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Jabbour SK, Kumar R, Anderson B, Chino JP, Jethwa KR, McDowell L, Lo AC, Owen D, Pollom EL, Tree AC, Tsang DS, Yom SS. Combinatorial Approaches for Chemotherapies and Targeted Therapies With Radiation: United Efforts to Innovate in Patient Care. Int J Radiat Oncol Biol Phys 2024; 118:1240-1261. [PMID: 38216094 DOI: 10.1016/j.ijrobp.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Abstract
Combinatorial therapies consisting of radiation therapy (RT) with systemic therapies, particularly chemotherapy and targeted therapies, have moved the needle to augment disease control across nearly all disease sites for locally advanced disease. Evaluating these important combinations to incorporate more potent therapies with RT will aid our understanding of toxicity and efficacy for patients. This article discusses multiple disease sites and includes a compilation of contributions from expert Red Journal editors from each disease site. Leveraging improved systemic control with novel agents, we must continue efforts to study novel treatment combinations with RT.
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Affiliation(s)
- Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Jersey.
| | - Ritesh Kumar
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Jersey
| | - Bethany Anderson
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Junzo P Chino
- Department of Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Krishan R Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Lachlan McDowell
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - Andrea C Lo
- Department of Radiation Oncology, BC Cancer Vancouver Centre, Vancouver, British Columbia, Canada
| | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Alison C Tree
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, California
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Crosswell HE, LaCasce AS, Bartlett NL, Straus DJ, Savage KJ, Zinzani PL, Collins GP, Fanale M, Fenton K, Dong C, Miao H, Grigg AP. Brentuximab vedotin with chemotherapy in adolescents and young adults with stage III or IV classical Hodgkin lymphoma in ECHELON-1. Haematologica 2024; 109:982-987. [PMID: 37794803 PMCID: PMC10905068 DOI: 10.3324/haematol.2023.283303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Howland E Crosswell
- Bon Secours Hematology and Oncology, Bon Secours, St. Francis Health System, Greenville, SC.
| | - Ann S LaCasce
- Dana-Farber Cancer Institute, Partners Cancer Care, Boston, MA
| | - Nancy L Bartlett
- Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - David J Straus
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Pier Luigi Zinzani
- IRCCS University Hospital of Bologna, Institute of Hematology "Seràgnoli," Bologna, Italy; Department of Specialized Medicine, Diagnostic and Experimental, University of Bologna, Bologna
| | | | | | | | - Cassie Dong
- Takeda Development Center Americas, Inc. (TDCA), Lexington, MA
| | - Harry Miao
- Takeda Development Center Americas, Inc. (TDCA), Lexington, MA
| | - Andrew P Grigg
- Department of Clinical Haematology, Austin Hospital, VIC
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Kelly KM, Friedberg JW. Classic Hodgkin Lymphoma in Adolescents and Young Adults. J Clin Oncol 2024; 42:653-664. [PMID: 37983570 DOI: 10.1200/jco.23.01799] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/18/2023] [Revised: 08/28/2023] [Accepted: 09/20/2023] [Indexed: 11/22/2023] Open
Abstract
Hodgkin lymphoma (HL) represents one of the more common cancers occurring in adolescent and young adults (AYAs) age 15-39 years. Despite a generally high cure rate, age-related differences in HL biology and the optimal therapeutic approaches including supportive care and risks for long-term adverse effects in the AYA population remain understudied. After an overview of HL epidemiology and biology in the AYA population, this review will cover frontline pediatric and adult treatment approaches. Recently completed and ongoing studies will foster harmonization of risk group definition and trial eligibility criteria across the AYA spectrum, enabling more rapid progress. In addition to treatment approaches, an evolving holistic care approach to AYA HL will result in enhanced understanding of unique challenges, and continued improved short- and long-term outcome for these patients.
