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Bjerring AW, Smeland KH, Stokke T, Haugaa KH, Holte E, Rösner A, Kiserud CE, Edvardsen T, Sarvari SI. Long-term cardiac effects of modern treatment for Hodgkin's lymphoma. Cardiooncology 2024; 10:19. [PMID: 38576044 PMCID: PMC10993441 DOI: 10.1186/s40959-024-00222-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/15/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Hodgkin's lymphoma (HL) is a hematological malignancy that affects both children and young adults. Traditional treatment is associated with a life-time prevalence of cardiac disease exceeding 50%. In the late 1990s protocols were modified to reduce cancer therapy-related adverse cardiac effects. This study aimed to assess the long-term impact of advances in treatment protocols on the cardiac health of HL survivors (HLS). METHODS HLS (n = 246) treated between 1997 and 2007 with anthracycline-based chemotherapy in three centers in Norway were included. Of these, 132 (53%) had also received mediastinal radiotherapy. HLS were compared to controls (n = 58) recruited from the general population and matched for sex, age, smoking status, and heredity for coronary artery disease. All subjects underwent echocardiography, clinical assessment, and blood sampling. RESULTS The HLS were 46 ± 9 years old and had been treated 17 ± 3 years before inclusion in the study. There was no significant difference between HLS and controls in ejection fraction (EF) (58%±5 vs. 59%±4, p = 0.08) or prevalence of heart failure. HLS treated with both anthracyclines and mediastinal radiotherapy (AC + MRT) had slightly worse left ventricular global longitudinal strain than controls (-19.3 ± 2.5% vs. -20.8 ± 2.0%, p < 0.001), but those treated with only anthracyclines did not. HLS treated with AC + MRT had a higher prevalence of valve disease than those treated only with anthracyclines (12% vs. 4%, p < 0.05). CONCLUSIONS HLS treated with anthracyclines after the late 1990s have similar cardiac function and morphology as age-matched controls, apart from higher rates of valvular disease in those who also underwent mediastinal radiotherapy.
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Affiliation(s)
- Anders W Bjerring
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo N-0027, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Knut Hb Smeland
- National advisory unit for late effects after cancer, Department of Oncology, Oslo University hospital, Oslo, Norway
| | - Thomas Stokke
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo N-0027, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristina H Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo N-0027, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Espen Holte
- Department of Circulation and Medical Imaging, Clinic of Cardiology, St. Olavs University Hospital, Norwegian University of Science and Technology, Trondheim, Norway
| | - Assami Rösner
- Cardiological Department, University Hospital North Norway, Tromsø, Norway
- Institute of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Cecilie E Kiserud
- National advisory unit for late effects after cancer, Department of Oncology, Oslo University hospital, Oslo, Norway
| | - Thor Edvardsen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo N-0027, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sebastian Imre Sarvari
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo N-0027, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
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Casey M, Odhiambo L, Aggarwal N, Shoukier M, Islam KM, Cortes J. Representation of the population in need for pivotal clinical trials in lymphomas. Blood 2023; 142:846-855. [PMID: 37363870 DOI: 10.1182/blood.2023020052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 06/28/2023] Open
Abstract
Despite the advances in cancer outcomes, significant health disparities persist. Several new agents have been recently approved for treatment of lymphomas, leading to improved outcomes. Extending the benefits of these new agents starts by adequate enrollment of all affected patient populations. This study aimed to evaluate the extent to which randomized controlled trials (RCTs) match the demographic and geographic diversity of the population affected by lymphoma. Two Food and Drug Administration databases, clinicaltrials.gov, and relevant primary manuscripts were reviewed for drug approval data and demographic representation in RCTs for classical Hodgkin lymphoma (cHL) and non-Hodgkin lymphoma. Maps showing the distribution and frequency of trial participation relative to disease burden, insurance status, and racial representation were created. Black, Hispanic, and female patients were significantly underrepresented in the RCTs for lymphoma compared with that for the disease burden (3.6% [95% confidence interval (CI), 2.8-5.4] vs 14.6% [95% CI, 13.8-15.3]; 6.7% [95% CI, 5.5-7.9] vs 16.3% [95% CI, 15.5-17.1]; and 39.1% [95% CI, 37.3-40.9] vs 42.7% [95% CI, 42.3-43.1], respectively). White and male patients were overrepresented. More counties with higher mortality rates and racial minority representation had low access to the trials, particularly for cHL in the southern region of the United States. There are significant racial misrepresentations in pivotal RCTs in the United States, and geographic distribution of these trials may not provide easy access to all patients in need. Disparities in enrollment should be corrected to make results applicable to all populations.
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Affiliation(s)
- Mycal Casey
- Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, GA
| | - Lorriane Odhiambo
- Institute of Public Health and Preventive Health, Augusta University, Augusta, GA
| | - Nidhi Aggarwal
- Medical College of Georgia at Augusta University, Augusta, GA
| | - Mahran Shoukier
- Division of Hematology and Oncology, Georgia Cancer Center at Augusta University, Augusta, GA
| | - K M Islam
- Institute of Public Health and Preventive Health, Augusta University, Augusta, GA
- Medical College of Georgia at Augusta University, Augusta, GA
| | - Jorge Cortes
- Division of Hematology and Oncology, Georgia Cancer Center at Augusta University, Augusta, GA
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Núñez-García B, Clemente MB, Sánchez JC, Royuela A, Ibargüen BCSD, Méndez M, López-Ibor JV, Martínez M, Traseira C, Garitaonaindia Y, Aguado R, Calvo V, Torrente M, Parejo C, Provencio Z, Provencio M. Long-term outcomes in Hodgkin lymphoma survivors. Temporary trends and comparison with general population. Hematol Oncol 2023; 41:407-414. [PMID: 36934306 DOI: 10.1002/hon.3131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/08/2023] [Indexed: 03/20/2023]
Abstract
The high cure rates of Hodgkin lymphoma (HL) make this oncological disease among those with the greatest number of long-term survivors. This single-institution study including 383 HL patients with up to 45 years of follow-up, analyses the morbidity and mortality of this population after treatments in comparison with the overall Spanish population, and investigates whether it has changed over time stratifying by periods of time, as a consequence of therapeutic optimization. The median age was 34.8 years (range 15-87) with median overall survival of 30 years, significantly higher in women (HR 0.58, 95% CI 0.42-0.79) (p = 0.0002). 185 late-stage diseases were noted (35% patients), cardiovascular disease (CVD) being the most frequent (23.2%). 30% of patients developed at least one second malignant neoplasm (SMN) to give a total of 174 SMNs. 20.9% of the patients died from HL and 67.0% died from non-HL causes (32.2% from SMN, 17% from CVD). The overall standardized mortality ratio (SMR) was 3.57 (95% CI: 3.0-4.2), with striking values of 7.73 (95% CI: 5.02-8.69) and of 14.75 (95% CI: 11.38-19.12) for women and patients <30 years at diagnosis, respectively. Excluding HL as the cause of death, the SMRs of those diagnosed before 2000 and from 2000 were proved to be similar (3.88 vs 2.73), maintaining in this last period an unacceptable excess of mortality due to secondary toxicity in patients cured of HL. Our study confirm that HL treatment substantially reduces the life expectancy of patients cured of HL. In recent periods, despite therapeutic optimization, deaths from toxicity continue to occur, mainly from CVD and SMN. Risk-factor monitoring should be intensified, prevention programs developed, and therapeutic optimization of LH investigated, especially in two vulnerable groups: those aged <30 years at diagnosis, and women.
