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Suwanban T, Chamnanchanunt S, Thungthong P, Nakhahes C, Iam‐arunthai K, Akrawikrai T, Bunworasate U. Survival rates of adult patients with Hodgkin lymphoma who underwent ABVD versus escalated BEACOPP in a resource-limited country: An observational study. Cancer Rep (Hoboken) 2023; 6:e1839. [PMID: 37254799 PMCID: PMC10432437 DOI: 10.1002/cnr2.1839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/03/2023] [Accepted: 05/22/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The survival rate of adult patients with Hodgkin lymphoma (HL) depends on the responses to standard chemotherapy, radiotherapy, or combined therapy. Resource-limited countries face numerous obstacles in supporting patients with HL who undergo chemotherapy, especially in advanced stages. AIM To analyze the survival outcomes of adult patients with HL after combined-modality treatment (CMT) with involved-field or non-involved-field radiotherapy. METHODS AND RESULTS We retrospectively reviewed the medical records of 90 adult patients with HL who received CMT at Rajavithi Hospital, Bangkok between 2007 and 2021. Patients with stage I-IV disease received different therapies depending on their risk group. The risk groups were evaluated according to initial response, bulky disease, and B symptoms. Patients (n = 90) who underwent CMT were followed up for 34.7 months (range, 1-141 months). The median follow-up periods of early and advanced-stage patients were 53.1 months and 23.5 months, respectively. The estimated 5-year overall survival (OS) and progression-free survival (PFS) rates of patients with advanced-stage diseases were 85% and 62%, respectively. There was a difference in the 3-year overall survival among advance-stage patients who underwent ABVD (94%) compared to those administered BEACOPPesc (50%), and the 3-year PFS (84%) among patients who underwent ABVD was higher than that among those administered BEACOPPesc (66%). Radiotherapy increased toxicity but did not improve the survival rate. CONCLUSION Chemotherapy administered to patients with advanced-stage adult HL was more effective than BEACOPPesc when ABVD was administered. Our findings are relevant for hospitals with limited resources.
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Affiliation(s)
- Tawatchai Suwanban
- Division of Hematology, Department of Medicine, Rajavithi HospitalCollege of Medicine, Rangsit UniversityBangkokThailand
| | - Supat Chamnanchanunt
- Division of Hematology, Department of Medicine, Rajavithi HospitalCollege of Medicine, Rangsit UniversityBangkokThailand
- Department of Clinical Tropical Medicine, Faculty of Tropical MedicineMahidol UniversityBangkokThailand
| | - Pravinwan Thungthong
- Division of Hematology, Department of Medicine, Rajavithi HospitalCollege of Medicine, Rangsit UniversityBangkokThailand
| | - Chajchawan Nakhahes
- Division of Hematology, Department of Medicine, Rajavithi HospitalCollege of Medicine, Rangsit UniversityBangkokThailand
| | - Kunapa Iam‐arunthai
- Division of Hematology, Department of Medicine, Rajavithi HospitalCollege of Medicine, Rangsit UniversityBangkokThailand
| | - Tananchai Akrawikrai
- Division of Hematology, Department of Medicine, Rajavithi HospitalCollege of Medicine, Rangsit UniversityBangkokThailand
| | - Udomsak Bunworasate
- Division of Hematology, Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
- Research Unit in Translational Hematology, Faculty of MedicineChulalongkorn UniversityBangkokThailand
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Çokgezer S, Elverdi T, Salihoğlu A, Ar MC, Öngören Ş, Başlar Z, Eşkazan AE. Treatment Responses, Toxicity, and Survival in Patients with Classical Hodgkin Lymphoma Aged ≥50 Years: A Single-Center Experience Over Two Decades. Cancer Manag Res 2022; 14:1911-1921. [PMID: 35698602 PMCID: PMC9188373 DOI: 10.2147/cmar.s363235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The aim of this study was to evaluate treatment responses, toxicity, and survival among cHL patients aged ≥50 years. Methods We retrospectively identified all newly diagnosed cHL patients and only included cases who were ≥50 years old at the time of diagnosis and with data available between 1999 and 2020. Results There were 101 patients, of which 52 were between 50 and 59 years of age, and 49 patients were ≥60 years old. Sixty-two patients were male, and the most common histopathological