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Affiliation(s)
- Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center., Buffalo, NY
- Division of Pediatric Hematology/Oncology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
- Pediatric Hematology/Oncology, Oishei Children's Hospital, Buffalo, NY
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Scheijde-Vermeulen MA, Kester LA, Westera L, Tops BBJ, Meyer-Wentrup FAG. Integration of RNA Sequencing, Whole Exome Sequencing, and Flow Cytometry Into Routine Diagnostic Workup of Pediatric Lymphomas. J Transl Med 2024; 104:100267. [PMID: 37898291 DOI: 10.1016/j.labinv.2023.100267] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/13/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023] Open
Abstract
The study was conducted to assess the feasibility of integrating state-of-the-art sequencing techniques and flow cytometry into diagnostic workup of pediatric lymphoma. RNA sequencing (RNAseq), whole exome sequencing, and flow cytometry were implemented into routine diagnostic workup of pediatric biopsies with lymphoma in the differential diagnosis. Within 1 year, biopsies from 110 children (122 specimens) were analyzed because of suspected malignant lymphoma. The experience with a standardized workflow combining histology and immunohistochemistry, flow cytometry, and next-generation sequencing technologies is reported. Flow cytometry was performed with fresh tissue in 83% (102/122) of specimens and allowed rapid diagnosis of T-cell and B-cell non-Hodgkin lymphomas. RNAseq was performed in all non-Hodgkin lymphoma biopsies and 42% (19/45) of Hodgkin lymphoma samples. RNAseq detected all but one of the translocations found by fluorescence in situ hybridization and PCR. RNAseq and whole exome sequencing identified additional genetic abnormalities not detected by conventional approaches. Finally, 3 cases are highlighted to exemplify how synergy between different diagnostic techniques and specialists can be achieved. This study demonstrates the feasibility and discusses the added value of integrating modern sequencing techniques and flow cytometry into a workflow for routine diagnostic workup of lymphoma. The inclusion of RNA and DNA sequencing not only supports diagnostics but also will lay the ground for the development of novel research-based treatment strategies for pediatric lymphoma patients.
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Affiliation(s)
| | - Lennart A Kester
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Liset Westera
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Bastiaan B J Tops
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Parsons SK, Rodday AM, Pei Q, Keller FG, Wu Y, Henderson TO, Cella D, Kelly KM, Castellino SM. Performance of the FACT-GOG-Ntx to assess chemotherapy-induced peripheral neuropathy (CIPN) in pediatric high risk Hodgkin lymphoma: report from the Children's Oncology Group AHOD 1331 study. J Patient Rep Outcomes 2023; 7:113. [PMID: 37947987 PMCID: PMC10638179 DOI: 10.1186/s41687-023-00653-0] [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: 05/15/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is an under-recognized complication of several chemotherapy agents used as part of curative-intent therapy for Hodgkin Lymphoma (HL). In the absence of validated self- or proxy-report measures for children and adolescents, CIPN reporting has relied on clinician rating, with grading scales often restricted to severe manifestations. In a proof-of-concept study, we assessed the feasibility and psychometric performance of the Functional Assessment of Cancer Therapy-Gynecologic Oncology Group-Neurotoxicity (FACT-GOG-Ntx), a unidimensional CIPN symptom scale widely used adults with CIPN, in pediatric HL at risk for CIPN. METHODS Youth (11+ years) and parents of all children (5-17.9 years) with newly diagnosed high-risk HL enrolled on Children's Oncology Group AHOD1331 (NCT02166463) were invited to complete the FACT-GOG-Ntx and a health-related quality of life (HRQL) measure at pre-treatment (Time 1), and during cycles 2 (Time 2) and 5 (Time 3) of chemotherapy during the first half of study accrual. Clinical grading of CIPN by providers was also assessed using the Balis Pediatric Neuropathy Scale. We evaluated Cronbach's alpha, construct validity, and agreement between raters. Change in FACT-GOG-Ntx scores over time was assessed using a repeated measures model. RESULTS 306 patients had at least one completed FACT-GOG-Ntx with time-specific completion rates of > 90% for both raters. Cronbach's alpha was > 0.7 for youth and parent-proxy report at all time points. Correlations between FACT-GOG-Ntx and HRQL scores were moderate (0.41-0.48) for youth and parent-proxy raters across all times. Youth and parent-proxy raters both reported worse FACT-GOG-Ntx scores at Time 3 for those who had clinically-reported CIPN compared to those who did not. