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Rosenbrock J, Kaul H, Oertel M, Celik E, Linde P, Fan J, Eichenauer DA, Bröckelmann PJ, von Tresckow B, Kobe C, Dietlein M, Fuchs M, Borchmann P, Eich HT, Baues C. Involved-site Radiation Therapy is Equally Effective and Less Toxic Than Involved-field Radiation Therapy in Patients Receiving Combined Modality Treatment for Early-stage Unfavorable Hodgkin Lymphoma-An Analysis of the Randomized Phase 3 HD17 Trial of the German Hodgkin Study Group. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00514-5. [PMID: 38631539 DOI: 10.1016/j.ijrobp.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 04/01/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Combined modality treatment with chemotherapy followed by consolidation radiation therapy (RT) provides excellent outcomes for patients with early-stage Hodgkin lymphoma. The international standard of care for consolidation RT, involved-site/involved-node radiation therapy (ISRT/INRT), has never been evaluated in a randomized phase 3 trial against the former standard involved-field radiation therapy (IFRT). METHODS AND MATERIALS In the multicenter phase 3 GHSG (German Hodgkin Study Group) HD17 trial, patients with early-stage unfavorable Hodgkin lymphoma were randomized between the standard Combined modality treatment group and a positron-emission tomography (PET)-guided group. In the standard group, patients received 2 cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) and 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by 30 Gy IFRT. In the experimental group, patients received no further therapy if postchemotherapy PET was negative and 30 Gy GHSG INRT, comparable to and therefore termed here ISRT, if PET was positive. Here, we analyze the interim PET-positive patients in a post hoc analysis, and therefore the randomized comparison of IFRT versus INRT/ISRT. RESULTS A total of 1100 patients were randomized, of which 311 had a positive PET after chemotherapy. Kaplan-Meier estimates of 4-year progression-free survival were 96.8% (95% CI, 91.6%-98.8%) in the IFRT group and 95.4% (95% CI, 89.9%-97.9%; HR, 1.40; 95% CI, 0.44-4.42) in the ISRT group. The pattern of recurrence analyses indicated that none of the cases of disease progression or recurrence in the ISRT group would have been prevented by the use of IFRT. Acute grade 3/4 toxicities occurred in 8.5% of IFRT patients and 2.6% of ISRT patients (P = .03). CONCLUSIONS For the first time, consolidation INRT/ISRT was randomly compared with IFRT in a phase 3 trial. Regarding progression-free survival, no advantage of IFRT could be demonstrated. In summary, our data confirm the status of INRT/ISRT as the current standard of care.
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Affiliation(s)
- Johannes Rosenbrock
- German Hodgkin Study Group (GHSG); Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Helen Kaul
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Michael Oertel
- German Hodgkin Study Group (GHSG); Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Eren Celik
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp Linde
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jiaqi Fan
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dennis A Eichenauer
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Paul J Bröckelmann
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group (GHSG); Department of Hematology and Stem Cell Transplantation, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Carsten Kobe
- German Hodgkin Study Group (GHSG); Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Markus Dietlein
- German Hodgkin Study Group (GHSG); Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Michael Fuchs
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Peter Borchmann
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Hans Theodor Eich
- German Hodgkin Study Group (GHSG); Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Christian Baues
- German Hodgkin Study Group (GHSG); Department of Radiation Oncology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
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Burlile JF, Frechette KM, Breen WG, Hwang SR, Higgins AS, Nedved AN, Harmsen WS, Pulsipher SD, Witzig TE, Micallef IN, Hoppe BS, Habermann TM, Thanarajasingam G, Johnston PB, Inwards DJ, Bennani NN, Peterson JL, Stish BJ, Rule WG, Ansell SM, Lester SC. Patterns of progression after immune checkpoint inhibitors for Hodgkin lymphoma: implications for radiation therapy. Blood Adv 2024; 8:1250-1257. [PMID: 38206755 PMCID: PMC10912840 DOI: 10.1182/bloodadvances.2023011533] [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: 08/27/2023] [Revised: 11/29/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024] Open
Abstract
ABSTRACT Immune checkpoint inhibitors (ICIs) have demonstrated remarkable response rates in relapsed or refractory Hodgkin lymphoma (HL). Still, most patients eventually progress. Patterns of progression after ICIs are not well described and are essential to defining the role of local therapies in combination with ICIs. We identified patients who received ICIs for HL between 2013 and 2022. Fludeoxyglucose-18 positron emission tomography (FDG-PET) before initiating ICI and at progression on/after ICI were reviewed, and areas of active HL were recorded. An exploratory analysis of treatable progression included patients with ≤5 sites of disease on pre-ICI FDG-PET and progression only at pre-ICI sites. Ninety patients were identified; 69 had complete records, and of these, 32 (52%) had relapsed at ICI initiation, 17 (25%) were refractory, and 16 (23%) received ICI as first-line therapy. Forty-five of 69 patients had ≤5 sites of disease (limited) on pre-ICI FDG-PET. Patients with >5 sites of disease had a higher risk of progression, and every site of disease >5 sites conferred an additional 1.2x higher chance of progression. At a median follow-up of 4.0 years, 41 of 69 patients had progressed on/after ICIs (cumulative incidence 66.4%), and of these, 22 of 41 patients progressed only at pre-ICI sites (cumulative incidence 39.4%). In an exploratory analysis, the cumulative incidence of a treatable progression among 45 patients with limited disease was 34%. The cumulative incidence of any progression among this cohort was 58.9%. More than one-third of patients with limited disease before ICIs experienced progression only at pre-ICI sites of disease. These patients could be candidates for radiation during or after ICIs.
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Affiliation(s)
| | | | | | - Steven R. Hwang
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | | | - William S. Harmsen
- Department of Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Sydney D. Pulsipher
- Department of Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Thomas E. Witzig
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Ivana N. Micallef
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | | | - David J. Inwards
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - N. Nora Bennani
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | - Stephen M. Ansell
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Scott C. Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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Soldi LR, Rabelo DH, da Silva PHR, Silva VLC, Silva MJB. The Impact of Bleomycin Deficit on Survival in Hodgkin's Lymphoma Patients: A Retrospective Study. Cancer Treat Res Commun 2024; 38:100790. [PMID: 38241969 DOI: 10.1016/j.ctarc.2024.100790] [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: 08/11/2023] [Revised: 01/03/2024] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
PURPOSE Hodgkin's lymphoma is currently treated with a chemotherapy protocol consisting of doxorubicin, bleomycin, vinblastine, and dacarbazine. Due to Brazil facing a bleomycin shortage in 2017, and this drug's high toxicity, this retrospective study evaluates the effect that the absence of bleomycin had on treatment response and overall survival of Hodgkin's lymphoma patients. METHODS The medical records of 126 HL patients treated between 2007 and 2021 were reviewed and their data collected, followed by grouping into ABVD and AVD groups according to bleomycin use. Data concerning the patient's characteristics, cancer type, and treatment plan were analyzed with proportion tests, Kaplan-Meier curves. univariate Cox regression, and χ2 tests. RESULTS No discernible differences were found in this study between the overall survival and recurrence rate of patients treated with bleomycin compared to those without. Additionally, there was an increased risk of death in each subsequent cycle of chemotherapy of the complete ABVD protocol, demonstrating a risk of toxicity. Among the variables analyzed, hypertension and the presence of B symptoms were also associated with an increased risk of death, while the use of radiotherapy significantly improved survival. CONCLUSION The results of this study suggest that bleomycin did not impact the outcome of Hodgkin's lymphoma treatment. Moreover, the increased risk of death associated with its toxicity during each cycle of treatment raises concerns about its role as an essential component of the gold standard for Hodgkin's lymphoma treatment. Therefore, further research and consideration are needed to reassess the use of bleomycin in Hodgkin's lymphoma treatment protocols.
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Affiliation(s)
- Luiz Ricardo Soldi
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil; Tumor Biomarkers and Osteoimmunology Laboratory, Av. Pará - 1720 - Block 6T, Room 07 - District Umuarama, Uberlândia, MG, Brazil; Student of the Graduate Program in Applied Immunology and Parasitology, Federal University of Uberlândia, Brazil..
| | - Diogo Henrique Rabelo
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil; Tumor Biomarkers and Osteoimmunology Laboratory, Av. Pará - 1720 - Block 6T, Room 07 - District Umuarama, Uberlândia, MG, Brazil; Student of the Graduate Program in Applied Immunology and Parasitology, Federal University of Uberlândia, Brazil..
| | - Paulo Henrique Rosa da Silva
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil; Tumor Biomarkers and Osteoimmunology Laboratory, Av. Pará - 1720 - Block 6T, Room 07 - District Umuarama, Uberlândia, MG, Brazil; Student of the Graduate Program in Applied Immunology and Parasitology, Federal University of Uberlândia, Brazil..
| | - Victor Luigi Costa Silva
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil; Tumor Biomarkers and Osteoimmunology Laboratory, Av. Pará - 1720 - Block 6T, Room 07 - District Umuarama, Uberlândia, MG, Brazil.
| | - Marcelo José Barbosa Silva
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil; Tumor Biomarkers and Osteoimmunology Laboratory, Av. Pará - 1720 - Block 6T, Room 07 - District Umuarama, Uberlândia, MG, Brazil.
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Husi K, Szabó R, Pinczés LI, Földeák D, Dudley R, Szomor Á, Koller B, Gopcsa L, Illés Á, Miltényi Z. Improved survival of autologous stem cell transplantation in primary refractory and relapsed Hodgkin lymphoma in the brentuximab vedotin era - real-world data from Hungary. Ann Hematol 2023; 102:2555-2563. [PMID: 37428200 PMCID: PMC10444678 DOI: 10.1007/s00277-023-05354-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/30/2023] [Indexed: 07/11/2023]
Abstract
Autologous stem cell transplantation (ASCT) is the standard treatment of primary refractory or relapsed Hodgkin-lymphoma, which can provide a cure rate of about 50%. The aim of our study was to analyze the data of 126 HL patients undergoing AHSCT in Hungary between 01/01/2016 and 31/12/2020. We assessed the progression-free and overall survival, the prognostic role of PET/CT performed before transplantation and effect of brentuximab vedotin (BV) treatment on survival outcomes. The median follow-up time from AHSCT was 39 (1-76) months. The 5-year OS comparing PET- and PET + patients was 90% v. 74% (p = 0.039), and 5-year PFS was 74% v. 40% (p = 0.001). There was no difference in either OS or PFS compared to those who did not receive BV before AHSCT. We compared BV treatments based on their indication (BV only after AHSCT as maintenance therapy, BV before and after AHSCT as maintenance treatment, BV only before AHSCT, no BV treatment). There was statistically significant difference in the 5-year PFS based on the inication of BV therapy. Recovery rates of our R/R HL patient population, who underwent AHSCT, improved significantly. Our positive results can be attributed to the PET/CT directed, response-adapted treatment approach, and the widespread use of BV.
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Affiliation(s)
- Kata Husi
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, 4032, Debrecen, Hungary
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - Roxána Szabó
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, 4032, Debrecen, Hungary
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - László Imre Pinczés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, 4032, Debrecen, Hungary
| | - Dóra Földeák
- Division of Hematology, 2nd Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Réka Dudley
- Division of Hematology, 1st Department of Internal Medicine, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - Árpád Szomor
- Division of Hematology, 1st Department of Internal Medicine, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - Beáta Koller
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - László Gopcsa
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Árpád Illés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, 4032, Debrecen, Hungary
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsófia Miltényi
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei Krt. 98, 4032, Debrecen, Hungary.
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary.
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Munir F, Hardit V, Sheikh IN, AlQahtani S, He J, Cuglievan B, Hosing C, Tewari P, Khazal S. Classical Hodgkin Lymphoma: From Past to Future-A Comprehensive Review of Pathophysiology and Therapeutic Advances. Int J Mol Sci 2023; 24:10095. [PMID: 37373245 DOI: 10.3390/ijms241210095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/04/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Hodgkin lymphoma, a hematological malignancy of lymphoid origin that typically arises from germinal-center B cells, has an excellent overall prognosis. However, the treatment of patients who relapse or develop resistant disease still poses a substantial clinical and research challenge, even though current risk-adapted and response-based treatment techniques produce overall survival rates of over 95%. The appearance of late malignancies after the successful cure of primary or relapsed disease continues to be a major concern, mostly because of high survival rates. Particularly in pediatric HL patients, the chance of developing secondary leukemia is manifold compared to that in the general pediatric population, and the prognosis for patients with secondary leukemia is much worse than that for patients with other hematological malignancies. Therefore, it is crucial to develop clinically useful biomarkers to stratify patients according to their risk of late malignancies and determine which require intense treatment regimens to maintain the ideal balance between maximizing survival rates and avoiding late consequences. In this article, we review HL's epidemiology, risk factors, staging, molecular and genetic biomarkers, and treatments for children and adults, as well as treatment-related adverse events and the late development of secondary malignancies in patients with the disease.
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Affiliation(s)
- Faryal Munir
- Department of Pediatrics, Pediatric Hematology/Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Viney Hardit
- CARTOX Program, Department of Pediatrics, Pediatric Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Irtiza N Sheikh
- Department of Pediatrics, Pediatric Hematology/Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Shaikha AlQahtani
- Department of Pediatrics, Pediatric Hematology/Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jiasen He
- Department of Pediatrics, Pediatric Hematology/Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Branko Cuglievan
- Department of Pediatrics, Pediatric Hematology/Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Pediatrics-Patient Care, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Chitra Hosing
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Priti Tewari
- CARTOX Program, Department of Pediatrics, Pediatric Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sajad Khazal
- CARTOX Program, Department of Pediatrics, Pediatric Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Ansell SM. Hodgkin lymphoma: 2023 update on diagnosis, risk-stratification, and management. Am J Hematol 2022; 97:1478-1488. [PMID: 36215668 DOI: 10.1002/ajh.26717] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 01/28/2023]
Abstract
DISEASE OVERVIEW Hodgkin lymphoma (HL) is an uncommon B-cell lymphoid malignancy affecting 8540 new patients annually and representing approximately 10% of all lymphomas in the United States. DIAGNOSIS HL is composed of two distinct disease entities: classical HL and nodular lymphocyte-predominant HL. Nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte-rich HL are subgroups of classical HL. RISK STRATIFICATION An accurate assessment of the stage of disease in patients with HL is critical for the selection of the appropriate therapy. Prognostic models that identify patients at low or high risk for recurrence, as well as the response to therapy as determined by positron emission tomography scan, are used to optimize therapy. RISK-ADAPTED THERAPY Initial therapy for HL patients is based on the histology of the disease, the anatomical stage, and the presence of poor prognostic features. Patients with early-stage disease are typically treated with combined modality strategies utilizing abbreviated courses of combination chemotherapy followed by involved-field radiation therapy, while those with advanced-stage disease receive a longer course of chemotherapy, often without radiation therapy. However, newer agents, including brentuximab vedotin and anti-programmed death-1 (PD-1) antibodies, are now being incorporated into frontline therapy. MANAGEMENT OF RELAPSED/REFRACTORY DISEASE High-dose chemotherapy (HDCT) followed by an autologous stem cell transplant (ASCT) is the standard of care for most patients who relapse following initial therapy. For patients who fail HDCT with ASCT, brentuximab vedotin, PD-1 blockade, non-myeloablative allogeneic transplant, or participation in a clinical trial should be considered.
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Shbib Dabaja B, Boyce-Fappiano D, Dong W, Damron E, Fang P, Gunther J, Rodriguez MA, Strati P, Steiner R, Nair R, Lee H, Abou Yehia Z, Shihadeh F, Pinnix C, Ng AK. Second Malignancies in Patients with Hodgkin’s Lymphoma: Half a Century of Experience. Clin Transl Radiat Oncol 2022; 35:64-69. [PMID: 35601797 PMCID: PMC9121058 DOI: 10.1016/j.ctro.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/07/2022] [Accepted: 04/25/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose Therapeutic improvements for Hodgkin’s Lymphoma (HL) has resulted in excellent survival outcomes. Thus, patients are increasing susceptible to developing secondary malignancy (SM) a feared iatrogenic complication. Materials & Methods We evaluated the SM risk in a cohort of patients with HL treated over a 50-year period. In total, 1653 patients were treated for HL from 1956 to 2009 at a tertiary-cancer-center. A cumulative incidence function was used to quantify SM risk and the Fine and Gray competing risk model was used to identify disease and treatment related correlates. Results Two-hundred-ninety patients (19%) developed SMs. Paradoxically, SM risk was higher in the modern era with 20-year cumulative incidence rates of 11.1%, 11.9%, 17% and 21.8%, for patients treated <1970, 1971–1986, 1986–1995 and 1996–2009, respectively. We hypothesized that the disproportionately high rate of early deaths in the early era may skew the assessment of SM risks, a much-delayed event. When the analysis was restricted to patients with early-stage favorable HL treated >1980, we found a reversal of the trend, especially on the risk of solid tumor, with a hazard ratio of 0.57 (p = 0.0651) in patients treated after 1996. Conclusion Our findings highlight the limitations of comparing the risk of a late event between groups with disparate rates of early deaths, despite the use of a competing risk model. When partially corrected for, patients treated in the more recent time period experienced a lower solid tumor risk.
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Affiliation(s)
- Bouthaina Shbib Dabaja
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Corresponding author at: Department of Radiation Oncology, Division of Radiation Oncology Incident Commander, University of Texas MD Anderson Cancer Center, Director of Research of the International Lymphoma Radiation Oncology Group (ILROG), 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - David Boyce-Fappiano
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wenli Dong
- Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ethan Damron
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Penny Fang
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jill Gunther
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria A. Rodriguez
- Departments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paolo Strati
- Departments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Raphael Steiner
- Departments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ranjit Nair
- Departments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hun Lee
- Departments of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zeinab Abou Yehia
- Department of Radiation Oncology, Rutgers Robertwood Johnson Medical Center, Houston, TX, USA
| | - Ferial Shihadeh
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chelsea Pinnix
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrea K. Ng
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Houston, TX, USA
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Gudapati P, Abouamara M. Treatment-related peripheral small cell lung carcinoma in a Hodgkin lymphoma survivor. BMJ Case Rep 2022; 15:e249104. [PMID: 35264395 PMCID: PMC8915357 DOI: 10.1136/bcr-2022-249104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 12/31/2022] Open
Abstract
Hodgkin lymphoma (HL) survivors have an increased risk of developing subsequent treatment-related primary malignancies. In the last few decades, advances in knowledge, radiotherapy, chemotherapy and autologous stem cell transplantation have led to the transformation of lethal malignancy into highly curable malignancy, thereby improving outcomes. With prolonged survival, the risk of developing subsequent treatment-related late adverse effects, such as malignancies, steadily increases over time. Herein, we present the first case of a treatment-related second primary stage IV peripheral small cell lung carcinoma in a female HL survivor who was also diagnosed with right breast cancer 13 years after HL treatment and 1 year before her lung cancer diagnosis.
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Affiliation(s)
- Prathyusha Gudapati
- Internal Medicine, UNC Health Southeastern, Lumberton, North Carolina, USA
- Internal Medicine, Campbell University Jerry M Wallace School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Mouna Abouamara
- Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Valenzuela J, Echegaray JJ, Dodds E, Kurup SK, Lowder C, Ondrejka SL, Singh AD. Ophthalmic Manifestations of Hodgkin Lymphoma: A Review. Ocul Oncol Pathol 2022; 7:381-389. [PMID: 35087814 DOI: 10.1159/000519032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/13/2021] [Indexed: 12/16/2022] Open
Abstract
Background Hodgkin lymphoma (HL) is a hematopoietic neoplasm characterized by cancerous Reed-Sternberg cells. In contrast to ophthalmic manifestations by non-HL that are well recognized, there is paucity of the literature as it relates to ophthalmic manifestation by HL. We performed a comprehensive review of published studies (case reports and small case series) to characterize the ophthalmic manifestations of HL. Summary Thirty patients were identified with ophthalmic manifestation of HL. Thirteen (43%) were male, and 14 (46%) were female (in 3 cases, sex was not specified). The median age at ophthalmic presentation was 27 years. Diagnosis of HL was made after ophthalmic manifestation in 10 (33%) cases, whereas 11 (36%) cases had a prior diagnosis of HL. Ophthalmic manifestations can be classified into 3 main groups; direct infiltration, inflammatory reaction, and paraneoplastic process. Seven cases had infiltration of the optic nerve. Uveal inflammatory reaction was reported in 21 cases. The presence of intraocular Reed-Sternberg cells had been confirmed in 1 case with granulomatous uveitis. Conjunctival and corneal reaction was seen in 3 cases. HL was in stage 2 or higher, with only 1 case with stage 1A (12 cases HL stage not specified). Seven cases (22%) died of HD, all were diagnosed with advanced lymphoma, and none was treated with chemotherapy. Key Message Ocular involvement in HL is extremely rare. A few cases of histopathologically confirmed optic nerve/tract infiltration are within the spectrum of CNS involvement by HL. Inflammatory uveitis is the most common ophthalmic association of HL. In the presence of prior known diagnosis of HL, restaging should be considered to exclude recurrence. Toxicity or adverse reaction to drugs used to treat HL may also contribute to ophthalmic involvement.
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Affiliation(s)
- Juan Valenzuela
- Department of Retina and Ophthalmic Oncology, Consultores Oftalmológicos, Buenos Aires, Argentina
| | - Jose J Echegaray
- University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Emilio Dodds
- Department of Uveitis, Consultores Oftalmologicos, Buenos Aires, Argentina
| | - Shree K Kurup
- University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Careen Lowder
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sarah L Ondrejka
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arun D Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
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10
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Einwaller P. [Involvement of an extralymphatic organ in Hodgkin's lymphoma]. Aktuelle Urol 2021; 52:586-588. [PMID: 30763975 DOI: 10.1055/a-0834-6027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This case report describes the rare entity of Hodgkin's lymphoma manifesting itself in an extralymphatic organ. To rule out a second malignancy, we performed a transurethral resection of the urinary bladder (TUR-B) in our urology department, confirming the histological findings. After that, the patient received oncological treatment based on the current guidelines.
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Affiliation(s)
- Pierre Einwaller
- Alexianer Krefeld GmbH, Klinik für Urologie und Kinderurologie, Krefeld
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11
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Nukui J, Takahashi H, Tokunaga M, Suzuki T, Suzuki M, Yokose T, Nakamura N, Sakai R, Nakajima H. Successful treatment with brentuximab vedotine for a patient with very late relapse of limited stage classic Hodgkin lymphoma. Int Cancer Conf J 2021; 11:27-30. [DOI: 10.1007/s13691-021-00510-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022] Open
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12
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Nouri N, Aghebati-Maleki L, Yousefi M. Adipose-Derived Mesenchymal Stem Cells: A Promising Tool in the Treatment of pre mature ovarian failure. J Reprod Immunol 2021; 147:103363. [PMID: 34450435 DOI: 10.1016/j.jri.2021.103363] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 08/03/2021] [Accepted: 08/15/2021] [Indexed: 12/12/2022]
Abstract
Despite being rare, primary ovarian insufficiency (POI) is a significant cause of infertility and deficiency of ovarian hormone in women. Several health risks are also associated with POI, which include dry eye syndrome, reduced density of bones and enhanced fracture risks, troublesome menopausal symptoms, early development of cardiovascular disease, and psychological effects such as declined cognition, reduced perceived psychological support, anxiety, and depression. Replacing premenopausal levels of ovarian sex steroids through proper hormone replacement therapy could improve the quality of life for POI women and ameliorate related health risks. Herein, POI and its complications, in addition to hormone replacement therapies, which are safe and effective, are discussed. It is proposed that the use of HRT) Hormone replacement therapy (formulations which mimic normal production of ovarian hormones could reduce POI-associated morbidity rates if they are continued by the age 50, which is approximately the natural age of menopause. Particular populations of POI women are also addressed, which include those with enhanced risk of ovarian or breast cancer, those with Turner syndrome, those approaching natural menopause, and those who are breastfeeding. It is generally predicted that stem cell-based therapies would be both safe and effective. In fact, several types of cells have been described as safe, though their effectiveness and therapeutic application are yet to be defined. Several factors exist which could affect the results of treatment, such as cell handling, ex-vivo preparation strategies, variations in tissue of origin, potency, and immunocompatibility. Accordingly, cell types potentially effective in regenerative medicine could be recognized. Notably, products of MSCs from various sources of tissues show different levels of regenerative capabilities. The ultimate focus of the review is on adipose tissue-derive MCSs (ADMSCs), which possess exceptional features such as general availability, great ability to proliferate and differentiate, immunomodulatory capabilities, and low immunogenicity.
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Affiliation(s)
- Narges Nouri
- Student's Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leili Aghebati-Maleki
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mehdi Yousefi
- Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Stem Cell Research Center, Tabriz University of Medical Science, Tabriz, Iran.