subtype was mixed cellularity cHL (58.4%). ECOG PS, CCI, CIRS, and ACE-27 scores were significantly higher in patients aged ≥60 years than those of 50–59 age group. While all patients aged 50–59 years received ABVD as first-line therapy, 79% (n=39) of cases aged ≥60 years had ABVD. In patients receiving ABVD, 95% and 92.7% of the cases aged 50–59 and ≥60 years had CR, respectively (p=0.999). Age groups were comparable in terms of hematological and non-hematological toxicities (p=0.369, p=0.127, respectively). Although not statistically significant, median survival was longer in patients receiving a transplant than in those without transplantation (108 months vs 52 months, p=0.069). In multivariate analysis, the risk of progression was higher in patients with lymphocyte ≤600/mm3 and in those who were unresponsive to first-line therapy (p=0.002 and p<0.001, respectively). Patients with B symptoms, age ≥60 years, and CIRS >3 had higher risk of mortality (p=0.001, p=0.012, p=0.038, respectively). By using these 3 parameters, we defined a new risk score, which divided our patient cohort into two as low- and high-risk groups. Low-risk patients had significantly higher survival rates than the high-risk group (83.9% vs 40.5%, p<0.001). Discussion This new prognostic score should be further tested and validated in other patient populations. Although our study has some limitations including the limited number of patients and its retrospective nature, there are not so many studies in elderly cHL patients and elderly and/or frail patients are generally excluded in most of the clinical trials. Thus, this real-life single-center experience would contribute to the literature.
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Affiliation(s)
- Simay Çokgezer
- Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Tuğrul Elverdi
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Ayşe Salihoğlu
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Şeniz Öngören
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Zafer Başlar
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
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Kumar AJ, Nelson J, Rodday AM, Evens AM, Friedberg JW, Wildes TM, Parsons SK. Development and validation of a prediction model for 1-year mortality among older adults with Hodgkin Lymphoma who receive dose-intense chemotherapy. J Geriatr Oncol 2021; 12:1233-1239. [PMID: 34330667 DOI: 10.1016/j.jgo.2021.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/12/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Older adults with Hodgkin Lymphoma (HL) have poorer outcomes than younger patients. There are little data about which baseline patient and disease factors inform prognosis among older patients. We sought to create a prediction model for 1-year mortality among older patients with new HL who received dose-intense chemotherapy. METHODS We included adults ≥65 years old with a new diagnosis of classical HL between 2000-2013 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare dataset who received full-regimen chemotherapy. Through a non-random 2:1 split, we created development and validation cohorts. Multiple imputation was used for missing data. Using stepwise selection and logistic regression, we identified predictive variables for 1-year mortality. The model was applied to the validation cohort. A final model was then fit in the full cohort. RESULTS We included 1315 patients. In the development cohort (n = 813), we identified significant predictors of 1-year mortality including age, Charlson comorbidity index (CCI), B symptoms at diagnosis, and advanced stage at diagnosis. The c-statistic was 0.70. When this model was applied to the validation cohort (n = 502), the c-statistic was 0.65. Predictors of 1-year mortality in the final model were CCI (OR = 1.41), B symptoms (OR = 1.54), advanced stage (OR = 1.44), and older age at diagnosis (OR = 1.33). CONCLUSION We present a prediction model for use among older adults with HL who receive intensive chemotherapy. We identify risk factors for death within 1 year of diagnosis. Future work will build upon prognostication and shared decision-making after diagnosis for this population.
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Affiliation(s)
- Anita J Kumar
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America; Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, United States of America.
| | - Jason Nelson
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America
| | - Angie Mae Rodday
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America
| | - Andrew M Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Jonathan W Friedberg
- Wilmot Cancer Institute, University of Rochester, Rochester, NY, United States of America
| | - Tanya M Wildes
- Cancer and Aging Research Group, United States of America
| | - Susan K Parsons
- Institute for Clinical Research & Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America; Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, United States of America; Department of Medicine and Pediatrics, Tufts University School of Medicine, Boston, MA, United States of America
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Evens AM, Carter J, Loh KP, David KA. Management of older Hodgkin lymphoma patients. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:233-242. [PMID: 31808898 PMCID: PMC6913478 DOI: 10.1182/hematology.2019000028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Hodgkin lymphoma (HL) in older patients, commonly defined as ≥60 years of age, is a disease for which survival rates have historically been significantly lower compared with younger patients. Older HL patients appear to have different disease biology compared with younger patients, including increased incidence of mixed cellularity histology, Epstein-Barr virus-related, and advanced-stage disease. For prognostication, several studies have documented the significance of comorbidities and functional status in older HL patients, as well as the importance of achieving initial complete remission. Collectively, selection of therapy for older HL patients should be based in part on functional status, including pretreatment assessment of activities of daily living (ADL), comorbidities, and other geriatric measures (eg, cognition, social support). Treatment of fit older HL patients should be given with curative intent, regardless of disease stage. However, attention should be paid to serious treatment-related toxicities, including risk of treatment-related mortality. Although inclusion of anthracycline therapy is important, bleomycin-containing regimens (eg, doxorubicin, bleomycin, vinblastine, dacarbazine) may lead to prohibitive pulmonary toxicity, and intensive therapies (eg, bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) are too toxic. Brentuximab vedotin given sequentially before and after doxorubicin, vinblastine, and dacarbazine to fit, untreated advanced-stage older HL patients was recently shown to be tolerable and highly effective. Therapy for patients who are unfit or frail because of comorbidities and/or ADL loss is less clear and should be individualized with consideration of lower-intensity therapy, such as brentuximab vedotin with or without dacarbazine. Altogether, therapy for older HL patients should be tailored based upon a geriatric assessment, and novel targeted agents should continue to be integrated into treatment paradigms.
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Affiliation(s)
- Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and
| | - Jordan Carter
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and
| | - Kah Poh Loh
- Division of Hematology and Oncology, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - Kevin A David
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; and
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Drozd‐Sokołowska J, Zaucha JM, Żółtak T, Jamroziak K, Grzybowska‐Izydorczyk O, Witkowska M, Waszczuk‐Gajda A, Kaźmierczak M, Szczepaniak A, Subocz E, Knopińska‐Posłuszny W, Hołojda J, Kopińska A, Hus I, Rybka J, Wołowiec D, Kwiatkowski J, Hałaburda K, Smolewski P, Giebel S, Wiktor‐Jędrzejczak W. Hodgkin lymphoma transformation of chronic lymphocytic leukemia—A real life data from the Polish Lymphoma Research Group. Hematol Oncol 2019; 37:383-391. [DOI: 10.1002/hon.2624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Joanna Drozd‐Sokołowska
- Department of Hematology, Oncology and Internal Diseases Medical University of Warsaw Warsaw Poland
| | - Jan Maciej Zaucha
- Department of Hematology and Transplantology Medical University of Gdańsk Gdańsk Poland
| | | | - Krzysztof Jamroziak
- Department of Hematology Institute of Hematology and Transfusion Medicine Warsaw Poland
| | | | - Magdalena Witkowska
- Department of Experimental Hematology Medical University of Lodz Lodz Poland
| | - Anna Waszczuk‐Gajda
- Department of Hematology, Oncology and Internal Diseases Medical University of Warsaw Warsaw Poland
| | - Maciej Kaźmierczak
- Department of Hematology and Bone Marrow Transplantation Poznan University of Medical Sciences Poznan Poland
| | - Andrzej Szczepaniak
- Department of Hematology and Bone Marrow Transplantation Poznan University of Medical Sciences Poznan Poland
| | - Edyta Subocz
- Department of Hematology Military Institute of Medicine Warsaw Poland
| | - Wanda Knopińska‐Posłuszny
- Department of Hematology Independent Public Health Care Ministry of the Interior of Warmia and Mazury Oncology Center Olsztyn Poland
| | - Jadwiga Hołojda
- Department of Hematology Specialist District Hospital Legnica Poland
| | - Anna Kopińska
- Department of Hematology and Bone Marrow Transplantation Medical University of Silesia Katowice Poland
| | - Iwona Hus
- Independent Clinical Transplantology Unit Medical University of Lublin Lublin Poland
| | - Justyna Rybka
- Department of Hematology Wroclaw Medical University Wroclaw Poland
| | - Dariusz Wołowiec
- Department of Hematology Wroclaw Medical University Wroclaw Poland
| | | | - Kazimierz Hałaburda
- Department of Hematopoietic Stem Cell Transplantation Institute of Hematology and Transfusion Medicine Warsaw Poland
| | - Piotr Smolewski
- Department of Experimental Hematology Medical University of Lodz Lodz Poland
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Hematology‐Oncology Maria Sklodowska‐Curie Institute‐Cancer Center Gliwice Poland
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