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Affiliation(s)
- Beatriz Núñez-García
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | | | - Ana Royuela
- Biostatistics Unit, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA. CIBERESP, ISCIII, Madrid, Spain
| | | | - Miriam Méndez
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Marta Martínez
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Cristina Traseira
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Yago Garitaonaindia
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Ramón Aguado
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Virginia Calvo
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - María Torrente
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Consuelo Parejo
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Zaida Provencio
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Mariano Provencio
- Department of Medical Oncology, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
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Nabiałek-Trojanowska I, Jankowska H, Sławiński G, Dąbrowska-Kugacka A, Lewicka E. Echocardiographic Findings in Asymptomatic Mediastinal Lymphoma Survivors Years after Treatment Termination. J Clin Med 2023; 12:jcm12103427. [PMID: 37240533 DOI: 10.3390/jcm12103427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Patients treated due to mediastinal lymphomas are at risk of cardiovascular complications, as they receive chemotherapy, usually containing anthracyclines, often combined with thoracic radiotherapy. The aim of this prospective study was to assess early asymptomatic cardiac dysfunction using resting and dobutamine stress echocardiography (DSE) at least 3 years after the end of mediastinal lymphoma treatment. Two groups of patients were compared: those treated with chemoradiotherapy and those exclusively treated with chemotherapy. Left ventricular contractile reserve (LVCR) during DSE was assessed using changes in LV ejection fraction (LVEF), LV global longitudinal strain (LV GLS), and a novel parameter-Force, which is the ratio of the systolic blood pressure to the LV end-systolic volume. The study included 60 patients examined at a median of 89 months after the end of treatment. Resting echocardiography showed normal LVEF of 58.9 ± 9.6%, borderline LV GLS of -17.7 ± 3%, decreased mean stroke volume (SV) of 51.4 ± 17 mL, and indexed SV of 27.3 ± 8 mL/m2, and the right ventricular free wall longitudinal strain (LS) was impaired in some patients but not in all. There were no significant differences between the groups, with the exception of arterial hypertension, which was more common in the chemotherapy group (32% vs. 62.5%, p = 0.04). In resting echocardiography, only LV posterior wall LS differed significantly and was impaired in patients treated with chemotherapy (-19.1 ± 3.1% vs. -16.5 ± 5.1%, p = 0.04). DSE, performed in 21 patients after a median of 166 months from the end of cancer treatment, detected new contractility disorders in 1 patient (4.8%) and decreased LVCR in the majority of patients when determined using changes in LVEF or LV GLS, and in all patients when assessed with changes in Force. Conclusions: Most asymptomatic mediastinal lymphoma survivors showed preserved ventricular function on resting echocardiography. However, all of them showed impaired LV contractile reserve on DSE, as assessed with a simple parameter-Force. This may indicate subtle LV dysfunction and confirms the need for long-term monitoring of patients with potentially cardiotoxic cancer treatment.
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Affiliation(s)
- Izabela Nabiałek-Trojanowska
- First Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Hanna Jankowska
- Division of Cardiac Diagnostics, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Grzegorz Sławiński
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Alicja Dąbrowska-Kugacka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
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Bhurani D, Nair R, Rajappa S, Rao SA, Sridharan N, Boya RR, Raman GS, Menon H, Seshachalam A, Nimmagadda R. Real-World Outcomes of Hodgkin Lymphoma: A Multi-Centric Registry From India. Front Oncol 2022; 11:799948. [PMID: 35223455 PMCID: PMC8881143 DOI: 10.3389/fonc.2021.799948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundHodgkin’s lymphoma (HL) is one of the most curable malignancies with a 5-year survival of over 80%. Most published literature from low-middle income countries comes from single institute experience.MethodologyThe OncoCollect Lymphoma group registry was set up in 2017 and has 9 major participating sites across India. Data of newly diagnosed classical HL (CHL) patients, treated between 2011 and 2017, were collected using OncoCollect software. The clinical features, subtypes, prognostic stratification, treatment patterns, response to first-line treatment, and 5-year outcomes were analyzed. All statistical analysis was done using Microsoft R Open statistical software linked to OncoCollect software.ResultsThere were 939 newly diagnosed CHL patients with a median age of 38 (range, 18–99) years at presentation. The male-to-female ratio was 2.07:1. Histological subtypes included mixed cellularity, CHL (MC, CHL), nodular sclerosis, CHL (NS, CHL), lymphocyte-rich, CHL (LR, CHL), and lymphocyte-depleted, CHL (LD, CHL), in 60.60%, 26.94%, 9.80%, and 2.66%, respectively. At presentation, 50.43% had B symptoms and 53.35% had advanced disease. 29.71% of advanced-stage patients had high Hodgkin IPI score. 79% and 21% of patients received 1st-line treatment with chemotherapy alone or combined modality treatment with chemotherapy and radiotherapy. The most common first-line chemotherapy was ABVD-based regimen (94.68%). The overall response rate was 93.48%. Complete response rates among early-stage favorable and unfavorable risk groups were 92.73% and 86.79%, and those among advanced-stage low- and high-risk groups were 76.64% and 69.78%, respectively. The median relapse-free follow-up duration was 51 months (IQR 22–69). A significant difference was found in 5-year EFS between the early- and advanced-stage disease 83.53% and 73.55% (p = 0.00087), respectively. Similarly, significant difference was found in EFS among early-stage patients treated with a combination of 4-cycle chemotherapy and radiotherapy vs. chemotherapy alone 88.57% and 66.33% (p = 0.0042), respectively.ConclusionsIn this large cohort from India, survival of patients with HL was comparable to the developed world. With a median follow-up of 51 months, the 5-year EFS and OS of all patients were 78.24% and 83.63%, respectively.
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Affiliation(s)
- Dinesh Bhurani
- Department of Haematology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
- *Correspondence: Dinesh Bhurani,
| | - Reena Nair
- Department of Haematology, Tata Medical Centre, Kolkata, India
| | - Senthil Rajappa
- Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - Suparna Ajit Rao
- Department of Medical Oncology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | | | - Rakesh Reddy Boya
- Department of Medical Oncology, Mahatama Gandhi Cancer Hospital and Research Center, Visakhapatnam, India
| | - Ganapathi S. Raman
- Department of Medical Oncology, Kumaran Hospital Private Ltd., Chennai, India
| | - Hari Menon
- Department of Medical Oncology, CyteCare Cancer Hospitals, Bengaluru, India
| | | | - Ramesh Nimmagadda
- Department of Medical Oncology, Apollo Cancer Institute, Chennai, India
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Abstract
IMPORTANCE Hodgkin lymphoma is an aggressive blood cancer that is highly curable in younger patients who receive multiagent chemotherapy. Worse survival in older patients may reflect less-aggressive treatment, competing risks of death, or different disease biological factors. OBJECTIVE To examine the association between treatment intensity and cause-specific mortality among older adults with Hodgkin lymphoma. DESIGN, SETTING, AND PARTICIPANTS This was a population-based cohort study of patients aged 65 years or older with Medicare Part A and B fee-for-service coverage who received a diagnosis of Hodgkin lymphoma from 2000 to 2013. The association between treatment intensity and cause-specific mortality was estimated separately for early-stage and advanced-stage disease with Cox proportional hazards models. Multivariable adjustment and propensity score weighting helped control for confounding. Data are from the 1999 to 2016 Surveillance, Epidemiology, and End Results Medicare database. Data analysis was performed from April 2020 to June 2021. EXPOSURES First-line treatment categorized as (1) full chemotherapy regimen, (2) partial chemotherapy regimen, (3) single chemotherapy agent or radiotherapy, or (4) no treatment. MAIN OUTCOMES AND MEASURES The main outcome was 3-year Hodgkin lymphoma-specific and other-cause mortality. RESULTS Among 2686 patients (mean [SD] age, 75.7 [6.9] years; 1333 men [50%]), 1307 had early-stage disease and 1379 had advanced-stage disease. For Hodgkin lymphoma-specific mortality in patients with early-stage disease, hazard ratios (HRs) were higher for partial regimens (HR, 1.77; 95% CI, 1.22-2.57) or no treatment (HR, 1.91; 95% CI, 1.31-2.79) than for full regimens; there was no difference between single-agent chemotherapy or radiotherapy and full regimens. For other-cause mortality in patients with early-stage disease, HRs were higher for partial regimens (HR, 1.69; 95% CI, 1.18-2.44), single-agent chemotherapy or radiotherapy (HR, 1.62; 95% CI, 1.13-2.33), or no treatment (HR, 2.71; 95% CI, 1.95-3.78) than for full regimens. For Hodgkin lymphoma-specific mortality in patients with advanced-stage disease, HRs were higher for partial regimens (HR, 3.26; 95% CI, 2.44-4.35), single-agent chemotherapy or radiotherapy (HR, 2.85; 95% CI, 1.98-4.11), or no treatment (HR, 4.06; 95% CI, 3.06-5.37) than for full regimens. For other-cause mortality in patients with advanced-stage disease, HRs were higher for partial regimens (HR, 1.76; 95% CI, 1.32-2.33), single-agent chemotherapy or radiotherapy (HR, 1.65; 95% CI, 1.15-2.37), or no treatment (HR, 2.24; 95% CI, 1.71-2.94) than for full regimens. CONCLUSIONS AND RELEVANCE This cohort study found variability in the magnitude of the association between treatment intensity and mortality by stage and cause-specific mortality, possibly reflecting competing risks of death. However, full chemotherapy regimens were associated with lower mortality and could be considered for older adults who can tolerate them.
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Affiliation(s)
- Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Theresa Hahn
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Anita J. Kumar
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Peter K. Lindenauer
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School Baystate, Springfield
| | | | | | - Susan K. Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
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Gao J, Chen Y, Wu P, Wang F, Tao H, Shen Q, Wang S, Gong S, Zhang X, Zhou Z, Song X, Jia Y. Causes of death and effect of non-cancer-specific death on rates of overall survival in adult classic Hodgkin lymphoma: a populated-based competing risk analysis. BMC Cancer 2021; 21:955. [PMID: 34433456 PMCID: PMC8390285 DOI: 10.1186/s12885-021-08683-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 08/09/2021] [Indexed: 02/08/2023] Open
Abstract
Background The improved prognosis of classic Hodgkin lymphoma (cHL) has been accompanied by elevated risks of non–cancer-specific death (non-CSD). The aim of this study was to verify the occurrence of non-CSD and its effect on rates of overall survival among adult patients with cHL. Methods To ensure sufficient follow-up time, we analyzed retrospective data from patients aged ≥20 years with cHL that was diagnosed between 1983 and 2005 in the Surveillance, Epidemiology, and End Results (SEER) database. Logistic regression was applied to analyze the non-CSD occurrence in relation to all factors. Using Fine-Gray’s method, we calculated the cumulative incidences of CSD and non-CSD. Stacked cumulative incidence plots and ratio of non-CSD to all causes of death were applied to evaluate the effect of non-CSD on rates of overall survival. Finally, we analyzed long-term mortality through Cox proportional hazard regression analysis and competing risk regression analysis to emphasize a more appropriate model of survival for patients with cHL. Results Among the 18,518 patients included, there were 3768 cases of CSD (20.3%) and 3217 of non-CSD (17.4%). Older age, earlier period, male sex, unmarried status, mixed cellularity (MC) and lymphocyte-depletion (LD) histological subtype, and patients received radiotherapy (RT) only were associated with more non-CSD according to binary logistic analysis. The cumulative incidence of non-CSD exceeded CSD after approximately 280 months follow-up. The most common causes of non-CSDs were cardiovascular disease, subsequent primary neoplasms, infectious diseases, accidents, and suicide. In a Cox proportional hazards model, patients who were black, unmarried, at an advanced stage or underwent chemotherapy (CT) alone were at greater risk of mortality than were white patients, who were married, at an early stage, and underwent combined modality; these populations were also found to be at greater risk for CSD in a competing risk model, but the risk of non-CSD did not differ significantly according to race and marital status, patients with early-stage disease and who underwent RT only were found to be at higher risk of non-CSD instead. Conclusions Lymphoma was the cause of death in most patients who died, but non-CSD was not unusual. Patients with cHL should be monitored closely for signs of cardiovascular disease and malignant tumors. Rates of overall survival of patients were diminished by non-CSD, and a competing risk model was more suitable for establishing the prognosis than was the Cox proportional hazards model. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08683-x.
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Affiliation(s)
- Jie Gao
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yingying Chen
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Pengqiang Wu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China.,Department of Hematology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Fujue Wang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China.,Department of Hematology, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Huan Tao
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Qianqing Shen
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Shuoting Wang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Shuaige Gong
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Xue Zhang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhencang Zhou
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China.,Department of Hematology, The Third Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Xianmin Song
- Department of Hematology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Yongqian Jia
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China.
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8
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Hutchings M, Radford J, Ansell SM, Illés Á, Sureda A, Connors JM, Sýkorová A, Shibayama H, Abramson JS, Chua NS, Friedberg JW, Kořen J, LaCasce AS, Molina L, Engley G, Fenton K, Jolin H, Liu R, Gautam A, Gallamini A. Brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine in patients with advanced-stage, classical Hodgkin lymphoma: A prespecified subgroup analysis of high-risk patients from the ECHELON-1 study. Hematol Oncol 2021; 39:185-195. [PMID: 33462822 PMCID: PMC8247884 DOI: 10.1002/hon.2838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 11/06/2022]
Abstract
Approximately one-third of patients diagnosed with Hodgkin lymphoma presenting with Stage IV disease do not survive past 5 years. We present updated efficacy and safety analyses in high-risk patient subgroups, defined by Stage IV disease or International Prognostic Score (IPS) of 4-7, enrolled in the ECHELON-1 study that compared brentuximab vedotin plus doxorubicin, vinblastine, and dacarbazine (A + AVD) versus doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) as first-line therapy after a median follow-up of 37.1 months. Among patients treated with A + AVD (n = 664) or ABVD (n = 670), 64% had Stage IV disease and 26% had an IPS of 4-7. Patients with Stage IV disease treated with A + AVD showed consistent improvements in PFS at 3 years as assessed by investigator (hazard ratio [HR], 0.723; 95% confidence interval [CI], 0.537-0.973; p = 0.032). Similar improvements were seen in the subgroup of patients with IPS of 4-7 (HR, 0.588; 95% CI, 0.386-0.894; p = 0.012). The most common adverse events (AEs) in A + AVD-treated versus ABVD-treated patients with Stage IV disease were peripheral neuropathy (67% vs. 40%) and neutropenia (71% vs. 55%); in patients with IPS of 4-7, the most common AEs were peripheral neuropathy (69% vs. 45%), neutropenia (66% vs. 55%), and febrile neutropenia (23% vs. 9%), respectively. Patients in high-risk subgroups did not experience greater AE incidence or severity than patients in the total population. This updated analysis of ECHELON-1 shows a favorable benefit-risk balance in high-risk patients.