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13
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Iorio GC, Salvestrini V, Borghetti P, De Felice F, Greco C, Nardone V, Fiorentino A, Gregucci F, Desideri I. The impact of modern radiotherapy on radiation-induced late sequelae: Focus on early-stage mediastinal classical Hodgkin Lymphoma. A critical review by the Young Group of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Crit Rev Oncol Hematol 2021; 161:103326. [PMID: 33862247 DOI: 10.1016/j.critrevonc.2021.103326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/07/2021] [Accepted: 03/26/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The historically feared radiation-induced secondary cancers and cardiac toxicities observed among mediastinal classical Hodgkin Lymphoma (cHL) patients may still negatively burden the benefit of radiotherapy among long-term survivors. Modern radiotherapy (RT) delivery techniques, including intensity-modulated RT (IMRT) and deep inspiration breath-hold (DIBH) solutions, are drastically changing this scenario. Results of a literature overview are reported and discussed in this paper. MATERIALS AND METHODS Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. RESULTS This paper contains a narrative report and a critical discussion of organs-at-risk dose-volume metrics linked with radiation-induced toxicities in cHL patients. CONCLUSIONS The scenario of early-stage cHL presents long-life expectancies, thus the goal of treatment should aim at maintaining high cure rates and limiting the onset of late complications. Further evaluations of dosimetric measures and clinical outcomes are warranted to identify patients at higher risk to target treatment tailoring.
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Affiliation(s)
| | - Viola Salvestrini
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Paolo Borghetti
- Department of Radiation Oncology, University and Spedali Civili, Brescia, Italy
| | - Francesca De Felice
- Department of Radiation Oncology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Carlo Greco
- Department of Radiation Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Valerio Nardone
- Department of Radiation Oncology, Ospedale del Mare, Viale della Metamorfosi, Naples, Italy
| | - Alba Fiorentino
- Department of Radiation Oncology, General Regional Hospital "F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Fabiana Gregucci
- Department of Radiation Oncology, General Regional Hospital "F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Isacco Desideri
- Department of Radiation Oncology, University of Florence, Florence, Italy
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14
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Abuelgasim KA, Shammari RA, Alshieban S, Alahmari B, Alzahrani M, Alhejazi A, Alaskar A, Damlaj M. Impact of cluster of differentiation 20 expression and rituximab therapy in classical Hodgkin lymphoma: Real world experience. Leuk Res Rep 2021; 15:100240. [PMID: 33936943 PMCID: PMC8076710 DOI: 10.1016/j.lrr.2021.100240] [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: 09/28/2020] [Revised: 03/25/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022] Open
Abstract
The prognostic impact of CD20 expression and rituximab therapy in classical Hodgkin lymphoma (cHL) is unclear. Among 310 patients, CD20 was expressed in 66 (22%) cases. The 3-year PFS was 75.1% for CD20+and 70% for CD20− (p = 0.36). The 3-year PFS was 84.7% for the rituximab group and 67.8% for the no rituximab group (p = 0.23). Only constitutional symptoms and positive interim PET/CT were significantly associated with worse outcome, HR 3.2 (1.14–9.01; p = 0.028) and 4.3 (2.27–8.1; p < 0.0001), respectively. Neither CD20 expression nor rituximab use significantly impacted outcome.
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Affiliation(s)
- Khadega A Abuelgasim
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Raed Al Shammari
- Internal Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Saeed Alshieban
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Pathology Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Bader Alahmari
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohsen Alzahrani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ayman Alhejazi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed Alaskar
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Moussab Damlaj
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Oncology Department, King Abdulaziz Medical City, Riyadh National Guard Health Affairs, Riyadh 11426, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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15
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Pugliese N, Picardi M, Della Pepa R, Giordano C, Muriano F, Leone A, Delle Cave G, D’Ambrosio A, Marafioti V, Rascato MG, Russo D, Mascolo M, Pane F. Rituximab-Containing Risk-Adapted Treatment Strategy in Nodular Lymphocyte Predominant Hodgkin Lymphoma: 7-Years Follow-Up. Cancers (Basel) 2021; 13:cancers13081760. [PMID: 33917062 PMCID: PMC8067750 DOI: 10.3390/cancers13081760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a rare variant of HL that accounts for 5% of all HL cases. The expression of CD20 on neoplastic lymphocytes provides a suitable target for novel treatments based on Rituximab. Due to its rarity, consolidated and widely accepted treatment guidelines are still lacking for this disease. METHODS Between 1 December 2007 and 28 February 2018, sixteen consecutive newly diagnosed adult patients with NLPHL received Rituximab (induction ± maintenance)-based therapy, according to the baseline risk of German Hodgkin Study Group prognostic score system. The treatment efficacy and safety of the Rituximab-group were compared to those of a historical cohort of 12 patients with NLPHL who received Doxorubicin, Bleomycin, Vinblastine, Dacarbazine (ABVD) chemotherapy followed by radiotherapy (RT), if needed, according to a similar baseline risk. The primary outcome was progression-free survival (PFS) and secondary outcomes were overall survival (OS) and side-effects (according to the Common Terminology Criteria for Adverse Events, v4.03). RESULTS After a 7-year follow-up (range, 1-11 years), PFS was 100% for patients treated with the Rituximab-containing regimen versus 66% for patients of the historical cohort (p = 0.036). Four patients in the latter group showed insufficient response to therapy. The PFS for early favorable and early unfavorable NLPHLs was similar between treatment groups, while a better PFS was recorded for advanced-stages treated with the Rituximab-containing regimen. The OS was similar for the two treatment groups. Short- and long-term side-effects were more frequently observed in the historical cohort. Grade ≥3 neutropenia was more frequent in the historical cohort compared with the Rituximab-group (58.3% vs. 18.7%, respectively; p = 0.03). Long-term non-hematological toxicities were observed more frequently in the historical cohort. CONCLUSION Our results confirm the value of Rituximab in NLPHL therapy and show that Rituximab (single-agent) induction and maintenance in a limited-stage, or Rituximab with ABVD only in the presence of risk factors, give excellent results while sparing cytotoxic agent- and/or RT-related damage. Furthermore, Rituximab inclusion in advanced-stage therapeutic strategy seems to improve PFS compared to conventional chemo-radiotherapy.
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Affiliation(s)
- Novella Pugliese
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
- Correspondence: ; Tel.: +39-0817462037
| | - Marco Picardi
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Roberta Della Pepa
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Claudia Giordano
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Francesco Muriano
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Aldo Leone
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Giuseppe Delle Cave
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Alessandro D’Ambrosio
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Violetta Marafioti
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Maria Gabriella Rascato
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
| | - Daniela Russo
- Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (D.R.); (M.M.)
| | - Massimo Mascolo
- Pathology Unit, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (D.R.); (M.M.)
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.P.); (R.D.P.); (C.G.); (F.M.); (A.L.); (G.D.C.); (A.D.); (V.M.); (M.G.R.); (F.P.)
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16
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Pinczés LI, Szabó R, Illés Á, Földeák D, Piukovics K, Szomor Á, Gopcsa L, Miltényi Z. Real-world efficacy of brentuximab vedotin plus bendamustine as a bridge to autologous hematopoietic stem cell transplantation in primary refractory or relapsed classical Hodgkin lymphoma. Ann Hematol 2020; 99:2385-2392. [PMID: 32748163 PMCID: PMC7481161 DOI: 10.1007/s00277-020-04204-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/27/2020] [Indexed: 11/26/2022]
Abstract
Up to 30% of patients with classical Hodgkin lymphoma (cHL) are not responsive to frontline therapy or relapse after primary treatment. In these cases, autologous hematopoietic stem cell transplantation (AHSCT) is the standard of care. The combination of brentuximab vedotin and bendamustine (BV + B) is an effective salvage regimen in this challenging subpopulation. This nationwide multicenter study investigated the real-world efficacy and safety of the BV + B regimen as a bridge to AHSCT in patients with primary refractory or relapsed cHL. A total of 41 cHL patients underwent AHSCT after receiving at least 1 cycle of BV + B (with brentuximab vedotin given at 1.8 mg/kg on day 1 and bendamustine at 90 mg/m2 on days 1-2 every 4 weeks). After a median of 3 (1-6) cycles of BV + B, the objective response rate was 78%, with 29 (70.7%) patients achieving complete remission. Twelve (29.3%) patients relapsed after AHSCT, 2 (4.9%) of them died, while 2 (4.9%) patients are lost to follow-up. After a median of 17 months of follow-up, the estimated 2-year overall- and progression-free survival after AHSCT was 93 and 62%, respectively. Features of advanced disease at recurrence (p = 0.038) and the presence of stage IV cHL at relapse (p = 0.024) are strong predictor markers of unfavorable outcomes. Twenty-four (58.5%) patients experienced adverse events of any grade, while no grade IV toxicities were reported. BV + B is an effective salvage option with a manageable toxicity profile in cHL. The real-world safety and efficacy of this combination are similar to the observations made on the study population.
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Affiliation(s)
- László Imre Pinczés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - Roxána Szabó
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Árpád Illés
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary
| | - Dóra Földeák
- Division of Hematology, 2nd Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Klára Piukovics
- Division of Hematology, 2nd Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Árpád Szomor
- Division of Hematology, 1st Department of Internal Medicine, Faculty of Medicine, University of Pécs, Pecs, Hungary
| | - László Gopcsa
- Department of Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Zsófia Miltényi
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary.
- Doctoral School of Clinical Medicine, University of Debrecen, Debrecen, Hungary.
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17
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Ansell SM. Hodgkin lymphoma: A 2020 update on diagnosis, risk-stratification, and management. Am J Hematol 2020; 95:978-989. [PMID: 32384177 DOI: 10.1002/ajh.25856] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 12/11/2022]
Abstract
DISEASE OVERVIEW Hodgkin lymphoma (HL) is an uncommon B-cell lymphoid malignancy affecting 8480 new patients annually and representing approximately 10% of all lymphomas in the United States. DIAGNOSIS Hodgkin lymphoma is composed of two distinct disease entities: classical HL and nodular lymphocyte predominant HL. Nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte-rich HL are subgroups of classical HL. RISK STRATIFICATION An accurate assessment of the stage of disease in patients with HL is critical for the selection of the appropriate therapy. Prognostic models that identify patients at low or high risk for recurrence, as well as the response to therapy as determined by positron emission tomography (PET) scan, are used to optimize therapy. RISK-ADAPTED THERAPY Initial therapy for HL patients is based on the histology of the disease, the anatomical stage and the presence of poor prognostic features. Patients with early stage disease are typically treated with combined modality strategies utilizing abbreviated courses of combination chemotherapy, followed by involved-field radiation therapy. Patients with advanced stage disease receive a longer course of chemotherapy, often without radiation therapy. However, newer agents including brentuximab vedotin and anti-PD-1 antibodies are now being incorporated into frontline therapy. MANAGEMENT OF RELAPSED/REFRACTORY DISEASE High-dose chemotherapy (HDCT) followed by an autologous stem cell transplant (ASCT) is the standard of care for most patients who relapse following initial therapy. For patients who fail HDCT with ASCT, brentuximab vedotin, PD-1 blockade, non-myeloablative allogeneic transplant or participation in a clinical trial should be considered.
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18
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Sakatani A, Igawa T, Okatani T, Fujihara M, Asaoku H, Sato Y, Yoshino T. Clinicopathological significance of CD79a expression in classic Hodgkin lymphoma. J Clin Exp Hematop 2020; 60:78-86. [PMID: 32641598 PMCID: PMC7596911 DOI: 10.3960/jslrt.20010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Classic Hodgkin lymphoma (CHL) is a lymphoid neoplasia characterized by the presence of large tumor cells, referred to as Hodgkin and Reed-Sternberg (HRS) cells, originating from B-cells in an inflammatory background. As the clinical significance of B-cell markers has yet to be fully elucidated, this study aimed to clarify the clinicopathological significance of CD79a in 55 patients with CHL. They were immunohistochemically divided into two groups, comprising of 20 CD79a-positive and 35 CD79a-negative patients. There was no significant correlation between CD79a and CD20 expression (rs = 0.125, P = 0.362). CD79a-positive patients were significantly older at onset (P = 0.011). There was no significant correlation between CD79a-positivity and clinical stage (P = 0.203), mediastinal involvement (P = 0.399), extranodal involvement (P = 0.749), or laboratory findings, including serum levels of lactate dehydrogenase (P = 1) and soluble interleukin-2 receptor (P = 0.251). There were significant differences in overall survival (OS) (P = 0.005) and progression-free survival (PFS) (P = 0.007) between CD79a-positive and CD79a-negative patients (5-year OS: 64.6% and 90.5%; 5-year PFS: 44.0% and 76.6%, respectively). Five patients in whom the majority (> 80%) of HRS cells expressed CD79a consisted of 4 males and 1 female aged between 52 and 81 years; 4 of them were in a limited clinical stage. We concluded that CD79a-positive CHL may have unique clinicopathological features.
