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De Re V, Lopci E, Brisotto G, Elia C, Mussolin L, Mascarin M, d’Amore ESG. Preliminary Study of the Relationship between Osteopontin and Relapsed Hodgkin's Lymphoma. Biomedicines 2023; 12:31. [PMID: 38275392 PMCID: PMC10813762 DOI: 10.3390/biomedicines12010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/27/2024] Open
Abstract
The primary objective of this study was to investigate the potential role of tissue osteopontin, also known as secreted phosphoprotein 1 (SPP1), as a contributing factor to an unfavorable prognosis in classical Hodgkin's lymphoma (HL) patients who received the same treatment protocol. The study involved 44 patients aged 4-22 years, with a median follow-up period of 3 years. Patients with higher levels of SPP1 were associated with tissue necrosis and inflammation, and there was a trend toward a poorer prognosis in this group. Before therapy, we found a correlation between positron emission tomography (PET) scans and logarithmic SPP1 levels (p = 0.035). However, the addition of SPP1 levels did not significantly enhance the predictive capacity of PET scans for recurrence or progression. Elevated SPP levels were associated with tissue mRNA counts of chemotactic and inflammatory chemokines, as well as specific monocyte/dendritic cell subtypes, defined by IL-17RB, PLAUR, CXCL8, CD1A, CCL13, TREM1, and CCL24 markers. These findings contribute to a better understanding of the potential factors influencing the prognosis of HL patients and the potential role of SPP1 in the disease. While the predictive accuracy of PET scans did not substantially improve during the study, the results underscore the complexity of HL and highlight the relationships between SPP1 and other factors in the context of HL relapse.
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Affiliation(s)
- Valli De Re
- Immunopatologia e Biomarcatori Oncologici, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, 33081 Aviano, Italy
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS—Humanitas Research Hospital, Rozzano, 20089 Milano, Italy
| | - Giulia Brisotto
- Immunopatologia e Biomarcatori Oncologici, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, 33081 Aviano, Italy
| | - Caterina Elia
- AYA Oncology and Pediatric Radiotherapy Unit, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, 33081 Aviano, Italy
| | - Lara Mussolin
- Pediatric Hemato-Oncology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padua, Italy
- Clinica di Oncoematologia Pediatrica, Azienda Ospedaliera—Università di Padova, 35128 Padova, Italy
| | - Maurizio Mascarin
- AYA Oncology and Pediatric Radiotherapy Unit, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, 33081 Aviano, Italy
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De Re V, Repetto O, Mussolin L, Brisotto G, Elia C, Lopci E, d’Amore ESG, Burnelli R, Mascarin M. Promising drugs and treatment options for pediatric and adolescent patients with Hodgkin lymphoma. Front Cell Dev Biol 2022; 10:965803. [PMID: 36506094 PMCID: PMC9729954 DOI: 10.3389/fcell.2022.965803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Currently-available therapies for newly-diagnosed pediatric and adolescent patients with Hodgkin lymphoma result in >95% survival at 5 years. Long-term survivors may suffer from long-term treatment-related side effects, however, so the past 20 years have seen clinical trials for children and adolescents with HL gradually abandon the regimens used in adults in an effort to improve this situation. Narrower-field radiotherapy can reduce long-term toxicity while maintaining good tumor control. Various risk-adapted chemo-radiotherapy strategies have been used. Early assessment of tumor response with interim positron emission tomography and/or measuring metabolic tumor volume has been used both to limit RT in patients with favorable characteristics and to adopt more aggressive therapies in patients with a poor response. Most classical Hodgkin's lymphoma relapses occur within 3 years of initial treatment, while relapses occurring 5 years or more after diagnosis are rare. As the outcome for patients with relapsed/refractory classical Hodgkin lymphoma remains unsatisfactory, new drugs have been proposed for its prevention or treatment. This review summarizes the important advances made in recent years in the management of pediatric and adolescent with classical Hodgkin lymphoma, and the novel targeted treatments for relapsed and refractory classical Hodgkin lymphoma.
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Affiliation(s)
- Valli De Re
- Immunopatologia e Biomarcatori Oncologici, Dipartimento di Ricerca e Diagnostica Avanzata dei Tumori, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, Aviano, Italy,*Correspondence: Valli De Re, ; Maurizio Mascarin,
| | - Ombretta Repetto
- Immunopatologia e Biomarcatori Oncologici, Dipartimento di Ricerca e Diagnostica Avanzata dei Tumori, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, Aviano, Italy
| | - Lara Mussolin
- Pediatric Hemato-Oncology Unit, Department of Women’s and Children’s Health, University of Padua, Padua, Italy
| | - Giulia Brisotto
- Immunopatologia e Biomarcatori Oncologici, Dipartimento di Ricerca e Diagnostica Avanzata dei Tumori, CRO Aviano, National Cancer Institute, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, Aviano, Italy
| | - Caterina Elia
- AYA Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico IRCCS, Aviano, Italy
| | - Egesta Lopci
- Nuclear Medicine, IRCCS—Humanitas Research Hospital, Rozzano, MI, Italy
| | | | - Roberta Burnelli
- Pediatric Hematology-Oncology Unit, Azienda Ospedaliera Universitaria, Ospedale Sant’Anna, Ferrara, Italy
| | - Maurizio Mascarin
- AYA Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico IRCCS, Aviano, Italy,*Correspondence: Valli De Re, ; Maurizio Mascarin,
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3
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Massano D, Carraro E, Mussolin L, Buffardi S, Barat V, Zama D, Muggeo P, Vendemini F, Sau A, Moleti ML, Verzegnassi F, D'Amico S, Casini T, Garaventa A, Schiavello E, Cellini M, Vinti L, Farruggia P, Perruccio K, Cesaro S, De Santis R, Marinoni M, D'Alba I, Mura RM, Burnelli R, Mascarin M, Pillon M. Brentuximab vedotin in the treatment of paediatric patients with relapsed or refractory Hodgkin's lymphoma: Results of a real-life study. Pediatr Blood Cancer 2022; 69:e29801. [PMID: 35656841 DOI: 10.1002/pbc.29801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/22/2022] [Accepted: 05/06/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Brentuximab vedotin (BV) is an antibody drug-conjugated anti-CD30 approved for the treatment of adult classical Hodgkin's lymphoma (HL), whereas it is considered as off-label indication in paediatrics. The aim of the study was to evaluate the safety and efficacy of BV to treat patients aged less than 18 years with refractory/relapsed HL. MATERIALS AND METHODS In this multicentre, retrospective study, 68 paediatric patients who received at least one dose of BV between November 2011 and August 2020 were enrolled. A median of nine doses of BV were administered as monotherapy (n = 31) or combined with other therapies (n = 37). BV was administrated alone as consolidation therapy after stem cell transplantation (SCT) in 12 patients, before SCT in 18 patients, whereas in 15 patients it was used before and after SCT as consolidation therapy. Median follow-up was 2.8 years (range: 0.6-8.9 years). RESULTS The best response was observed in the 86% of patients; the overall response rate was 66%. The 3-year progression-free survival was 58%, whereas the overall survival was 75%. No statistically significant differences between patients treated with BV monotherapy or combination were highlighted. In multivariate analysis, patients with non-nodular sclerosis HL and not transplanted had an increased risk of failure. Overall, 46% of patients had grade 3-4 adverse events that led to BV discontinuation in five of them. CONCLUSION In conclusion, our study confirms that BV was a safe and effective drug, able to induce complete remission, either as monotherapy or in association with standard therapy.