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Affiliation(s)
- Martin Hutchings
- Department of Haematology and Phase 1 Unit, Rigshospitalet, Copenhagen, Denmark
| | - John Radford
- Manchester Academic Health Science Centre, University of Manchester and the Christie NHS Foundation Trust, Manchester, UK
| | | | - Árpád Illés
- Department of Hematology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anna Sureda
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet and Institut d'Investigacions Biomèdiques de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain
| | - Joseph M Connors
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, British Columbia, Canada
| | - Alice Sýkorová
- University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | | | - Jeremy S Abramson
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Neil S Chua
- Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan W Friedberg
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA
| | - Jan Kořen
- First Faculty of Medicine, General University Hospital, Prague, Czech Republic
| | | | | | | | | | - Hina Jolin
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - Rachael Liu
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - Ashish Gautam
- Millennium Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - Andrea Gallamini
- Research and Innovation Department, Centre Antoine Lacassagne, Nice, France
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9
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Abstract
OBJECTIVES Lymphoma is the most common feline hematopoietic malignancy. Incidence of renal lymphoma has not been reported as a subset of a large population of feline lymphoma cases. Previous studies have reported renal lymphoma as both a singular entity as well as a component of multicentric disease. The clinical presentation, diagnostic evaluation, therapy and outcomes related to renal lymphoma have not been reported since Mooney et al in 1987. This retrospective study aimed to describe the incidence of renal lymphoma, clinical signs, treatment and survival. METHODS Using a database of cats diagnosed with lymphoma between January 2008 and October 2017, cats with renal lymphoma were selected for further analysis. Cases were retrospectively staged according to Mooney et al (1987) and Gabor et al (1998). Data collected included age, clinical signs, clinicopathologic data, diagnostic imaging findings, lymphoma diagnostic method(s), treatment protocol(s) and survival time. Analyses comparing median survival based on therapy administered, renal lymphoma vs multicentric lymphoma, central nervous system involvement, presence of azotemia, anemia and International Renal Interest Society (IRIS) stage at diagnosis were performed. RESULTS From a population of 740 cats with lymphoma, 27 cats had renal lymphoma (incidence, 3.6%), and 14 of those cats had multicentric lymphoma. Fewer stage IV and V cases were identified in this data set compared with Mooney et al; however, not all cats were completely staged. Median survival (range) for cats receiving corticosteroids alone compared with those receiving an L-CHOP (L-asparaginase, vincristine, cyclophosphamide, doxorubicin, prednisolone)-based protocol was 50 days (20-1027 days) in the corticosteroid group and 203 days (44-2364 days) for the L-CHOP group (P = 0.753) for cats that died secondary to lymphoma. CONCLUSIONS AND RELEVANCE Neither clinical stage nor other factors were predictive of survival. Prospective studies are required to determine the optimal chemotherapy protocol.
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Affiliation(s)
| | - Ann E Hohenhaus
- The Cancer Institute, Animal Medical Center, New York, NY, USA
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11
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Liu W, Yang M, Ping L, Xie Y, Wang X, Zhu J, Song Y. Chemotherapy with a Pegylated Liposomal Doxorubicin-Containing Regimen in Newly Diagnosed Hodgkin Lymphoma Patients. Cardiovasc Toxicol 2021; 21:12-6. [PMID: 32683546 DOI: 10.1007/s12012-020-09589-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/03/2020] [Indexed: 01/23/2023]
Abstract
Anthracycline-related cardiotoxicity is an important dose-limiting toxicity for Hodgkin lymphoma (HL) treatment. This study aimed to assess the efficacy and safety of pegylated liposomal doxorubicin (PLD) for HL treatment. Patients with newly diagnosed HL treated with at least two cycles of PLD-containing chemotherapy were retrospectively analyzed. The dosing and scheduling of the PLD-containing regimen (the PBVD regimen) were as follows: PLD 25 mg/m2, vincristine 1.4 mg/m2 (maximum dose of 2 mg), bleomycin 10 mg/m2, and dacarbazine 375 mg/m2 at days l and 15, repeated every 28 days. Forty-six HL patients were analyzed. The median age was 41.5 years (range 12-77 years), with a male/female ratio of 0.9:1. Fourteen (30%) patients had an Eastern Cooperative Oncology Group (ECOG) performance status score > 1, and 32 (70%) had a history of cardiovascular disease (CVD) or related risk factors. The median chemotherapy cycle number with the PBVD regimen was 6 (range, 2-8). The overall response rate (ORR) was 91% for the whole cohort; 35 (76%) patients achieved complete remission (CR), and 7 (15%) achieved partial remission. The efficacy of the PBVD regimen was similar in patients with or without CVD or related risk factors (ORR 93% vs. 91%, P = 1.00; CR 86% vs. 72%, P = 0.46). With a median follow-up of 28.5 months, the 3-year progression-free survival (PFS) and overall survival (OS) rates were 70% and 82%, respectively, for the whole cohort. The differences in the PFS and OS rates between the groups with or without CVD or related risk factors were not significant. Cardiotoxicity was observed in 6 (13%) patients. All adverse events were grades 1-2. The PBVD regimen is an effective chemotherapy option with tolerable toxicity, and it could be a substitute in HL patients who cannot be treated with conventional doxorubicin, especially those with CVD or related risk factors.
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12
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Cuglievan B, Berkman A, Dibaj S, Wang J, Andersen CR, Livingston JA, Gill J, Bleyer A, Roth M. Impact of Lagtime, Health Insurance Type, and Income Status at Diagnosis on the Long-Term Survival of Adolescent and Young Adult Cancer Patients. J Adolesc Young Adult Oncol 2020; 10:164-174. [PMID: 32678703 DOI: 10.1089/jayao.2020.0041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose: Delays in diagnosis can affect the short-term survival outcomes of adolescent and young adult (AYA) cancer patients. We sought to determine the extent to which delayed diagnosis, health insurance type, and income status are associated with the long-term survival of AYA cancer patients. Methods: We reviewed an institutional cohort of 268 patients age 15-29 years who were diagnosed with the most common neoplasms of the AYA population between 2001 and 2003. We grouped patients by the time of onset of cancer symptomatology to verified diagnosis (lagtime to diagnosis; short or long), health insurance type at diagnosis (public or private), zip-code-based median household income (≤U.S. $50,000 or >U.S. $50,000), and demographic variables. Overall survival (OS) and late OS (LOS; the time from the 5-year anniversary of cancer diagnosis to death from any cause) were the outcomes of interest. Results: OS and LOS did not differ between those with short or long lagtimes to diagnosis for all cancer and for specific cancer types. Among patients with long lagtimes, those with private insurance had significantly better LOS than those with public insurance (p = 0.03). Compared with those who had public insurance, patients who had private insurance at diagnosis had significantly better LOS (p = 0.008). Patients with household incomes >U.S. $50,000 had better LOS than those with household incomes ≤U.S. $50,000 (p = 0.02). Patients with public insurance and household incomes ≤U.S. $50,000 had the poorest LOS. Conclusions: AYA cancer patients with either public health insurance or a low household income at diagnosis are at risk of an inferior LOS.