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Affiliation(s)
- Akio Sakatani
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.,Department of Pathology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Takuro Igawa
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Takeshi Okatani
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.,Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Megumu Fujihara
- Department of Pathology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Hideki Asaoku
- Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Yasuharu Sato
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.,Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Armand P, Bello CM, Benitez CM, Bierman PJ, Boughan KM, Dabaja B, Gordon LI, Hernandez-Ilizaliturri FJ, Herrera AF, Hochberg EP, Huang J, Johnston PB, Kaminski MS, Kenkre VP, Khan N, Lynch RC, Maddocks K, McConathy J, McKinney M, Metzger M, Morgan D, Mulroney C, Rabinovitch R, Rosenspire KC, Seropian S, Tao R, Winter JN, Yahalom J, Burns JL, Ogba N. Hodgkin Lymphoma, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:755-781. [DOI: 10.6004/jnccn.2020.0026] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The NCCN Clinical Practice Guidelines in Oncology for Hodgkin Lymphoma (HL) provide recommendations for the management of adult patients with HL. The NCCN panel meets at least annually to review comments from reviewers within their institutions, examine relevant data, and reevaluate and update their recommendations. Current management of classic HL involves initial treatment with chemotherapy alone or combined modality therapy followed by restaging with PET/CT to assess treatment response. Overall, the introduction of less toxic and more effective regimens has significantly advanced HL cure rates. This portion of the NCCN Guidelines focuses on the management of classic HL.
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Affiliation(s)
| | | | - Weiyun Z. Ai
- 2UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | | | - Kirsten M. Boughan
- 7Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Leo I. Gordon
- 9Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Jiayi Huang
- 13Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Ryan C. Lynch
- 18Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Kami Maddocks
- 19The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Monika Metzger
- 22St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | - Randa Tao
- 28Huntsman Cancer Institute at the University of Utah
| | - Jane N. Winter
- 9Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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20
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Král Z, Michalka J, Móciková H, Marková J, Sýkorová A, Belada D, Jungová A, Vokurka S, Lukášová M, Procházka V, Ďuraš J, Hájek R, Dušek L, Drgoňa Ľ, Ladická M, Ballová V, Vranovský A. Treatment of Relapsed/Refractory Hodgkin Lymphoma: Real-World Data from the Czech Republic and Slovakia. J Cancer 2019; 10:5041-5048. [PMID: 31602255 PMCID: PMC6775599 DOI: 10.7150/jca.29308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 07/13/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction: Clinical trials have demonstrated the effectiveness of the CD30-targeted antibody-drug conjugate brentuximab vedotin (BV) for the treatment of relapsed/refractory Hodgkin lymphoma (R/R HL). In this study, we report on outcomes with BV in a real-world setting using data collected in clinics in the Czech Republic and Slovakia. Patients and Methods: Clinical and epidemiological data for patients with R/R HL who received treatment with BV at eight centers across the Czech Republic and Slovakia were examined. Data were amalgamated and analyzed retrospectively. Results: Clinical data for 58 patients (median age: 30.5 years) with R/R HL who received BV during the course of their treatment were collected and analyzed. Patients had received a median of 3 prior treatment regimens and most (91%) were treated with BV after relapse following autologous stem cell transplantation. Therapeutic responses after BV included 19 (33%) complete responses (CRs) and 8 (14%) partial responses. CRs occurred more frequently in patients who had received fewer prior treatment regimens. The 1-, 2-, and 3-year overall survival (OS) rates from initiation of BV were 78%, 62%, and 41%, respectively. Conclusion: Response rates and OS in this analysis of BV in real-world settings in the Czech Republic and Slovakia were consistent with those reported for pivotal clinical trials and from previous studies outside the clinical trial setting. The results support the efficacy of BV for treatment of R/R HL in real-life clinical practice.
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Affiliation(s)
- Zdeněk Král
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jozef Michalka
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Heidi Móciková
- Department of Clinical Hematology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jana Marková
- Department of Clinical Hematology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alice Sýkorová
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Kralove, Czech Republic and Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic
| | - David Belada
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Kralove, Czech Republic and Charles University in Prague, Faculty of Medicine in Hradec Kralove, Czech Republic
| | - Alexandra Jungová
- Department of Haemato-Oncology, University Hospital in Plzen, Plzen 304 60, Czech Republic
| | - Samuel Vokurka
- Department of Haemato-Oncology, University Hospital in Plzen, Plzen 304 60, Czech Republic
| | - Marie Lukášová
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic
| | - Vít Procházka
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic
| | - Juraj Ďuraš
- Department of Hemato-Oncology, Faculty of Medicine, University of Ostrava and University Hospital Ostrava, Ostrava, Czech Republic
| | - Roman Hájek
- Department of Hemato-Oncology, Faculty of Medicine, University of Ostrava and University Hospital Ostrava, Ostrava, Czech Republic
| | - Ladislav Dušek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Czech Republic
| | - Ľuboš Drgoňa
- Department of Oncohematology, Comenius University in Bratislava and National Cancer Institute, Bratislava, Slovakia
| | - Miriam Ladická
- Department of Oncohematology, Comenius University in Bratislava and National Cancer Institute, Bratislava, Slovakia
| | - Veronika Ballová
- Department of Hematology/Oncology, Kantonsspital Baden, Baden, Switzerland
| | - Andrej Vranovský
- Department of Oncohematology, Comenius University in Bratislava and National Cancer Institute, Bratislava, Slovakia
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Abstract
PURPOSE OF REVIEW Availability of highly effective novel agents has altered the approach to initial therapy in patients with classical Hodgkin lymphoma (cHL). We will review controversies in the following areas: (1) the role of radiation in early unfavorable disease and the optimal treatment strategies for (2) advanced-stage disease and (3) elderly patients. RECENT FINDINGS Strategies incorporating brentuximab vedotin into frontline treatment of cHL yielded favorable results in non-randomized elderly studies and were compared to ABVD in advanced disease among adults. Meanwhile, four cycles of escalated BEACOPP yielded unprecedented favorable results for the treatment of advanced disease in the German Hodgkin Study Group 18 study. The addition of novel agents to conventional treatment strategies has the potential to improve outcomes in high-risk groups of patients while reducing toxicity. The role of radiation therapy remains in question but may see diminished use with the incorporation of more effective agents in the frontline setting.
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22
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Prognostic value of some inflammatory markers in patients with lymphoma. Biosci Rep 2019; 39:BSR20182174. [PMID: 30814315 PMCID: PMC6422884 DOI: 10.1042/bsr20182174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/15/2019] [Accepted: 02/25/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Lymphoma is a group of blood cell tumors which develop from lymphocytes. The main forms of lymphoma are Hodgkin lymphoma (HL) and non-HL (NHL). Cytokines may contribute to lymphoma and they are related to risk NHL and HL. Aim: Assessment of the serum level of certain inflammatory markers as complementary indicators to confirm diagnosis of lymphoma patients that may be subjected to more invasive biopsy methods. Method: The serum levels of interleukin (IL)-1β (IL-1β), IL-6, IL-10, tumor necrosis factor-α (TNF-α), monocyte chemotactic protein-1 (MCP-1), granulocyte colony-stimulating factor (G-CSF), and eotaxin were assessed by Bio-Plex Pro assays in 81 lymphoma patients and 44 NHL and 37 HL patients before and after chemotherapy treatment as well as 20 healthy persons as a control group. Results: Lymphoma patients showed significantly raised marker levels before treatment and significantly reduced levels related to pre-treatment and controls of post-treatment for most of the markers. MCP-1 reported the highest diagnostic accuracy. G-CSF significantly raised pre-treatment and TNF-α. MCP-1 significantly increased in post treated HL compared with NHL. In order to distinguish HL from NHL, G-CSF reported the highest diagnostic accuracy. NHL patients reported complete remission (CR) and those who reported stable disease (SD) and progressive disease (PD) represented 25% and 38% respectively compared with 16% and 27% of HL patients, while partial remission (PR) of HL patients were 56% compared with 36% of NHL patients. Conclusion: Most of the markers were significantly increased in pre-treatment but significantly decreased post-treatment. However, it was not considerably enough to get better prognosis of the disease. Elevated serum levels of inflammatory markers correlate with disease severity and low benefit from treatment.
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23
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Bolukbasi Y, Sezen D, Saglam Y, Selek U. Lymphoma. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-97145-2_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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24
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Zhang T, Yao Y, Feng F, Zhao W, Tian J, Zhou C, Wang X, Dong S, Li J, Qi L, Sun C. Comparative effectiveness of different chemotherapy regimens of advanced-stage Hodgkin lymphoma in adults: a network meta-analysis. Cancer Manag Res 2018; 10:6017-6028. [PMID: 30538551 PMCID: PMC6257076 DOI: 10.2147/cmar.s179356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Combined chemotherapy is the cornerstone treatment for patients with advanced Hodgkin lymphoma (HL). The objective of our study was to perform a network meta-analysis of the efficacy of different chemotherapy regimens in adults with advanced-stage HL. Materials and methods We searched for relevant randomized controlled trials (RCTs) in titles/abstracts in PubMed, Embase, and the Cochrane Library. The search was last updated on April 3, 2018. RCTs that assessed the effectiveness of one of the following treatments were included: doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD); four cycles of increased dose of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPescalated) followed by two or four cycles of standard dose of BEACOPP (4× BEACOPPescalated + 2 or 4× BEACOPPbaseline); brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine (A+AVD); doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone combined with radiation therapy (Stanford V); mechlorethamine (cyclophosphamide), vincristine, procarbazine, and prednisone (M[C] OPP); sequential or alternating chemotherapy regimens with ABVD as the footstone (eg, COPP/ABVD or mechlorethamine, vincristine, procarbazine, and prednisone [MOPP]/ABVD); eight cycles of BEACOPPescalated; hybrid MOPP/ABV; and M[C]EC (M[C]OPP with epidoxorubicin, bleomycin, vinblastine [EBV], and lomustine, doxorubicin, and vindesine [CAD]). Results Overall, we screened 3,564 citations and deemed 18 reports of 16 trials eligible and included them in our network meta-analysis. A total of 11,928 participants were randomly assigned to one of the 12 combinations of chemotherapy regimens, of which 11,476 participants were analyzed. For the overall survival (OS), no differences were observed within any interventions when the ABVD regimen was used as the reference treatment. Similarly, relative to A+AVD, 8× BEACOPPescalated and 6× BEACOPPescalated also showed no differences (HR =1.07, 95% credible interval (CrI): 0.58–1.95; HR =0.62, 95% CrI: 0.16–1.83; and HR =0.71, 95% CrI: 0.30–1.72, respectively). In terms of complete remission (CR), enough evidence exists to support a maximum clinical treatment effect for 6× BEACOPPescalated (OR =1.88, 95% CrI: 1.20–2.96; and OR =3.43, 95% CrI: 1.87–6.24). Conclusion When compared across the 12 combined chemotherapy regimens, six cycles of BEACOPPescalated may be the optimal treatment for patients with advanced-stage HL.