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Affiliation(s)
- Davide Massano
- Paediatric Hematology, Oncology and Stem Cell Transplant Division, Padova University Hospital, Padua, Italy
| | - Elisa Carraro
- Paediatric Hematology, Oncology and Stem Cell Transplant Division, Padova University Hospital, Padua, Italy
| | - Lara Mussolin
- Maternal and Child Health Department, Padova University Hospital, Padua, Italy.,Istituto di Ricerca Pediatrica Città della Speranza, Padua, Italy
| | - Salvatore Buffardi
- Paediatric Haemato-Oncology Department, Santobono-Pausilipon Children's Hospital, Napoli, Italy
| | - Veronica Barat
- Paediatric Onco-Hematology and Stem Cell Transplant Division, City of Health and Science, Regina Margherita Children's Hospital, Torino, Italy
| | - Daniele Zama
- Department of Paediatrics, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Paola Muggeo
- Department of Paediatric Oncology and Hematology, University Hospital of Policlinico, Bari, Italy
| | - Francesca Vendemini
- Department of Paediatrics, Ospedale San Gerardo, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Antonella Sau
- Paediatric Hematology-Oncology Unit, Ospedale Civico, Pescara, Italy
| | - Maria Luisa Moleti
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | | | - Salvatore D'Amico
- Department of Clinical and Experimental Medicine, Paediatric Haemato-Oncology Unit, University of Catania, Catania, Italy
| | - Tommaso Casini
- Paediatric Haematology-Oncology Unit, Meyer Paediatric Hospital, Florence, Italy
| | - Alberto Garaventa
- Paediatric Oncology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elisabetta Schiavello
- Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Paediatric Oncology Unit, Milan, Italy
| | - Monica Cellini
- Department of Paediatrics, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Luciana Vinti
- Department of Paediatric Hematology and Oncology, IRCSS Ospedale Bambino Gesù, Rome, Italy
| | - Piero Farruggia
- Paediatric Hematology and Oncology Unit, Oncology Department, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
| | - Katia Perruccio
- Paediatric Hematology-Oncology Unit, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Simone Cesaro
- Paediatric Hematology Oncology Unit, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Raffaela De Santis
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Maddalena Marinoni
- Paediatric Department, Hospital 'F. Del Ponte', University of Insubria, Varese, Italy
| | - Irene D'Alba
- Division of Paediatric Hematology and Oncology, Ospedale G. Salesi, Ancona, Italy
| | - Rosa Maria Mura
- Paediatric Hematology and Oncology Unit, Ospedale Pediatrico Microcitemico, Cagliari, Italy
| | - Roberta Burnelli
- Paediatric Hemato-Oncology Unit, Azienda Ospedaliero Universitaria Sant'Anna di Ferrara, Ferrara, Italy
| | - Maurizio Mascarin
- AYA Oncology and Paediatric Radiotherapy Unit, CRO-Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Marta Pillon
- Paediatric Hematology, Oncology and Stem Cell Transplant Division, Padova University Hospital, Padua, Italy
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4
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Vinti L, Pagliara D, Buffardi S, Di Ruscio V, Stocchi F, Mariggiò E, Parasole R, Di Matteo A, Petruzziello F, Paganelli V, De Vito R, Del Bufalo F, Strocchio L, Locatelli F. Brentuximab vedotin in combination with bendamustine in pediatric patients or young adults with relapsed or refractory Hodgkin lymphoma. Pediatr Blood Cancer 2022; 69:e29557. [PMID: 35107876 DOI: 10.1002/pbc.29557] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/29/2021] [Accepted: 12/18/2021] [Indexed: 01/07/2023]
Abstract
Although children and young adults with Hodgkin's lymphoma usually have a favorable prognosis, patients with primary refractory disease and some subsets of relapsed patients still have a dismal outcome. Brentuximab vedotin (BV) in combination with bendamustine may represent a suitable salvage therapy; data on 32 patients aged less than 25 years were retrospectively analyzed. Patients received up to six cycles of treatment of BV 1.8 mg/kg on day 1 and bendamustine 90-120 mg/m2 on days 2 and 3. At the end of treatment, the overall response rate was 81%. The 3-year overall and progression-free survivals are 78.1% and 67%, respectively.
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Affiliation(s)
- Luciana Vinti
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Daria Pagliara
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Salvatore Buffardi
- Department of Paediatric Haematology/Oncology, Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Valentina Di Ruscio
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Stocchi
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elena Mariggiò
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rosanna Parasole
- Department of Paediatric Haematology/Oncology, Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Antonia Di Matteo
- Department of Paediatric Haematology/Oncology, Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Fara Petruzziello
- Department of Paediatric Haematology/Oncology, Santobono Pausilipon Children's Hospital, Naples, Italy
| | - Valeria Paganelli
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rita De Vito
- Department of Pathology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Del Bufalo
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luisa Strocchio
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Franco Locatelli
- Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Pediatrics, Sapienza, University of Rome, Rome, Italy
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5
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Garaventa A, Parodi S, Guerrini G, Farruggia P, Sala A, Pillon M, Buffardi S, Rossi F, Bianchi M, Zecca M, Vinti L, Facchini E, Casini T, Bernasconi S, Amoroso L, D’Amico S, Provenzi M, De Santis R, Sau A, Muggeo P, Mura RM, Haupt R, Mascarin M, Burnelli R. Outcome of Children and Adolescents with Recurrent Classical Hodgkin Lymphoma: The Italian Experience. Cancers (Basel) 2022; 14:cancers14061471. [PMID: 35326622 PMCID: PMC8946075 DOI: 10.3390/cancers14061471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/04/2022] [Accepted: 03/11/2022] [Indexed: 02/01/2023] Open
Abstract
The objective of this study was to identify prognostic factors for children and adolescents with relapsed or progressive classical Hodgkin’s lymphoma (cHL) to design salvage therapy tailored to them. We analyzed a homogeneous pediatric population, diagnosed with progressive/relapsed cHL previously enrolled in two subsequent protocols of the Italian Association of Pediatric Hematology and Oncology in the period 1996−2016. There were 272 eligible patients, 17.5% of treated patients with cHL. Overall survival (OS) and event-free survival (EFS) after a 10-year follow-up were 65.3% and 53.3%, respectively. Patients with progressive disease (PD), advanced stage at recurrence, and ≥5 involved sites showed a significantly worse OS. PD, advanced stage, and extra-nodal involvement at recurrence were significantly associated with a poorer EFS. Multivariable analysis identified three categories for OS based on the type of recurrence and number of localizations: PD and ≥5 sites: OS 34%; PD and <5 sites: OS 56.5%; relapses: OS 73.6%. Four categories were obtained for EFS based on the type of recurrence and stage: PD and stage 3−4: EFS 25.5%; PD and stage 1−2: EFS 43%; relapse and stage 3−4: EFS 55.4%; relapse and stage 1−2: EFS 72.1%. Patients with PD, in advanced stage, or with ≥5 involved sites had a very poor survival and they should be considered refractory to first- and second-line standard chemotherapy. Probably, they should be considered for more innovative approaches since the first progression. Conversely, patients who relapsed later with localized disease had a better prognosis, and they could be considered for a conservative approach.
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Affiliation(s)
- Alberto Garaventa
- Paediatric Oncology Unit, IRCCS Istituto Giannina Gaslini, L.go G. Gaslini 5, 16147 Genova, Italy; (A.G.); (L.A.)
| | - Stefano Parodi
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, L.go G. Gaslini 5, 16147 Genova, Italy; (S.P.); (R.H.)
| | - Giulia Guerrini
- UOC Pediatria e Neonatologia, Grosseto USL-Toscana Sud-Est, Via Senese, 58100 Grosseto, Italy;
| | - Piero Farruggia
- Paediatric Haematology and Oncology Unit, A.R.N.A.S. Civic Hospital, Piazza Leotta Nicola 4, 90127 Palermo, Italy;
| | - Alessandra Sala
- Department of Paediatrics, Ospedale San Gerardo, University of Milano-Bicocca, Fondazione MBBM, Via Cadore, 20900 Monza, Italy;
| | - Marta Pillon
- Dipartimento di Oncoematologia Pediatrica, Università di Padova, Via Gattamelata 5687, 35128 Padova, Italy;
| | - Salvatore Buffardi
- Paediatric Haemato-Oncology Department, Santobono-Pausilipon Children’s Hospital, Via Mario Fiore 6, 80129 Naples, Italy;
| | - Francesca Rossi
- Dipartimento di Pediatria II Ateneo di Napoli, Servizio di Oncologia Pediatrica, Via Luigi De Crecchio 2, 80138 Naples, Italy;
| | - Maurizio Bianchi
- Pediatric Onco-Hematology and Stem Cell Transplant Division, City of Health and Science, Regina Margherita Children’s Hospital, Piazza Polonia 94, 10126 Turin, Italy;
| | - Marco Zecca
- Oncoematologia Pediatrica, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy;
| | - Luciana Vinti
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children’s Hospital, Piazza di Sant’Onofrio 4, 00165 Rome, Italy;
| | - Elena Facchini
- Pediatric Oncology and Hematology Unit “LallaSeràgnoli”, Department of Pediatrics, University of Bologna, Sant’Orsola Malpighi Hospital, Via Giuseppe Massarenti 9, 40138 Bologna, Italy;
| | - Tommaso Casini
- Division of Pediatric Oncology/Hematology, Meyer University Children’s Hospital, Via Gaetano Pieraccini 24, 50139 Florence, Italy;
| | - Sayla Bernasconi
- Pediatric Hematology Oncology, Bone Marrow Transplant, S. Chiara University Hospital of Pisa, Via Bonanno Pisano 93, 56126 Pisa, Italy;
| | - Loredana Amoroso
- Paediatric Oncology Unit, IRCCS Istituto Giannina Gaslini, L.go G. Gaslini 5, 16147 Genova, Italy; (A.G.); (L.A.)
| | - Salvatore D’Amico
- Paediatric Haemato-Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, Piazza Università 2, 95124 Catania, Italy;
| | - Massimo Provenzi
- Department of Pediatrics, Civic Hospital, Piazza OMS 1, 24127 Bergamo, Italy;
| | - Raffaela De Santis
- IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Viale Cappuccini, 47156 Foggia, Italy;
| | - Antonella Sau
- Pediatric Hematology-Oncology Unit, Ospedale Civico, Via Fonte Romana 8, 65124 Pescara, Italy;
| | - Paola Muggeo
- Department of Biomedicine of Developmental Age, University of Bari, Piazza Umberto I 1, 70121 Bari, Italy;
| | - Rosa Maria Mura
- Department of Paediatric Oncohaematology, Microcitemico Hospital, Via Edward Jenner 18, 09121 Cagliari, Italy;
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, L.go G. Gaslini 5, 16147 Genova, Italy; (S.P.); (R.H.)
| | - Maurizio Mascarin
- AYA Oncology and Pediatric Radiotherapy Unit, CRO-Centro di Riferimento Oncologico di Aviano, IRCCS Aviano, Via Franco Gallini 2, 33081 Aviano, Italy;
| | - Roberta Burnelli
- Pediatric Hemato-Oncology Unit, Azienda Ospedaliero Universitaria Sant’Anna di Ferrara, Cona, Via Aldo Moro, 44124 Ferrara, Italy
- Correspondence: ; Tel.: +39-0532-236601; Fax: +39-0532-239328
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6
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Kahn JM, Pei Q, Friedman DL, Kaplan J, Keller FG, Hodgson D, Wu Y, Appel BE, Bhatia S, Henderson TO, Schwartz CL, Kelly KM, Castellino SM. Survival by age in paediatric and adolescent patients with Hodgkin lymphoma: a retrospective pooled analysis of children's oncology group trials. Lancet Haematol 2022; 9:e49-e57. [PMID: 34971582 PMCID: PMC8815096 DOI: 10.1016/s2352-3026(21)00349-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Adolescents with Hodgkin lymphoma have worse disease outcomes than children. Whether these differences persist within clinical trials is unknown. We examined survival, by age, in patients receiving response-adapted therapy for Hodgkin lymphoma on Children's Oncology Group (COG) trials. METHODS Patients (aged 1-21 years) diagnosed with classical Hodgkin lymphoma and enrolled between Sept 23, 2002, and Jan 19, 2012, on one of three phase 3 COG trials in the USA and Canada were eligible for inclusion. The three COG trials were defined by risk group according to Ann Arbor stage, B-symptoms, and bulk (AHOD0431 [low risk; NCT00302003], AHOD0031 [intermediate risk; NCT00025259], or AHOD0831 [high risk; NCT01026220]). The outcomes of this study were event-free survival (death, relapse, or subsequent neoplasm) and overall survival. Cox proportional hazards models estimated survival, adjusting for disease and treatment factors both overall and in patients with mixed cellularity or non-mixed cellularity (nodular sclerosing and not-otherwise-specified) disease. FINDINGS Of 2155 patients enrolled on the three trials, 1907 (88·4%; 968 [50·8%] male and 939 [49·2%] female; 1227 [64·3%] non-Hispanic White) were included in this analysis. After a median follow-up of 7·4 years (IQR 4·3-10·2), older patients (aged ≥15 years) had worse unadjusted 5-year event-free survival (80% [95% CI 78-83]) than did younger patients (aged <15 years; 86% [83-88]; HR 1·38 [1·11-1·71]; p=0·0038). Older patients also had worse unadjusted 5-year overall survival than did younger patients (96% [95% CI 95-97] vs 99% [98-99]; HR 2·50 [1·41-4·45]; p=0·0012). In patients with non-mixed cellularity histology, older patients had a significantly increased risk of having an event than did younger patients with the same histology (HR 1·32 [1·03-1·68]; p=0·027). Older patients with mixed cellularity had significantly worse 5-year event-free survival than did younger patients in unadjusted (77% [95% CI 65-86] for older patients vs 94% [88-97] for younger patients; HR 2·93 [1·37-6·29]; p=0·0039) and multivariable models (HR 3·72 [1·56-8·91]; p=0·0032). Overall, older patients were more likely to die than younger patients (HR 3·08 [1·49-6·39]; p=0·0025). INTERPRETATION Adolescents (≥15 years) treated on COG Hodgkin lymphoma trials had worse event-free survival and increased risk of death compared with children (<15 years). Our findings highlight the need for prospective studies to examine tumour and host biology, and to test novel therapies across the age spectrum. FUNDING National Institutes of Health, St Baldrick's Foundation, and Lymphoma Research Foundation.