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Affiliation(s)
- Branko Cuglievan
- Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy Berkman
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Seyedeh Dibaj
- Divisions of Biostatistics and The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jian Wang
- Divisions of Biostatistics and The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Clark R Andersen
- Divisions of Biostatistics and The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John A Livingston
- Divisions of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan Gill
- Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Archie Bleyer
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Michael Roth
- Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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13
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Allen PB, Ayers A, Behera M, Evens AM, Flowers C. A systematic review of therapeutic regimens for older patients with newly diagnosed Hodgkin lymphoma. Leuk Lymphoma 2020; 61:1555-1564. [PMID: 32102579 DOI: 10.1080/10428194.2020.1731497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Classical Hodgkin lymphoma (cHL) in older adults is associated with inferior outcomes and increased toxicity compared to younger patients. Novel therapies like brentuximab vedotin (BV) have yielded promising results, yet their optimal use in older cHL remains unclear. We performed a systematic review to assess outcomes and toxicity associated with frontline regimens in older cHL. We screened 196 references involving chemotherapy without BV and 662 references containing BV and included 9 studies (12 arms) without BV and 6 studies (7 arms) with BV. Progression-free survival (PFS) ranged from 47 to 84% at 2 years in BV-containing arms and 42-79% at 5 years in non-BV containing trials. Pulmonary toxicity was more common in arms receiving >2 cycles of bleomycin, whereas peripheral neuropathy was associated with cumulative BV dose. This review summarizes available treatment outcomes in newly diagnosed older cHL patients and may aid clinicians in decision-making regarding available frontline approaches.Key PointsThis systematic review suggests that >2 cycles of bleomycin is associated with excess pulmonary toxicity in cHL patients older than 60 years of age.Peripheral neuropathy was more frequent in patients receiving BV-containing regimens and was associated with cumulative BV dose.BV-containing regimens are associated with high response rates in advanced-stage patients, but follow-up is limited.
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Affiliation(s)
- Pamela B Allen
- Department of Hematology and Oncology, Winship Cancer Institution of Emory University, Atlanta, GA, USA
| | - Amy Ayers
- Department of Hematology and Oncology, Winship Cancer Institution of Emory University, Atlanta, GA, USA
| | - Madhusmita Behera
- Department of Research Informatics, Winship Cancer Institution of Emory University, Atlanta, GA, USA
| | - Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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14
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Stone CR, Mickle AT, Boyne DJ, Mohamed A, Rabi DM, Brenner DR, Friedenreich CM. Treatment for lymphoma and late cardiovascular disease risk: A systematic review and meta-analysis. Health Sci Rep 2019; 2:e135. [PMID: 31667360 PMCID: PMC6811739 DOI: 10.1002/hsr2.135] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Lymphoma patients are frequently treated with cancer therapies that may increase the risk of adverse health outcomes later in life, including cardiovascular disease (CVD) mortality. We sought to investigate the long-term risk of CVD incidence in this survivor population relative to the general population to quantify this health burden. METHODS A systematic review and meta-analysis was conducted using EMBASE, MEDLINE, and CINAHL databases, from date of inception to November 2016, with additional searches completed through June 2018. Included reports were observational studies assessing CVD incidence in patients of either Hodgkin or non-Hodgkin lymphoma (HL, NHL) who survived for at least 5 years from the time of diagnosis or if the study had a median follow-up of 10 years. Meta-analyses were performed using random effects models, and subgroup analyses were conducted to determine the incidence of specific CVD subtypes (coronary heart disease, pericardial disease, valvular heart disease, myocardial disease, cardiac dysrhythmia, and cerebrovascular disease). Heterogeneity was assessed using I 2 statistics and prediction intervals. RESULTS Of the 7734 studies identified, 22 studies were included in this review, representing 32 438 HL and NHL survivors. Relative to the general population, lymphoma survivors had statistically significant two to threefold increases in the risk for nearly all subtypes of CVD examined. Lymphoma survivors appeared to be particularly susceptible to pericardial diseases (HL: 10.67, 95% confidence interval (CI), 7.75-14.69; NHL: 4.70, 95% CI, 2.08-10.61) and valvular diseases (HL: 13.10, 95% CI, 7.41-23.16; NHL: 3.76, 95% CI, 2.12-6.66). Although the 95% CIs were suggestive of increased risks, the 95% prediction intervals often included the null, reflecting the high heterogeneity of the estimates. CONCLUSION Given the suggested increased risks of cardiovascular outcomes in lymphoma survivor populations relative to the general population, tailored screening and prevention programmes may be warranted to offset the future burden of disease.
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Affiliation(s)
- Chelsea R. Stone
- Department of Cancer Epidemiology and Prevention Research, CancerControl AlbertaAlberta Health ServicesCalgaryAlbertaCanada
| | - Alexis T. Mickle
- Department of Cancer Epidemiology and Prevention Research, CancerControl AlbertaAlberta Health ServicesCalgaryAlbertaCanada
- Department of Community Health SciencesCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
| | - Devon J. Boyne
- Department of Cancer Epidemiology and Prevention Research, CancerControl AlbertaAlberta Health ServicesCalgaryAlbertaCanada
- Department of Community Health SciencesCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
| | - Aliya Mohamed
- Department of Cancer Epidemiology and Prevention Research, CancerControl AlbertaAlberta Health ServicesCalgaryAlbertaCanada
| | - Doreen M. Rabi
- Department of Community Health SciencesCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
- Department of MedicineCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
- Department of Cardiac SciencesCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
| | - Darren R. Brenner
- Department of Cancer Epidemiology and Prevention Research, CancerControl AlbertaAlberta Health ServicesCalgaryAlbertaCanada
- Department of Community Health SciencesCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
- Department of OncologyCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
| | - Christine M. Friedenreich
- Department of Cancer Epidemiology and Prevention Research, CancerControl AlbertaAlberta Health ServicesCalgaryAlbertaCanada
- Department of Community Health SciencesCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
- Department of OncologyCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
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15
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Guru Murthy GS, Szabo A, Hamadani M, Fenske TS, Shah NN. Contemporary Outcomes for Advanced-Stage Classical Hodgkin Lymphoma in the U.S.: Analysis of Surveillance, Epidemiology, and End Results Database. Oncologist 2019; 24:1488-1495. [PMID: 31467178 DOI: 10.1634/theoncologist.2019-0172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/17/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Advanced-stage Hodgkin lymphoma (HL) is a curable malignancy, although outcomes remain poor in certain patients. It remains unclear if recent advances have improved their population-level survival over time. MATERIALS AND METHODS Using the Surveillance, Epidemiology, and End Results database, we identified patients aged ≥18 years with stage III or IV classical HL as the first primary malignancy, diagnosed between 2000 and 2014 and treated with chemotherapy. Patients were stratified by date of diagnosis into three groups (2000-2004, 2005-2009, 2010-2014) to assess the trends in overall survival (OS). RESULTS A total of 9,042 patients with a median age of 41 years were included. The use of frontline radiation therapy decreased in each period (21.3% [2000-2004] vs. 15.5% [2005-2009] vs. 10.7% [2010-2014]; p < .001). Three-year OS was significantly higher for patients diagnosed between 2010 and 2014 (81.8%) and 2005 and 2009 (80.6%) compared with 2000 and 2004 (78.5%; p = .0008 and .02, respectively). Whereas outcomes were poorest in the age >60 cohort, similar improvements were also seen in 3-year OS over the three time periods within this patient population. On multivariate analysis, diagnosis in the earlier period and minority race were associated with higher mortality. Females and married patients had significantly lower mortality risk. CONCLUSION Survival of patients with advanced-stage HL has continued to improve over time, suggesting the impact of evolving treatment approaches. Three-year OS in the contemporary period remains inadequate at 81.8%, highlighting the need for continued research to improve their outcomes. IMPLICATIONS FOR PRACTICE This article evaluates contemporary outcomes for advanced-stage Hodgkin lymphoma (HL) in the U.S. using the Surveillance, Epidemiology, and End Results database. Although overall survival (OS) has improved in each 5-year period since 2000, the 3-year OS from 2010 to 2014 remains inadequate at 81.8% and is limited by patient demographics. New therapies are indicated to improve clinical outcomes in advanced-stage HL.