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Affiliation(s)
- Tingting Zhang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, People's Republic of China
| | - Yan Yao
- Clinical Medical College, Weifang Medical University, Weifang, Shandong Province, People's Republic of China
| | - Fubin Feng
- Department of Oncology, Weifang Traditional Chinese Hospital, Weifang, Shandong Province, People's Republic of China,
| | - Wenge Zhao
- Clinical Medical College, Weifang Medical University, Weifang, Shandong Province, People's Republic of China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu Province, People's Republic of China
| | - Chao Zhou
- Department of Oncology, Weifang Traditional Chinese Hospital, Weifang, Shandong Province, People's Republic of China,
| | - Xue Wang
- Clinical Medical Colleges, Qingdao University, Shinan District, Qingdao, Shandong Province, People's Republic of China
| | - Shengjie Dong
- Department of the Joint and Bone Surgery, Yantaishan Hospital, Yantai, Shandong Province, People's Republic of China
| | - Jia Li
- Clinical Medical College, Weifang Medical University, Weifang, Shandong Province, People's Republic of China
| | - Lingyu Qi
- College of First Clinical Medicine, Shandong University of Traditional Chinese Medicine, Ji'nan, People's Republic of China
| | - Changgang Sun
- Department of Oncology, Weifang Traditional Chinese Hospital, Weifang, Shandong Province, People's Republic of China, .,Department of Oncology, Affiliated Hospital of Weifang Medical University, Kuiwen District, Weifang, Shandong Province, People's Republic of China,
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25
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Tomassetti S, Herrera AF. Update on the role of brentuximab vedotin in classical Hodgkin lymphoma. Ther Adv Hematol 2018; 9:261-272. [PMID: 30210755 DOI: 10.1177/2040620718786833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/12/2018] [Indexed: 12/11/2022] Open
Abstract
Brentuximab vedotin (BV) is an effective and well-tolerated treatment for patients with classical Hodgkin lymphoma (HL). It was initially approved by the US FDA for the treatment of HL after failure of autologous hematopoietic stem cell transplant (autoHSCT) or after failure of at least two prior lines of multiagent chemotherapy in patients who are not transplant candidates, and then subsequently, as consolidation therapy after autoHSCT in patients who are at high risk for relapse. However, the role of BV in the treatment of HL is evolving. BV has shown promising efficacy as a salvage treatment in the second-line setting prior to autoHSCT. Most recently, the ECHELON-1 trial demonstrated that BV combined with AVD for the treatment of newly diagnosed advanced stage HL improved modified progression-free survival (mPFS) compared with standard ABVD. Based on these results, the US FDA has approved BV as part of the initial treatment of advanced stage HL. With the approval of BV as front-line therapy, depending on how widely the use of BV plus AVD is adopted, the role of BV in the treatment of patients with relapsed or refractory (rel/ref) HL may need to be redefined. BV retreatment can be effective, and studies of rational BV-based combination regimens may help to improve response rates and overcome BV resistance. Furthermore, BV has been demonstrated to be effective in the initial treatment of elderly or unfit patients, and ongoing studies are evaluating the addition of BV to initial chemotherapy in patients with early stage HL.
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Affiliation(s)
- Sarah Tomassetti
- Division of Hematology and Medical Oncology, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, 1500 E Duarte Road, Duarte, CA 91010, USA
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26
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Spinner MA, Advani RH, Connors JM, Azzi J, Diefenbach C. New Treatment Algorithms in Hodgkin Lymphoma: Too Much or Too Little? Am Soc Clin Oncol Educ Book 2018; 38:626-636. [PMID: 30231319 DOI: 10.1200/edbk_200679] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Hodgkin lymphoma treatment continues to evolve as new means of assessing response to treatment, new appreciation of important risk factors, and more effective therapeutic agents become available. Treatment algorithms integrating functional imaging now provide the opportunity to modify therapy during its delivery, allowing adjustment of duration and intensity of chemotherapy and rationale identification of patients who may benefit from the addition of therapeutic irradiation. Novel agents, including the antibody drug conjugate brentuximab vedotin and checkpoint inhibitors such as nivolumab and pembrolizumab can improve the effectiveness of treatment while keeping toxicity within acceptable limits. Carefully designed clinical trials permit the identification of superior approaches in which efficacy is enhanced and toxicity minimized. Clinicians treating patients with Hodgkin lymphoma now have access to novel treatment approaches, which will require detailed assessment of each patient and careful discussion of the goals and risks of treatment at the time of planning primary treatment, again during delivery of that treatment as data indicating ongoing effectiveness become available, at the conclusion of initial intervention, and, when the need arises, at the time of recurrence of disease.
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Affiliation(s)
- Michael A Spinner
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Ranjana H Advani
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Joseph M Connors
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Jacques Azzi
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
| | - Catherine Diefenbach
- From the Department of Medicine, Division of Oncology, Stanford University, Stanford, CA; BC Cancer Centre for Lymphoid Cancer and University of British Columbia, Vancouver, BC, Canada; Perlmutter Cancer Center at NYU Langone Health, New York, NY
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27
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Ansell SM. Hodgkin lymphoma: 2018 update on diagnosis, risk-stratification, and management. Am J Hematol 2018; 93:704-715. [PMID: 29634090 DOI: 10.1002/ajh.25071] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW Hodgkin lymphoma (HL) is an uncommon B-cell lymphoid malignancy affecting 8500 new patients annually and representing approximately 10.2% of all lymphomas in the United States. DIAGNOSIS HL is composed of two distinct disease entities: classical HL and nodular lymphocyte predominant HL. Nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte-rich HL are subgroups of classical HL. RISK STRATIFICATION An accurate assessment of the stage of disease in patients with HL is critical for the selection of the appropriate therapy. Prognostic models that identify patients at low or high risk for recurrence, as well as the response to therapy as determined by positron emission tomography scan, are used to optimize therapy. RISK-ADAPTED THERAPY Initial therapy for HL patients is based on the histology of the disease, the anatomical stage and the presence of poor prognostic features. Patients with early stage disease are typically treated with combined modality strategies utilizing abbreviated courses of combination chemotherapy followed by involved-field radiation therapy, while those with advanced stage disease receive a longer course of chemotherapy often without radiation therapy. Newer agents including brentuximab vedotin are now being incorporated into frontline therapy and these new combinations are becoming a standard of care. MANAGEMENT OF RELAPSED/REFRACTORY DISEASE High-dose chemotherapy (HDCT) followed by an autologous stem cell transplant (ASCT) is the standard of care for most patients who relapse following initial therapy. For patients who fail HDCT with ASCT, brentuximab vedotin, PD-1 blockade, nonmyeloablative allogeneic transplant or participation in a clinical trial should be considered.
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28
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Balancing risk and benefit in early-stage classical Hodgkin lymphoma. Blood 2018; 131:1666-1678. [DOI: 10.1182/blood-2017-10-772665] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/07/2018] [Indexed: 01/23/2023] Open
Abstract
Abstract
With defined chemotherapy and radiotherapy (RT) and risk-adapted treatment, early-stage classical Hodgkin lymphoma (HL) has become curable in a majority of patients. Hence, a major current goal is to reduce treatment-related toxicity while maintaining long-term disease control. Patients with early-stage favorable disease (ie, limited stage without risk factors [RFs]) are frequently treated with 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (2×ABVD) followed by 20-Gy involved-field or involved-site RT (IF/ISRT). In patients with early-stage unfavorable disease (ie, limited stage with RFs), 4 cycles of chemotherapy are usually consolidated with 30-Gy IF/ISRT. Compared with 4×ABVD, 2 cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (2×BEACOPPescalated) followed by 2×ABVD improved 5-year progression-free survival (PFS), with similar 5-year overall survival. Recently, treatment strategies based on [18F]fluorodeoxyglucose positron emission tomography (PET) response were evaluated. In early-stage unfavorable HL, a majority of patients achieved a negative interim PET after 2×ABVD and an excellent outcome after 4×ABVD, whereas in those with a positive interim PET, 2×BEACOPPescalated improved 5-year PFS. Furthermore, a PET-guided RT approach was evaluated to decrease long-term toxicity. Although both the RAPID and H10 trials reported poorer disease control without RT, PET-guided omission of RT can constitute a valid therapeutic option in patients with an increased risk of RT-associated toxicity (eg, because of sex, age, or disease localization). Implementation of drugs such as the anti-CD30 antibody-drug conjugate brentuximab vedotin or the anti–programmed death 1 antibodies nivolumab or pembrolizumab might allow further reduction of overall mortality and improve quality of life in affected patients.
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29
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Pinnix CC, Wirth A, Milgrom SA, Andraos TY, Aristophanous M, Pham M, Hancock D, Ludmir EB, Gunther JR, Fanale MA, Oki Y, Nastoupil L, Chuang HH, Mikhaeel NG, Dabaja BS. Omitting cardiophrenic lymph nodes in the treatment of patients with Hodgkin lymphoma via modified involved-site radiation therapy. Leuk Lymphoma 2018; 59:2650-2659. [PMID: 29616834 DOI: 10.1080/10428194.2018.1452211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Cardiophrenic lymph nodes (CPLNs) are occasionally involved in Hodgkin lymphoma (HL). We characterized the incidence of CPLN involvement among 169 HL patients and evaluated outcomes after treatment with omission of the CPLN region from the involved-site radiation therapy (ISRT) field. Three types of RT fields were used: standard (S)-ISRT, reduced-dose (RD)-ISRT (lower dose to CPLNs, standard to other sites), or modified (M)-ISRT (omission of CPLNs). CPLNs were involved at diagnosis in 29 patients (17%). Of the 20 patients who received RT after complete response to chemotherapy, 4(20%) received S-ISRT, 8(40%) RD-ISRT, and 8(40%) M-ISRT. The four-year progression-free survival was 94.7%. One relapse occurred at a non-CPLN site after RD-ISRT. The mean heart dose and volume of the heart that received 25 Gy was higher for S-ISRT patients compared to M-ISRT (p = .043 and p = .025, respectively). Re-planning the M-ISRT cases as S-ISRT resulted in significant increase in cardiac doses.
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Affiliation(s)
- Chelsea C Pinnix
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Andrew Wirth
- b Department of Radiation Oncology , Peter MacCallum Cancer Institute , Melbourne , Australia
| | - Sarah A Milgrom
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Therese Y Andraos
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Michalis Aristophanous
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Mary Pham
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Donald Hancock
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Ethan B Ludmir
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Jillian R Gunther
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Michelle A Fanale
- c Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Yasuhiro Oki
- c Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Loretta Nastoupil
- c Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Hubert H Chuang
- d Department of Nuclear Medicine , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - N George Mikhaeel
- e Department of Clinical Oncology , Guy's and St. Thomas' Hospital , London , UK
| | - Bouthaina S Dabaja
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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30
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Tavakoli MB, Maleki M, Akhavan A, Hadisinia T, Abedi I, Amouheidari A. Comparison and Evaluation of Different Treatment Plans with IFRT Field and 6 and 18 MV Energies in Hodgkin's Lymphoma Involvement Neck and Mediastinum. J Biomed Phys Eng 2018; 8:65-72. [PMID: 29732341 PMCID: PMC5928312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/18/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Radiotherapy with large mantle field is an effective technique in increasing the risk of secondary cancers among HL (Hodgkin Lymphoma) patients; therefore, it is essential to choose an effective treatment field including the least medical conditions in radiotherapy. OBJECTIVE The present study aimed to plan separate fields for neck and mediastinum using various energies, to compare dose distribution with MLC and to block field formation. MATERIALS AND METHODS In this study, 3D conformal treatments, Siemens Oncor accelerator equipped with multi-leaf collimator (MLC) were performed to create anterior-posterior fields. CT-scan data of 18 female patients with neck and mediastinal involvement was imported in TIGRT treatment planning system, and then treatment plans were introduced. RESULTS AND CONCLUSION Using treatment plan 1, photon 6 MV in neck weighting 1 from interior, 0.5 from posterior, photon 18MV in mediastinum weighting 1 from interior and 0.5 from posterior, it was shown that regarding the common treatment plan used with photon 6 MV, mean dose delivered to breast, lung, esophagus and larynx reduced 6, 7, 41 and 10 percent, respectively and uniformity index improved by 10 percent. Using block compared to MLC in all treatment plans offered improved average dose in all organs under study. To protect breast and lung while using MLC and block in the first treatment plan seemed to be more appropriate; however, using blocks in comparison to MLC increased delivered mean dose in all organs under study. Using separate fields with Pb blocks, though, showed smaller increase.
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Affiliation(s)
- M B Tavakoli
- Professor, Department of Medical Physics and Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Maleki
- M.Sc., Department of Medical Physics and Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Akhavan
- Assistant Professor, Department of Radiation-Oncology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - T Hadisinia
- Ph.D. Student, Department of Medical Physics and Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - I Abedi
- Ph.D. Student, Department of Medical Physics and Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Amouheidari
- Oncologist, Department of Radiation Oncology, Isfahan Milad Hospital, Isfahan, Iran
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Villani F, Busia A, Villani M, Vismara C, Viviani S, Bonfante V. Serum Cytokine in Response to Chemo-Radiotherapy for Hodgkin's Disease. TUMORI JOURNAL 2018; 94:803-8. [DOI: 10.1177/030089160809400605] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Mediastinal radiotherapy and multiple-drug chemotherapy, including bleomycin employed in the treatment of Hodgkin's disease, can produce lung toxicity leading to fibrosis. There is increasing evidence of the involvement in the fibrosing process of different cytokines and growth factors such as TNF-alfa, IL-1 beta, TGF-beta and PDGF. Material and Methods In a pilot study, we evaluated lung function in 20 patients suffering from Hodgkin's disease, mainly in stage II A, submitted to multiple-drug chemotherapy including bleomycin (ABVD) and mediastinal radiotherapy and correlated its modifications with serum concentration of the cytokines determined by immunoenzymatic assay. Spirometry and transfer lung function for carbon monoxide (DLCO) were performed before, at the end of chemotherapy, at the end of radiotherapy and after a follow-up of 6 and 12 months. Results DLCO decreased at the end of the combined treatment and then remained constantly decreased. TNF-alfa, TGF-beta and PDGF-alfa concentrations did not change, whereas IL-1 beta significantly increased after the completion of the combined treatment and after a follow-up of 6–months and then declined to normal values after 12 months. The serum concentration of the cytokine was significantly higher in patients who had a DLCO <75% of predicted after 1 year than in patients with a DLCO >75%. Conclusions The results indicate a potential role of IL-1 beta in the pathogenesis of chemoradiotherapy-induced lung toxicity, which needs to be confirmed in a larger patient population.