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Affiliation(s)
- Justine M Kahn
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.
| | - Qinglin Pei
- Department of Biostatistics, Children's Oncology Group Statistics & Data Center, Gainesville, FL, USA
| | - Debra L Friedman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics: Hematology and Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Joel Kaplan
- Levine Children's Cancer & Blood Disorders, Carolinas Medical Center, Charlotte, NC, USA
| | - Frank G Keller
- Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - David Hodgson
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Yue Wu
- Department of Biostatistics, Children's Oncology Group Statistics & Data Center, Gainesville, FL, USA
| | - Burton E Appel
- Children's Cancer Institute, Joseph M Sanzari Children's Hospital, Hackensack, NJ, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tara O Henderson
- University of Chicago Comer Children's Hospital, Chicago, IL, USA
| | - Cindy L Schwartz
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kara M Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Sharon M Castellino
- Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
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7
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Karalexi MA, Pourtsidis A, Panagopoulou P, Moschovi M, Polychronopoulou S, Kourti M, Hatzipantelis E, Stiakaki E, Dana H, Bouka P, Ntzani EE, Petridou ET. Overall and event-free survival of childhood lymphoma in Greece: analysis of harmonized clinical data over a 24-year active registration period. Leuk Lymphoma 2021; 62:2107-2119. [PMID: 34114936 DOI: 10.1080/10428194.2021.1907376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We assessed event-free (EFS) and overall (OS) survival in 676 incident cases of childhood Hodgkin (HL) and non-Hodgkin (NHL) lymphoma actively registered in Greece (1996-2019). HL-OS5-year was 96% and NHL-OS5-year 85%, whereas HL-EFS5-year was 86% and NHL-EFS5-year was 81%, notably similar to the respective OS rates (HL: 95%, NHL: 85%) in developed countries. For HL, older age at diagnosis, high maternal education and close proximity to treatment centers were linked to remarkably favorable outcomes. By contrast, stage IV patients showed worse OS and EFS. HL patients with low levels of hemoglobin were associated with worse EFS (hazard ratio: 2.81, 95% confidence intervals: 1.09-7.22). OS (76%) and EFS (73%) were poor among high-risk NHL patients and those with increased LDH (71%). The identified predictors of poor disease outcome point to the need for intensification of individualized treatments. Ongoing clinical cancer registration entailing clinical components could contribute to use of state-of-the-art treatments.
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Affiliation(s)
- Maria A Karalexi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Society for Social Pediatrics and Health Promotion, Athens, Greece
| | - Apostolos Pourtsidis
- Department of Pediatric Hematology-Oncology, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | | | - Maria Moschovi
- Pediatric Hematology/Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology-Oncology, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Maria Kourti
- Department of Pediatric Hematology and Oncology, Hippokration Hospital, Thessaloniki, Greece
| | - Emmanuel Hatzipantelis
- Hematology-Oncology Unit, 2nd Pediatric Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology, University of Crete, Heraklion, Greece
| | - Helen Dana
- Pediatric Hematology-Oncology Department, "Mitera" Children's Hospital, Athens, Greece
| | | | - Panagiota Bouka
- Hellenic Society for Social Pediatrics and Health Promotion, Athens, Greece
| | - Evangelia E Ntzani
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece.,Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Society for Social Pediatrics and Health Promotion, Athens, Greece
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