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Affiliation(s)
| | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mehdi Hamadani
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Timothy S Fenske
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nirav N Shah
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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16
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Wiessman M, Leshem D, Yeshurun M, Yavin H, Iakobishvilli Z, Raanani P, Kornowski R, Lev EI, Vaturi M. Dysfunctional endothelial progenitor cells in patients with Hodgkin's lymphoma in complete remission. Cancer Med 2018; 8:305-310. [PMID: 30549248 PMCID: PMC6346266 DOI: 10.1002/cam4.1914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 11/19/2018] [Indexed: 12/17/2022] Open
Abstract
Background Patients with a history of Hodgkin's lymphoma (HL) are at increased long‐term risk of cardiovascular morbidity and mortality. Studies report an association between the pathophysiology of coronary artery disease (CAD) and levels of circulating endothelial progenitor cells (EPC), which play an essential role in vascular injury repair. The aim of the present study was to investigate the potential involvement of abnormal EPC level or function in the CAD risk of survivors of HL in remission. Methods EPCs were isolated from peripheral blood samples drawn from 4 groups of patients aged 20‐50 years with no history of CAD: 17 patients with HL who had been in complete remission for at least 2 years, four newly diagnosed patients with HL before treatment, 28 patients with diabetes all attending a tertiary medical center, and 16 healthy individuals. Levels of EPC surface markers were measured by flow cytometry, and EPC function was evaluated by the number of colony‐forming units (CFUs) and MTT assay. Results Levels of circulating CD34(+)/VEGFR2(+) and CD133(+)/VEGFR2(+) were significantly higher in the newly diagnosed untreated patients with HL compared to the patients with HL in remission (P = 0.03 and P = 0.005, respectively), in the patients in remission compared to the patients with diabetes (P = 0.011 and P < 0.001, respectively), and in the patients in remission compared to the healthy individuals (P = 0.08 and P = 0.003, respectively). The analysis of cell viability and the number of colony‐forming units in the patients with HL in remission yielded significant differences from the healthy group (P = 0.005 and P < 0.001, respectively) but not from either the newly diagnosed patients with HL or the diabetic patients. Conclusions These results suggest that patients in complete remission of HL for at least 2 years have an abnormal EPC profile characterized by high circulating levels but attenuated function.
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Affiliation(s)
- Maya Wiessman
- Department of Medicine D, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit Leshem
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Felsenstein Medical Research Center, Petach Tikva, Israel
| | - Moshe Yeshurun
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Hagai Yavin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Zaza Iakobishvilli
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Pia Raanani
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Ran Kornowski
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Eli I Lev
- Department of Cardiology, Assuta Samson Ashdod Medical Center, Ashdod, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Mordehay Vaturi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Cardiology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
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17
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Patel B, Meeks H, Wan Y, Johnstone EB, Glenn M, Smith KR, Hotaling JM. Transgenerational effects of chemotherapy: Both male and female children born to women exposed to chemotherapy have fewer children. Cancer Epidemiol 2018; 56:1-5. [PMID: 30005388 DOI: 10.1016/j.canep.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/30/2018] [Accepted: 07/03/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is little known about the transgenerational effect of chemotherapy. For example, chemotherapy is known to decrease fecundity in women. But if women are able to have offspring after chemotherapy exposure, do these children also have decreased fecundity? METHODS This study is a retrospective cohort study utilizing the Utah Population Database (UPDB), a comprehensive resource that links birth, medical, death and cancer records for individuals in the state of Utah. The male and female children (F1 generation) of chemotherapy-exposed women (F0 generation) were identified. The number of live births (F2 generation) to this F1 generation was compared to two sets of chemotherapy-unexposed, matched controls using conditional Poisson regression models (regression coefficient, 95% confidence interval, P-value). The first unexposed was established using the general population and the second unexposed was established using first cousins to the F1 generation. RESULTS The exposed F1 individuals had 77.2% fewer children (-1.48; -2.51 to -0.70; p = 0.001) relative to the unexposed general population. F1 males had 86.9% fewer children (-2.03; -4.91 to -0.51; p = 0.005) and F1 females had 70.5% fewer children (-1.22; -2.40 to -0.36; p = 0.016). When comparing to their unexposed cousins, the F1 generation (both sexes combined) had 74.3% (-1.36; -2.82 to -0.29; p = 0.029) fewer children. CONCLUSION The sons and daughters (F1 generation) of chemotherapy-exposed women have fewer live births when compared to both matched, unexposed general population and cousin controls. Chemotherapy may have a transgenerational effect in exposed women which needs further investigation.
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Affiliation(s)
- Biren Patel
- Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, United States.
| | - Huong Meeks
- Family Consumer Studies, and Population Sciences, University of Utah, Salt Lake City, UT, United States
| | - Yuan Wan
- Family Consumer Studies, and Population Sciences, University of Utah, Salt Lake City, UT, United States
| | - Erica B Johnstone
- Obstetrics & Gynecology, University of Utah, Salt Lake City, UT, United States
| | - Martha Glenn
- Hematology and Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Ken R Smith
- Family Consumer Studies, and Population Sciences, University of Utah, Salt Lake City, UT, United States
| | - James M Hotaling
- Urology (General Surgery), University of Utah, Salt Lake City, UT, United States
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18
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Solans M, Serra L, Renart G, Osca-Gelis G, Comas R, Vilardell L, Gallardo D, Marcos-Gragera R. Incidence and survival of Hodgkin lymphoma patients in Girona (Spain) over three decades: a population-based study. Eur J Cancer Prev 2017; 26 Joining forces for better cancer registration in Europe:S164-9. [PMID: 28590273 DOI: 10.1097/CEJ.0000000000000383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Hodgkin lymphoma (HL) is characterized by heterogeneous histologic findings, clinical presentation and outcomes. Using the Girona population-based cancer registry data we sought to explore the incidence of HL over three decades in Girona Province (Spain) and examine the relationship between clinical features at diagnosis and survival. From 1985 to 2013, 459 cases were recorded. Patients were stratified by sex, age group, stage at diagnosis, histological subtypes and the presence of B-symptoms. The crude incidence rate (CR) was 2.7 and the corresponding European age-adjusted rate was 2.6, being higher in men than in women (sex ratio=1.6). Incidence remained constant throughout the period of study. Nodular sclerosis was the most frequent histology and showed an increasing incidence over time [estimated annual percentage change=+2.4, 95% confidence interval (CI): 0.8-4.0]. The 5-year observed survival and relative survival of patients diagnosed with HL were 73.1% (95% CI: 69.0-77.5) and 74.6% (95% CI: 70.0-79.4), respectively. No statistical differences in observed survival were observed across the three decades of study (P=0.455). Clinical parameters negatively influencing 5-year relative survival in the multivariate analysis were as follows: age at diagnosis at least 65 years; clinical stage IV; and presence of B-symptoms. These current patterns of presentation and outcomes of HL help delineate key populations in order to explore risk factors for HL and strategies to improve treatment outcomes.