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Affiliation(s)
- Fabrizio Villani
- UO di Pneumologia e Fisiopatologia Respiratoria, Istituto Nazionale Tumori, Milan, Italy
| | - Alessandra Busia
- UO di Pneumologia e Fisiopatologia Respiratoria, Istituto Nazionale Tumori, Milan, Italy
| | - Massimiliano Villani
- UO di Pneumologia e Fisiopatologia Respiratoria, Istituto Nazionale Tumori, Milan, Italy
| | - Chiara Vismara
- UO Analisi Clinica e Microbiologia, Istituto Nazionale Tumori, Milan, Italy
| | - Simonetta Viviani
- UO Oncologia Medica, Fondazione IRCCS, Istituto Nazionale Tumori, Milan, Italy
| | - Valeria Bonfante
- UO Oncologia Medica, Fondazione IRCCS, Istituto Nazionale Tumori, Milan, Italy
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Constine LS, Yahalom J, Ng AK, Hodgson DC, Wirth A, Milgrom SA, Mikhaeel NG, Eich HT, Illidge T, Ricardi U, Dieckmann K, Moskowitz CH, Advani R, Mauch PM, Specht L, Hoppe RT. The Role of Radiation Therapy in Patients With Relapsed or Refractory Hodgkin Lymphoma: Guidelines From the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys 2018; 100:1100-1118. [PMID: 29722655 DOI: 10.1016/j.ijrobp.2018.01.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/18/2017] [Accepted: 01/02/2018] [Indexed: 02/02/2023]
Abstract
Relapsed and refractory Hodgkin lymphoma (HL) challenges clinicians to devise treatment strategies that are effective and safe. This problem is particularly prominent in an era when de-escalation trials are designed to minimize therapeutic toxicities in both early- and advanced-stage disease. Radiation therapy is the single most effective treatment modality for HL, and its integration into salvage regimens, or its independent use in select patients, must be understood to maximize our success in treating these patients. The complexity of treating relapsed or refractory HL derives from the spectrum of primary treatment approaches currently in use that creates heterogeneity in both treatment exposure and the potential toxicities of salvage therapy. Patients can have relapsed or refractory disease after limited or aggressive primary therapy (with or without radiation therapy), at early or delayed time points, with limited or extensive disease volumes, and with varying degrees of residual morbidity from primary therapy. Their response to salvage systemic therapy can be partial or complete, and the use of consolidative stem cell transplantation is variably applied. New biologics and immunotherapeutic approaches have broadened but also complicated salvage treatment approaches. Through all of this, radiation therapy remains an integral component of treatment for many patients, but it must be used effectively and judiciously. The purpose of this review is to describe the different treatment scenarios and provide guidance for radiation dose, volume, and timing in patients with relapsed or refractory HL.
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Affiliation(s)
- Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York; Department of Pediatrics, University of Rochester Medical Center, Rochester, New York.
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrea K Ng
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - David C Hodgson
- Department of Radiation Oncology, University of Toronto and Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - Andrew Wirth
- Division of Radiation Oncology, Peter MacCallum Cancer Institute, East Melbourne, Australia
| | - Sarah A Milgrom
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - N George Mikhaeel
- Department of Clinical Oncology, Guy's Cancer Centre and King's College London University, London, UK
| | - Hans Theodor Eich
- Department of Radiation Oncology, University of Münster, Münster, Germany
| | - Tim Illidge
- Division of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester, UK
| | - Umberto Ricardi
- Radiation Oncology Unit, Department of Oncology, University of Torino, Torino, Italy
| | - Karin Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Craig H Moskowitz
- Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ranjana Advani
- Department of Medicine, Division of Medical Oncology, Stanford University, Stanford, California
| | - Peter M Mauch
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts; Died September 8, 2017
| | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Richard T Hoppe
- Department of Radiation Oncology, Stanford University, Stanford, California
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Eichenauer DA, Becker I, Monsef I, Chadwick N, de Sanctis V, Federico M, Fortpied C, Gianni AM, Henry-Amar M, Hoskin P, Johnson P, Luminari S, Bellei M, Pulsoni A, Sydes MR, Valagussa P, Viviani S, Engert A, Franklin J. Secondary malignant neoplasms, progression-free survival and overall survival in patients treated for Hodgkin lymphoma: a systematic review and meta-analysis of randomized clinical trials. Haematologica 2017; 102:1748-1757. [PMID: 28912173 PMCID: PMC5622859 DOI: 10.3324/haematol.2017.167478] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/19/2017] [Indexed: 11/29/2022] Open
Abstract
Treatment intensification to maximize disease control and reduced intensity approaches to minimize the risk of late sequelae have been evaluated in newly diagnosed Hodgkin lymphoma. The influence of these interventions on the risk of secondary malignant neoplasms, progression-free survival and overall survival is reported in the meta-analysis herein, based on individual patient data from 9498 patients treated within 16 randomized controlled trials for newly diagnosed Hodgkin lymphoma between 1984 and 2007. Secondary malignant neoplasms were meta-analyzed using Peto’s method as time-to-event outcomes. For progression-free and overall survival, hazard ratios derived from each trial using Cox regression were combined by inverse-variance weighting. Five study questions (combined-modality treatment vs. chemotherapy alone; more extended vs. involved-field radiotherapy; radiation at higher doses vs. radiation at 20 Gy; more vs. fewer cycles of the same chemotherapy protocol; standard-dose chemotherapy vs. intensified chemotherapy) were investigated. After a median follow-up of 7.4 years, dose-intensified chemotherapy resulted in better progression-free survival rates (P=0.007) as compared with standard-dose chemotherapy, but was associated with an increased risk of therapy-related acute myeloid leukemia/myelodysplastic syndromes (P=0.0028). No progression-free or overall survival differences were observed between combined-modality treatment and chemotherapy alone, but more secondary malignant neoplasms were seen after combined-modality treatment (P=0.010). For the remaining three study questions, outcomes and secondary malignancy rates did not differ significantly between treatment strategies. The results of this meta-analysis help to weigh up efficacy and secondary malignancy risk for the choice of first-line treatment for Hodgkin lymphoma patients. However, final conclusions regarding secondary solid tumors require longer follow-up.
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Affiliation(s)
- Dennis A Eichenauer
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), University Hospital Cologne, Germany
| | - Ingrid Becker
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany
| | - Ina Monsef
- Cochrane Haematological Malignancies Group, First Department of Internal Medicine, University Hospital Cologne, Germany
| | | | | | | | - Catherine Fortpied
- European Organisation of Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | | | - Michel Henry-Amar
- Centre de Traitement des Données du Cancéropôle Nord-Ouest, Centre François Baclesse, Caen, France
| | | | - Peter Johnson
- Cancer Research UK Centre, University of Southampton, UK
| | | | - Monica Bellei
- University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Pulsoni
- Cellular Biotechnology and Hematology Department, University "La Sapienza", Rome, Italy
| | - Matthew R Sydes
- Medical Research Council (MRC), Clinical Trials Unit at University College London (UCL), UK
| | | | | | - Andreas Engert
- First Department of Internal Medicine and German Hodgkin Study Group (GHSG), University Hospital Cologne, Germany
| | - Jeremy Franklin
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany
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Franklin J, Eichenauer DA, Becker I, Monsef I, Engert A. Optimisation of chemotherapy and radiotherapy for untreated Hodgkin lymphoma patients with respect to second malignant neoplasms, overall and progression-free survival: individual participant data analysis. Cochrane Database Syst Rev 2017; 9:CD008814. [PMID: 28901021 PMCID: PMC6483617 DOI: 10.1002/14651858.cd008814.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Efficacy and the risk of severe late effects have to be well-balanced in treatment of Hodgkin lymphoma (HL). Late adverse effects include secondary malignancies which often have a poor prognosis. To synthesise evidence on the risk of secondary malignancies after current treatment approaches comprising chemotherapy and/or radiotherapy, we performed a meta-analysis based on individual patient data (IPD) from patients treated for newly diagnosed HL. OBJECTIVES We investigated several questions concerning possible changes in the risk of secondary malignancies when modifying chemotherapy or radiotherapy (omission of radiotherapy, reduction of the radiation field, reduction of the radiation dose, use of fewer chemotherapy cycles, intensification of chemotherapy). We also analysed whether these modifications affect progression-free survival (PFS) and overall survival (OS). SEARCH METHODS We searched MEDLINE and Cochrane CENTRAL trials databases comprehensively in June 2010 for all randomised trials in HL since 1984. Key international trials registries were also searched. The search was updated in March 2015 without collecting further IPD (one further eligible study found) and again in July 2017 (no further eligible studies). SELECTION CRITERIA We included randomised controlled trials (RCTs) for untreated HL patients which enrolled at least 50 patients per arm, completed recruitment by 2007 and performed a treatment comparison relevant to our objectives. DATA COLLECTION AND ANALYSIS Study groups submitted IPD, including age, sex, stage and the outcomes secondary malignant neoplasm (SMN), OS and PFS as time-to-event data. We meta-analysed these data using Petos method (SMN) and Cox regression with inverse-variance pooling (OS, PFS) for each of the five study questions, and performed subgroup and sensitivity analyses to assess the applicability and robustness of the results. MAIN RESULTS We identified 21 eligible trials and obtained IPD for 16. For four studies no data were supplied despite repeated efforts, while one study was only identified in 2015 and IPD were not sought. For each study question, between three and six trials with between 1101 and 2996 participants in total and median follow-up between 6.7 and 10.8 years were analysed. All participants were adults and mainly under 60 years. Risk of bias was assessed as low for the majority of studies and outcomes. Chemotherapy alone versus same chemotherapy plus radiotherapy. Omitting additional radiotherapy probably reduces secondary malignancy incidence (Peto odds ratio (OR) 0.43, 95% confidence interval (CI) 0.23 to 0.82, low quality of evidence), corresponding to an estimated reduction of eight-year SMN risk from 8% to 4%. This decrease was particularly true for secondary acute leukemias. However, we had insufficient evidence to determine whether OS rates differ between patients treated with chemotherapy alone versus combined-modality (hazard ratio (HR) 0.71, 95% CI 0.46 to 1.11, moderate quality of evidence). There was a slightly higher rate of PFS with combined modality, but our confidence in the results was limited by high levels of statistical heterogeneity between studies (HR 1.31, 95% CI 0.99 to 1.73, moderate quality of evidence). Chemotherapy plus involved-field radiation versus same chemotherapy plus extended-field radiation (early stages) . There is insufficient evidence to determine whether smaller radiation field reduces SMN risk (Peto OR 0.86, 95% CI 0.64 to 1.16, low quality of evidence), OS (HR 0.89, 95% C: 0.70 to 1.12, high quality of evidence) or PFS (HR 0.99, 95% CI 0.81 to 1.21, high quality of evidence). Chemotherapy plus lower-dose radiation versus same chemotherapy plus higher-dose radiation (early stages). There is insufficient evidence to determine the effect of lower-radiation dose on SMN risk (Peto OR 1.03, 95% CI 0.71 to 1.50, low quality of evidence), OS (HR 0.91, 95% CI 0.65 to 1.28, high quality of evidence) or PFS (HR 1.20, 95% CI 0.97 to 1.48, high quality of evidence). Fewer versus more courses of chemotherapy (each with or without radiotherapy; early stages). Fewer chemotherapy courses probably has little or no effect on SMN risk (Peto OR 1.10, 95% CI 0.74 to 1.62), OS (HR 0.99, 95% CI 0.73 to1.34) or PFS (HR 1.15, 95% CI 0.91 to 1.45).Outcomes had a moderate (SMN) or high (OS, PFS) quality of evidence. Dose-intensified versus ABVD-like chemotherapy (with or without radiotherapy in each case). In the mainly advanced-stage patients who were treated with intensified chemotherapy, the rate of secondary malignancies was low. There was insufficient evidence to determine the effect of chemotherapy intensification (Peto OR 1.37, CI 0.89 to 2.10, low quality of evidence). The rate of secondary acute leukemias (and for younger patients, all secondary malignancies) was probably higher than among those who had treatment with standard-dose ABVD-like protocols. In contrast, the intensified chemotherapy protocols probably improved PFS (eight-year PFS 75% versus 69% for ABVD-like treatment, HR 0.82, 95% CI 0.7 to 0.95, moderate quality of evidence). Evidence suggesting improved survival with intensified chemotherapy was not conclusive (HR: 0.85, CI 0.70 to 1.04), although escalated-dose BEACOPP appeared to lengthen survival compared to ABVD-like chemotherapy (HR 0.58, 95% CI 0.43 to 0.79, moderate quality of evidence).Generally, we could draw valid conclusions only in terms of secondary haematological malignancies, which usually occur less than 10 years after initial treatment, while follow-up within the present analysis was too short to record all solid tumours. AUTHORS' CONCLUSIONS The risk of secondary acute myeloid leukaemia and myelodysplastic syndrome (AML/MDS) is increased but efficacy is improved among patients treated with intensified chemotherapy protocols. Treatment decisions must be tailored for individual patients. Consolidating radiotherapy is associated with an increased rate of secondary malignancies; therefore it appears important to define which patients can safely be treated without radiotherapy after chemotherapy, both for early and advanced stages. For early stages, treatment optimisation methods such as use of fewer chemotherapy cycles and reduced field or reduced-dose radiotherapy did not appear to markedly affect efficacy or secondary malignancy risk. Due to the limited amount of long-term follow-up in this meta-analysis, further long-term investigations of late events are needed, particularly with respect to secondary solid tumours. Since many older studies have been included, possible improvement of radiotherapy techniques must be considered when interpreting these results.
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Affiliation(s)
- Jeremy Franklin
- University Hospital of CologneInstitute of Medical Statistics, Informatics and EpidemiologyKerpener Str. 62CologneGermany50937
| | - Dennis A. Eichenauer
- University Hospital of CologneDepartment I of Internal Medicine, Center of Integrated Oncology Köln BonnCologneGermany50924
| | - Ingrid Becker
- University Hospital of CologneInstitute of Medical Statistics, Informatics and EpidemiologyKerpener Str. 62CologneGermany50937
| | - Ina Monsef
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Andreas Engert
- University Hospital of CologneDepartment I of Internal MedicineKerpener Str. 62CologneGermany50924
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Abstract
This topic addresses the treatment of newly diagnosed patients with favorable prognosis stage I and II Hodgkin lymphoma. In most cases, combined modality therapy (chemotherapy followed by involved site radiation therapy) constitutes the current standard of care. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. By combining the most recent medical literature and expert opinion, this revised guideline can aid clinicians in the appropriate use of combined modality therapy for favorable prognosis stage I and II Hodgkin lymphoma. Increasing information about the late effects of treatment has led to attempts to decrease toxicity by using less chemotherapy (decreased duration and/or intensity or different agents) and less radiation therapy (reduced volume and/or dose) while maintaining excellent efficacy.
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Kirova Y, Horn S, Chen JY. Évolution des techniques d’irradiation pour la prise en charge de la maladie de Hodgkin : histoire et avenir. Cancer Radiother 2017. [DOI: 10.1016/j.canrad.2017.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ozuah NW, LaCasce AS. How to Approach a Patient With Limited Stage Hodgkin Lymphoma Who Remains PET Positive at the End of Chemotherapy: Radiation Therapy? CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:710-715. [PMID: 28711575 DOI: 10.1016/j.clml.2017.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
Abstract
The use of 18-F fluorodeoxyglucose (FDG) positron emission tomography (PET) with computed tomography has emerged as a crucial tool for response-adapted therapy in Hodgkin lymphoma (HL). Although more studies have focused on the predictive value of an interim or early PET obtained after 2 cycles of chemotherapy, there are indications that the end of therapy PET might even be more predictive of outcome. The optimal treatment of patients with limited stage HL who are PET-positive after chemotherapy is unknown. Here we review the prognostic significance of end of treatment PET in early stage HL, the role of consolidative radiotherapy in patients who have FDG-PET avidity at the end of chemotherapy, and discuss the place of salvage chemotherapy and autologous transplantation in these patients.
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Affiliation(s)
- Nmazuo W Ozuah
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Ann S LaCasce
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
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Petroccia H, Mendenhall N, Liu C, Hammer C, Culberson W, Thar T, Mitchell T, Li Z, Bolch W. A hybrid phantom Monte Carlo-based method for historical reconstruction of organ doses in patients treated with cobalt-60 for Hodgkin's lymphoma. Phys Med Biol 2017; 62:6261-6289. [PMID: 28714462 DOI: 10.1088/1361-6560/aa7c2f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Historical radiotherapy treatment plans lack 3D images sets required for estimating mean organ doses to patients. Alternatively, Monte Carlo-based models of radiotherapy devices coupled with whole-body computational phantoms can permit estimates of historical in-field and out-of-field organ doses as needed for studies associating radiation exposure and late tissue toxicities. In recreating historical patient treatments with 60Co based systems, the major components to be modeled include the source capsule, surrounding shielding layers, collimators (both fixed and adjustable), and trimmers as needed to vary field size. In this study, a computational model and experimental validation of the Theratron T-1000 are presented. Model validation is based upon in-field commissioning data collected at the University of Florida, published out-of-field data from the British Journal of Radiology (BJR) Supplement 25, and out-of-field measurements performed at the University of Wisconsin's Accredited Dosimetry Calibration Laboratory (UWADCL). The computational model of the Theratron T-1000 agrees with central axis percentage depth dose data to within 2% for 6 × 6 to 30 × 30 cm2 fields. Out-of-field doses were found to vary between 0.6% to 2.4% of central axis dose at 10 cm from field edge and 0.42% to 0.97% of central axis dose at 20 cm from the field edge, all at 5 cm depth. Absolute and relative differences between computed and measured out-of-field doses varied between ±2.5% and ±100%, respectively, at distances up to 60 cm from the central axis. The source-term model was subsequently combined with patient-morphometry matched computational hybrid phantoms as a method for estimating in-field and out-of-field organ doses for patients treated for Hodgkin's Lymphoma. By changing field size and position, and adding patient-specific field shaping blocks, more complex historical treatment set-ups can be to recreated, particularly those for which 2D or 3D image sets are unavailable.
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Affiliation(s)
- Heather Petroccia
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States of America
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Melatonin and Fertoprotective Adjuvants: Prevention against Premature Ovarian Failure during Chemotherapy. Int J Mol Sci 2017; 18:ijms18061221. [PMID: 28590419 PMCID: PMC5486044 DOI: 10.3390/ijms18061221] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 12/22/2022] Open
Abstract
Premature ovarian failure is one of the side effects of chemotherapy in pre-menopausal cancer patients. Preservation of fertility has become increasingly important in improving the quality of life of completely recovered cancer patients. Among the possible strategies for preserving fertility such as ovarian tissue cryopreservation, co-treatment with a pharmacological adjuvant is highly effective and poses less of a burden on the human body. Melatonin is generally produced in various tissues and acts as a universally acting antioxidant in cells. Melatonin is now more widely used in various biological processes including treating insomnia and an adjuvant during chemotherapy. In this review, we summarize the information indicating that melatonin may be useful for reducing and preventing premature ovarian failure in chemotherapy-treated female patients. We also mention that many adjuvants other than melatonin are developed and used to inhibit chemotherapy-induced infertility. This information will give us novel insights on the clinical use of melatonin and other agents as fertoprotective adjuvants for female cancer patients.
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Abstract
Hematological malignancies manifest as lymphoma, leukemia, and myeloma, and remain a burden on society. From initial therapy to endless relapse-related treatment, societal burden is felt not only in the context of healthcare cost, but also in the compromised quality of life of patients. Long-term therapeutic strategies have become the standard in keeping hematological malignancies at bay as these cancers develop resistance to each round of therapy with time. As a result, there is a continual need for the development of new drugs to combat resistant disease in order to prolong patient life, if not to produce a cure. This review aims to summarize advances in targeting lymphoma, leukemia, and myeloma through both cutting-edge and well established platforms. Current standard of treatment will be reviewed for these malignancies and emphasis will be made on new therapy development in the areas of antibody engineering, epigenetic small molecule inhibiting drugs, vaccine development, and chimeric antigen receptor cell engineering. In addition, platforms for the delivery of these and other drugs will be reviewed including antibody-drug conjugates, micro- and nanoparticles, and multimodal hydrogels. Lastly, we propose that tissue engineered constructs for hematological malignancies are the missing link in targeted drug discovery alongside mouse and patient-derived xenograft models.
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Rimner A, Lovie S, Hsu M, Chelius M, Zhang Z, Chau K, Moskowitz AJ, Matasar M, Moskowitz CH, Yahalom J. Accelerated Total Lymphoid Irradiation-containing Salvage Regimen for Patients With Refractory and Relapsed Hodgkin Lymphoma: 20 Years of Experience. Int J Radiat Oncol Biol Phys 2017; 97:1066-1076. [PMID: 28332991 PMCID: PMC5474094 DOI: 10.1016/j.ijrobp.2017.01.222] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/03/2017] [Accepted: 01/23/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE We report the long-term results of integrated accelerated involved field radiation therapy (IFRT) followed by total lymphoid irradiation (TLI) as part of the high-dose salvage regimen followed by autologous bone marrow transplantation or autologous stem cell transplantation in patients with relapsed or refractory Hodgkin lymphoma (HL). METHODS AND MATERIALS From November 1985 to July 2008, 186 previously unirradiated patients with relapsed or refractory HL underwent salvage therapy on 4 consecutive institutional review board-approved protocols. All patients had biopsy-proven primary refractory or relapsed HL. After standard-dose salvage chemotherapy (SC), accelerated IFRT (18-20 Gy) was given to relapsed or refractory sites, followed by TLI (15-18 Gy) and high-dose chemotherapy. Overall survival (OS) and event-free survival (EFS) were analyzed by Cox analysis and disease-specific survival (DSS) by competing-risk regression. RESULTS With a median follow-up period of 57 months among survivors, 5- and 10-year OS rates were 68% and 56%, respectively; 5- and 10-year EFS rates were 62% and 56%, respectively; and 5- and 10-year cumulative incidences of HL-related deaths were 21% and 29%, respectively. On multivariate analysis, complete response to SC was independently associated with improved OS and EFS. Primary refractory disease and extranodal disease were independently associated with poor DSS. Eight patients had grade 3 or higher cardiac toxicity, with 3 deaths. Second malignancies developed in 10 patients, 5 of whom died. CONCLUSIONS Accelerated IFRT followed by TLI and high-dose chemotherapy is an effective, feasible, and safe salvage strategy for patients with relapsed or refractory HL with excellent long-term OS, EFS, and DSS. Complete response to SC is the most important prognostic factor.
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Affiliation(s)
- Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shona Lovie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meier Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Monica Chelius
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Karen Chau
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison J Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew Matasar
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Craig H Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
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The Pathobiology and Treatment of Hodgkin Lymphoma. Where do We go from Gianni Bonadonna's Lesson? TUMORI JOURNAL 2017; 103:101-113. [DOI: 10.5301/tj.5000608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 01/18/2023]
Abstract
This article reviews the evolution of the diagnosis and treatment of Hodgkin lymphoma (HL) since its discovery in 1832. The morphological, phenotypic and molecular characteristics of both nodular lymphocyte-predominant HL and classical HL are revised in the light of recent molecular information and possible impact on the identification of risk groups as well as the use of targeted therapies. The seminal contribution of Gianni Bonadonna to developing new treatment strategies for both advanced and early-stage HL is highlighted.
