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