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Li Y, Sun H, Yan Y, Sun T, Wang S, Ma H. Long-Term Survival Rates of Patients with Stage III-IV Hodgkin Lymphoma According to Age, Sex, Race, and Socioeconomic Status, 1984-2013. Oncologist 2018; 23:1328-1336. [PMID: 29739895 DOI: 10.1634/theoncologist.2017-0541] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 03/23/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Long-term survival rates for patients with stage III-IV Hodgkin lymphoma, or advanced Hodgkin lymphoma (aHL), have increased substantially since the 1960s. Because large-scale research of aHL is rare, we aimed to demonstrate the differences in incidence and survival of aHL according to four patient variables in recent decades, with a focus on the outcomes of treatment of aHL and the advancement of public health care. MATERIALS AND METHODS Data on aHL cases diagnosed during 1984-2013 were extracted from the Surveillance, Epidemiology, and End Results Program database. Relative survival, Kaplan-Meier, and Cox proportional hazards regression analyses were performed to identify prognosis indicators for aHL. RESULTS The incidence rates for aHL were 1.1, 0.8, and 1.0 per 100,000 in the first, second, and third decades, respectively, during 1984-2013. The 120-month relative survival rate improved continuously in each decade from 58.5% to 64.6% to 72.1%. In addition, disparities in the 120-month relative survival rate between male and female patients and among patients of different races narrowed over time. The difference in long-term survival rate between the poor (medium and high poverty) and rich (low poverty) groups narrowed across the 3 decades. CONCLUSION The long-term survival rate for patients with aHL increased in each decade, whereas survival rate disparities according to sex, race, and socioeconomic status narrowed, except for older patients aged >60 years and the high-poverty group. IMPLICATIONS FOR PRACTICE Long-term survival rates of patients with advanced Hodgkin lymphoma were elaborated in this article. The disparities according to sex, race, and socioeconomic status of survival condition were analyzed and showed the development of the public health care system and modern medicine technology.
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Affiliation(s)
- Yushi Li
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China
| | - Huanhuan Sun
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China
| | - Yan Yan
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China
| | - Tiantian Sun
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Shuncong Wang
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China
| | - Haiqing Ma
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China
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Arts LPJ, Oerlemans S, Tick L, Koster A, Roerdink HTJ, van de Poll-Franse LV. More frequent use of health care services among distressed compared with nondistressed survivors of lymphoma and chronic lymphocytic leukemia: Results from the population-based PROFILES registry. Cancer 2018; 124:3016-3024. [PMID: 29698556 PMCID: PMC6055849 DOI: 10.1002/cncr.31410] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Follow-up care for a growing population of survivors of lymphoma and chronic lymphocytic leukemia (CLL) together with the adverse effects these survivors may experience as a result of their cancer and treatment have led to more pressure being placed on health care services. The objectives of the current study were to: 1) compare the use of medical care services by survivors with that of a normative population; 2) evaluate the use of medical and psychosocial care services among distressed and nondistressed survivors; and 3) identify associated sociodemographic and clinical factors. METHODS Survivors of lymphoma and CLL diagnosed between 1999 and 2012 were selected via the population-based Netherlands Cancer Registry and completed the Hospital Anxiety and Depression Scale questionnaire and questions regarding health care. Outcomes were compared with an age-matched and sex-matched normative population. RESULTS A total of 1444 survivors responded (69%). Survivors of lymphoma and CLL contacted their general practitioner (3.8 vs 2.3; P<.001) and medical specialist (5.7 vs 1.6; P<.001) more often within the last year compared with a normative population. In addition, psychologically distressed survivors had even more medical contacts and received psychosocial care more often compared with nondistressed survivors. In addition to psychological distress, comorbidity, female sex, and older age were found to be associated with a greater use of medical services, whereas younger age was associated with receiving psychosocial care. CONCLUSIONS Survivors of lymphoma and CLL, especially those who are psychologically distressed, report an increased use of health care services compared with a normative population. Further studies are needed to explore whether the use of widely applicable psychosocial interventions could reduce the frequency of medical contacts. Cancer 2018;124:3016-24. © 2018 Netherlands Comprehensive Cancer Organisation. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
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Affiliation(s)
- Lindy P J Arts
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Simone Oerlemans
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, the Netherlands
| | - Lidwine Tick
- Department of Internal Medicine, Maxima Medical Centre, Eindhoven and Veldhoven, the Netherlands
| | - Ad Koster
- Department of Internal Medicine, VieCuri Medical Centre, Venlo and Venray, the Netherlands
| | - Henk T J Roerdink
- Department of Internal Medicine, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, the Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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Perez-Callejo D, Zurutuza L, Royuela A, Torrente M, Núñez B, Calvo V, Méndez M, Franco F, Brenes MA, Sánchez JC, Provencio M. Long-term follow up of Hodgkin lymphoma. Oncotarget 2018; 9:11638-11645. [PMID: 29545926 PMCID: PMC5837753 DOI: 10.18632/oncotarget.24392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/13/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hodgkin lymphoma (HL) is the paradigm of curable disease. This study analyzed the overall survival (OS) of patients with HL and compared their survival between decades and with the expected survival of a general population. RESULTS The median follow-up was 22 years. The median OS was 33 years. The incidence mortality rate for all causes is 2 per every 100 patients per year. The OS of our cohort at 10 years from diagnosis was 76% (95% CI: 72-79) and 52% at 30 years (95% CI: 48-57). Overall SMR (1980-2013) was 2,943 (95% CI: 2,518-3,439). Excluding the primary tumor as the cause of death, the SMR obtained is 2,266 (95% CI: 1,895-2,710). The SMR for those patients diagnosed before the year 2000 was 2,097 (95% CI: 1,732-2,539); and for those diagnosed after 2000 was 5,218 (95% CI: 8,655). The group of patients diagnosed after 2000 had statistically significant more advanced stages, were older and less responsive to treatment. CONCLUSIONS Despite the advances achieved, the risk of death remains higher than in the general population, mainly for those patients diagnosed after year 2000, even after almost 40 years of follow-up. This data might suggest a shift to more aggressive forms of disease in recent years. PATIENTS AND METHODS A total of 595 patients diagnosed with HL were included between January 1966 and February 2014. The standardized mortality ratio (SMR) was analyzed using the annual rate of mortality in the general Spanish population, adjusted for age, sex and time period.
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Affiliation(s)
- David Perez-Callejo
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Lorea Zurutuza
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Ana Royuela
- Statistics Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Maria Torrente
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Beatriz Núñez
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Virginia Calvo
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Miriam Méndez
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Fernando Franco
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Juan Cristobal Sánchez
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Mariano Provencio
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
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Abstract
INTRODUCTION Inhibitors against the PD-1/PD-L1 pathway are revolutionizing the treatment and management of malignancies. AREAS COVERED We summarize our current understanding of the function of PD-1, its role in immune evasion, the clinical data available that support the use of PD-1 antagonist in Hodgkin and non-Hodgkin lymphomas, and potential predictors of response. EXPERT OPINION We anticipate that in the next 10 years, agents that modulate the immune system such as PD-1 antagonists will be increasingly used in favor over traditional cytotoxic chemotherapeutic agents. PD-1 antagonists will be combined with future immunotherapies or used as adjuncts to cellular therapy to boost tumor-specific immune responses.