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Herst J, Crump M, Baldassarre F, MacEachern J, Sussman J, Hodgson D, Cheung M. Management of Early-stage Hodgkin Lymphoma: A Practice Guideline. Clin Oncol (R Coll Radiol) 2017; 29:e5-e12. [DOI: 10.1016/j.clon.2016.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/28/2016] [Accepted: 08/02/2016] [Indexed: 10/20/2022]
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Yao S, Li J, Yao Z, Xu Y, Chu J, Zhang J, Jin S, Huang Y, Zhang J, Ma J, Zhao Y, Yang S, Liu Y. Extranodal involvement in young patients with diffuse large B-cell lymphoma: distribution, prognostic value and treatment options. Chin J Cancer Res 2017; 29:57-65. [PMID: 28373754 PMCID: PMC5348476 DOI: 10.21147/j.issn.1000-9604.2017.01.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Extranodal involvement represents a peculiar presentation of diffuse large B-cell lymphoma (DLBCL). Previous studies have suggested that older patients are more prone to extranodal involvement. This study retrospectively addressed the distribution, prognostic value and treatment options of extranodal involvement in young patients with DLBCL. METHODS A total of 329 patients were enrolled according to the inclusion requirements. The effects of gender, extranodal involvement, age-adjusted international prognostic index (aaIPI), rituximab infusion and radiotherapy on patient outcomes were evaluated. RESULTS Among these patients, 59% presented extranodal involvement in 16 anatomic sites. More than one instance was linked to many poorer clinical characteristics and poorer survival compared with either nodal disease or one instance. In patients with one extranodal lesion, multivariate analysis revealed that the site of extranodal involvement, but not the aaIPI or rituximab infusion, was independently related to the outcome, and radiotherapy had a negative influence on survival. CONCLUSIONS Extranodal involvement is common in younger patients and exhibits a ubiquitous distribution. The site of extranodal involvement is of strong prognostic significance. Radiotherapy for extranodal lesions does not improve patient outcomes.
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Affiliation(s)
- Shuna Yao
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Junbo Li
- Department of Internal Medicine, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China
| | - Zhihua Yao
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Yuanlin Xu
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Junfeng Chu
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Jiuyang Zhang
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Shuiling Jin
- Department of Internal Medicine, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China
| | - Yangyang Huang
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Jianbo Zhang
- Department of Pathology, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Jie Ma
- Department of Pathology, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Yan Zhao
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Shujun Yang
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Yanyan Liu
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
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Diefenbach CS, Connors JM, Friedberg JW, Leonard JP, Kahl BS, Little RF, Baizer L, Evens AM, Hoppe RT, Kelly KM, Persky DO, Younes A, Kostakaglu L, Bartlett NL. Hodgkin Lymphoma: Current Status and Clinical Trial Recommendations. J Natl Cancer Inst 2016; 109:2742050. [PMID: 28040700 DOI: 10.1093/jnci/djw249] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/24/2016] [Accepted: 09/26/2016] [Indexed: 12/12/2022] Open
Abstract
The National Clinical Trials Network lymphoid malignancies Clinical Trials Planning Meeting (CTPM) occurred in November of 2014. The scope of the CTPM was to prioritize across the lymphoid tumors clinically significant questions and to foster strategies leading to biologically informed and potentially practice changing clinical trials. This review from the Hodgkin lymphoma (HL) subcommittee of the CTPM discusses the ongoing clinical challenges in HL, outlines the current standard of care for HL patients from early to advanced stage, and surveys the current science with respect to biomarkers and the landscape of ongoing clinical trials. Finally, we suggest areas of unmet need in HL and elucidate promising therapeutic strategies to guide future HL clinical trials planning across the NCTN.
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Affiliation(s)
- Catherine S Diefenbach
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Joseph M Connors
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Jonathan W Friedberg
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - John P Leonard
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Brad S Kahl
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Richard F Little
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Lawrence Baizer
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Andrew M Evens
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Richard T Hoppe
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Kara M Kelly
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Daniel O Persky
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Anas Younes
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Lale Kostakaglu
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
| | - Nancy L Bartlett
- Affiliations of authors: NYU Perlmutter Cancer Center, New York, NY (CSD); BC Cancer Agency Centre for Lymphoid Cancer, Vancouver, BC, Canada (JMC); Wilmot Cancer Center and Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY (JWF); Department of Medicine, Weil Cornell University, New York, NY (JPL); Oncology Division, Department of Medicine, Washington University, St. Louis, MO (BSK, NLB); Division of Cancer Treatment and Diagnosis (RFL) and Coordinating Center for Clinical Trials (LB), Tufts Cancer Center and Division of Hematology/Oncology, Tufts University School of Medicine, Boston, MA (AME); Stanford Cancer Institute, Stanford University Medical School, Stanford, CA (RTH); Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY (KMK); Department of Medicine, University of Arizona Cancer Center, Tucson, AZ (DOP); Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY (AY); Department of Radiology, Mount Sinai Hospital, New York, NY (LK)
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Dorri Giv M, Bahreini Toosi MH, Aghamiri SMR, Akbari F, Taeb S. Calculation of Thyroid Dose with Planner System and Evaluation of Thyroid Function after Radiotherapy for Patients with Breast Cancer. J Biomed Phys Eng 2016; 6:220-234. [PMID: 28144591 PMCID: PMC5219573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 10/26/2015] [Indexed: 06/06/2023]
Abstract
BACKGROUND Much research has widely been conducted into thyroid hormones levels following radiotherapy for breast cancer. Consequently, in this study, we evaluated to relate the rate of thyroid hormones levels with the dose distribution among breast cancer patients. MATERIAL AND METHODS Thirty patients were treated with 4-field breast cancer radiotherapy. The dose volume histograms, the volume percentage of the thyroid absorbing respectively 20, 30, 40 and 50 Gy were then estimated (V20, V30, V40 and V50) together with the individual average thyroid dose over the whole gland derived from their computed tomography-based treatment plans. Then, in serum samples triiodothyronine [T3], thyroxine [T4], thyroid-stimulating hormone [TSH] of the patients were measured before and after radiotherapy. RESULTS There were no significant differences in thyroid hormones levels before and after radiotherapy for patients with breast cancer (P value >.05). CONCLUSION On the balance, we understood that thyroid stimulating hormones levels did not change before and after cancer breast radiotherapy.
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Affiliation(s)
- M Dorri Giv
- Radiology and Radiotherapy Department, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M H Bahreini Toosi
- Medical Physics Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - S M R Aghamiri
- Radiology and Radiotherapy Department, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F Akbari
- Medical Physics Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - S Taeb
- MSc of Radiation Biology and Orotection, Shiraz University of Medical Science, Shiraz, Iran
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Dorri Giv M, Bahreini Toosi M, Aghamiri S, Akbari F, Taeb S. Calculation of Thyroid Dose with Planner System and Evaluation of Thyroid Function after Radiotherapy for Patients with Breast Cancer. J Biomed Phys Eng 2016; 6:229-234. [PMID: 28144592 PMCID: PMC5251202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 10/26/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Much research has widely been conducted into thyroid hormones levels following radiotherapy for breast cancer. Consequently, in this study, we evaluated to relate the rate of thyroid hormones levels with the dose distribution among breast cancer patients. MATERIAL AND METHODS Thirty patients were treated with 4-field breast cancer radiotherapy. The dose volume histograms, the volume percentage of the thyroid absorbing respectively 20, 30, 40 and 50 Gy were then estimated (V20, V30, V40 and V50) together with the individual average thyroid dose over the whole gland derived from their computed tomography-based treatment plans. Then, in serum samples triiodothyronine [T3], thyroxine [T4], thyroid-stimulating hormone [TSH] of the patients were measured before and after radiotherapy. RESULTS There were no significant differences in thyroid hormones levels before and after radiotherapy for patients with breast cancer (P value >.05). CONCLUSION On the balance, we understood that thyroid stimulating hormones levels did not change before and after cancer breast radiotherapy.
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Affiliation(s)
- M. Dorri Giv
- Radiology and Radiotherapy Department, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M.H. Bahreini Toosi
- Medical Physics Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - S.M.R. Aghamiri
- Radiology and Radiotherapy Department, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F. Akbari
- Medical Physics Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - S. Taeb
- MSc of Radiation Biology and Orotection, Shiraz University of Medical Science, Shiraz, Iran
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Secondary Breast Cancer Risk by Radiation Volume in Women With Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2016; 97:35-41. [PMID: 27979454 DOI: 10.1016/j.ijrobp.2016.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/12/2016] [Accepted: 10/04/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine whether the risk of secondary breast cancer (SBC) is reduced in women with Hodgkin lymphoma (HL) treated with smaller field radiation therapy (SFRT) versus mantle field radiation therapy (MRT). METHODS AND MATERIALS We used the BC Cancer Agency (BCCA) Lymphoid Cancer Database to identify female patients treated for HL between January 1961 and December 2009. Radiation therapy volumes were categorized as MRT or SFRT, which included involved field, involved site, or involved nodal radiation therapy. SBC risk estimates were compared using competing risk analysis and Fine and Gray multivariable model: MRT ± chemotherapy, SFRT ± chemotherapy, or chemotherapy-only. RESULTS Of 734 eligible patients, 75% of the living patients have been followed up for more than 10 years, SBC has developed in 54, and 15 have died of breast cancer. The 20-year estimated risks (competing risk cumulative incidence) for SBC differed significantly: MRT 7.5% (95% confidence interval [CI] 4.4%-11.5%), SFRT 3.1% (95% CI 1.0%-7.7%), and chemotherapy-only 2.2% (95% CI 1.0%-4.8%) (P=.01). Using a Fine and Gray model to control for death and patients lost to follow-up, MRT was associated with a higher risk of SBC (hazard ratio [HR] = 2.9; 95% CI 1.4%-6.0%; P=.004) compared with chemotherapy-only and with SFRT (HR = 3.3; 95% CI 1.3%-8.4%; P=.01). SFRT was not associated with a greater risk of SBC compared with chemotherapy-only (HR = 0.87; 95% CI 0.28%-2.66%; P=.80). CONCLUSION This study confirms that large-volume MRT is associated with a markedly increased risk of SBC; however, more modern small-volume RT is not associated with a greater risk of SBC than chemotherapy alone.
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ACR Appropriateness Criteria® Hodgkin Lymphoma—Unfavorable Clinical Stage I and II. Am J Clin Oncol 2016; 39:384-95. [DOI: 10.1097/coc.0000000000000294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Krebs L, Amorin S, Brice P, Guillerm S, Menard J, Hennequin C, Quéro L. Analyses of patterns-of-failure and prognostic factors according to radiation fields in early-stage Hodgkin lymphoma. Strahlenther Onkol 2016; 193:116-124. [PMID: 27316376 DOI: 10.1007/s00066-016-0969-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/09/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Doses and volumes of radiation therapy (RT) for early stages of Hodgkin lymphoma (HL) have been reduced over the last 30 years. Combined modality therapy (CMT) is currently the standard treatment for most patients with early-stage HL. The aim of this study was to analyze the site of relapse after RT according to the extent of radiation fields. PATIENTS AND METHODS Between 1987 and 2011, 427 patients were treated at our institution with RT ± chemotherapy for stage-I/II HL. Among these, 65 patients who experienced a relapse were retrospectively analyzed. Most patients had nodular sclerosis histology (86 %) and stage-II disease (75.9 %). Bulky disease was present in 21 % and 56 % of patients belonged to the unfavorable risk group according to European Organization for Research and Treatment of Cancer (EORTC)/The Lymphoma Study Association (LYSA) definitions. CMT was delivered to 91 % of patients. All patients received RT with doses ranging from 20 to 45 Gy (mean = 34 ± 5.3 Gy). The involved-field RT technique was used in 59 % of patients. RESULTS The mean time between diagnosis and relapse was 4.2 years (range 0.3-24.5). Out-of-field relapses were suffered by 53 % of patients. Relapses occurred more frequently at out-of-field sites in patients with a favorable disease status, whereas in-field relapses were associated with bulky mediastinal disease. Relapses occurred later for favorable compared with the unfavorable risk group (3.5 vs. 2.9 years, p = 0.5). From multivariate analyses, neither RT dose nor RT field size were predictive for an in-field relapse (p = 0.25 and p = 0.8, respectively), only bulky disease was predictive (p = 0.018). CONCLUSION In patients with bulky disease, RT dose and RT field size were not predictive for an in-field relapse. In this subgroup of patients, chemotherapy should be intensified. We confirmed the bad prognosis of early relapses.
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Affiliation(s)
- Lorraine Krebs
- Radiation Oncology Department, Saint Louis Hospital, 1, Avenue Claude Vellefaux, 75010, Paris, France
| | - Sandy Amorin
- Hematooncology Department, Saint Louis Hospital, AP-HP, Paris, France
| | - Pauline Brice
- Hematooncology Department, Saint Louis Hospital, AP-HP, Paris, France
| | - Sophie Guillerm
- Radiation Oncology Department, Saint Louis Hospital, 1, Avenue Claude Vellefaux, 75010, Paris, France
| | - Jean Menard
- Radiation Oncology Department, Saint Louis Hospital, 1, Avenue Claude Vellefaux, 75010, Paris, France
| | - Christophe Hennequin
- Radiation Oncology Department, Saint Louis Hospital, 1, Avenue Claude Vellefaux, 75010, Paris, France
| | - Laurent Quéro
- Radiation Oncology Department, Saint Louis Hospital, 1, Avenue Claude Vellefaux, 75010, Paris, France.
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