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Affiliation(s)
- Andres Chang
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322
- Emory Vaccine Center, Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322
| | - Danielle Schlafer
- Department of Pharmaceutical Services, Emory Healthcare, Atlanta, GA 30322
| | - Christopher R. Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322
| | - Pamela B. Allen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322
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Jaime-Pérez JC, Gamboa-Alonso CM, Padilla-Medina JR, Jiménez-Castillo RA, Olguín-Ramírez LA, Gutiérrez-Aguirre CH, Cantú-Rodríguez OG, Gómez-Almaguer D. High frequency of primary refractory disease and low progression-free survival rate of Hodgkin's lymphoma: a decade of experience in a Latin American center. Rev Bras Hematol Hemoter 2017; 39:325-330. [PMID: 29150104 PMCID: PMC5693277 DOI: 10.1016/j.bjhh.2017.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Reports dealing with clinical outcomes of classical Hodgkin's lymphoma in low- to middle-income countries are scarce and response to therapy is poorly documented. This report describes the characteristics and clinical outcomes of patients with classical Hodgkin's lymphoma from a single institution in Latin America. METHOD A retrospective study was conducted over ten years of patients with classical Hodgkin's lymphoma treated at a referral center. Progression-free and overall survival rates were estimated by Kaplan-Meier analysis. The univariate Cox regression model was used to estimate associations between important variables and clinical outcomes. MAIN RESULTS One hundred and twenty-eight patients were analyzed. The mean age was 28.5 years. The five-year progression-free and overall survival were 37.3% and 78.9%, respectively. Of the whole group, 55 (43%) were primary refractory cases. Only 39/83 (47%) patients with advanced disease vs. 34/45 (75.6%) in early stages (p-value=0.002) achieved complete remission. Those with advanced disease had a five-year overall survival of 68.7% vs. 91.8% for early disease (p-value=0.132). Thirty-one patients relapsed (24.2%) and 20 (64.5%) received a transplant. The hazard ratio for progression with bone marrow infiltration was 2.628 (p-value=0.037). For death, an International Prognostic Score ≥4 had a hazard ratio of 3.355 (p-value=0.050) in univariate analysis. Two-thirds of classical Hodgkin's lymphoma patients diagnosed at advanced stages had a low progression-free survival but an overall survival similar to high-income countries. CONCLUSION Patients diagnosed with classical Hodgkin's lymphoma in Northeastern Mexico had a significantly low progression-free survival rate and presented with advanced disease, underscoring the need for earlier diagnosis and improved contemporary therapeutic strategies in these mainly young productive-age Hodgkin's lymphoma patients.
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Bates JE, Dhakal S, Mazloom A, Casulo C, Constine LS. Benefit from the inclusion of radiation therapy in the treatment of patients with stage III classical Hodgkin lymphoma: A propensity matched analysis of the Surveillance, Epidemiology, and End Results database. Radiother Oncol 2017; 124:325-330. [PMID: 28778348 DOI: 10.1016/j.radonc.2017.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/13/2017] [Accepted: 07/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND While stage III and IV classical Hodgkin lymphoma (HL) patients are often combined and defined as "advanced stage," there are significant differences in disease distribution and burden between the two stages. This may obscure advantages of radiotherapy (RT) in a combined modality therapy strategy in stage III disease due to the relative lack of benefit in stage IV patients. METHODS We queried the Surveillance, Epidemiology, and End Results (SEER) database, restricting our search to patients with stage III classical HL diagnosed from 2004 to 2012, to examine the difference in overall and cause-specific survival (OS and CSS) between patients who did or did not receive RT. RESULTS Patients treated with RT had improved OS and CSS relative to those treated without RT (5-year OS 91.6% with RT compared to 71.4% without RT, HR=0.34, p<0.001) and CSS (5-year OS 95.4% with RT compared to 84.7% without RT, HR=0.32, p<0.001). A benefit in OS and/or CSS was seen in all patient subgroups except for older adults (>64years). CONCLUSION These data support at least a cautionary approach to omitting RT from treatment strategies for patients with advanced stage HL.
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Affiliation(s)
- James E Bates
- Department of Radiation Oncology, University of Florida, Gainesville, USA
| | - Sughosh Dhakal
- Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, USA
| | - Ali Mazloom
- Tacoma Valley Radiation Oncology Center, USA
| | - Carla Casulo
- Department of Medicine, Division of Medical Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, USA
| | - Louis S Constine
- Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, USA.
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Koshy M, Fairchild A, Son CH, Mahmood U. Improved survival time trends in Hodgkin's lymphoma. Cancer Med 2016; 5:997-1003. [PMID: 26999817 PMCID: PMC4924356 DOI: 10.1002/cam4.655] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 11/07/2022] Open
Abstract
There have been dramatic changes in the staging and treatment of Hodgkin's lymphoma (HL) over the past 30 years. We undertook this study to determine if a stage migration had occurred and also examined if treatment associated with later years has improved survival. Patients with stage I-IV HL between 1983 and 2011 were selected from the Surveillance, Epidemiology, and End Results database. Multivariable analysis (MVA) was performed using Cox proportional hazards modeling. The study cohort included 35,680 patients. The stage breakdown in 1983 according to A and B symptoms was follows: 18%, 21%, 12%, and 5% for stage IA, IIA, IIIA, and IVA disease, respectively, and 6%, 11%, 12%, and 15% for stage IB, IIB, IIIB, and IVB disease. The stage breakdown in 2011 according to A and B symptoms was follows: 9%, 29%, 10%, and 6% for stage IA, IIA, IIIA, and IVA disease, respectively, and 4%, 16%, 12%, and 13% for stage IB, IIB, IIIB, and IVB disease. The median follow-up for the entire cohort is 6.1 years. On MVA, the HR for mortality of patients diagnosed in 2006 was 0.60 (95% Confidence Interval (CI): 0.52-0.70) compared to 1983. For stage I and II patients diagnosed in 2006 the HR was 0.62 (95% CI: 0.44-0.87) and 0.40 (95% CI: 0.30-0.55), respectively, compared to patients diagnosed in 1983. For stage III and IV patients diagnosed in 2006 the HR was 0.72 (95% CI: 0.53-0.98) and 0.74 (95% CI: 0.56-0.99), respectively, compared to patients diagnosed in 1983. This is the first study to demonstrate a significant stage migration in early stage Hodgkin's lymphoma. Furthermore, these results demonstrate an improvement in survival over time for patients with Hodgkin's lymphoma which was particularly notable for those with early stage disease.
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Affiliation(s)
- Matthew Koshy
- Department of Radiation OncologyUniversity of Illinois at ChicagoChicagoIllinois60637
- Departments of Radiation and Cellular OncologyThe University of ChicagoChicagoIllinois60637
| | - Andrew Fairchild
- Department of Radiation OncologyUniversity of Illinois at ChicagoChicagoIllinois60637
| | - Christina H. Son
- Departments of Radiation and Cellular OncologyThe University of ChicagoChicagoIllinois60637
| | - Usama Mahmood
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexas
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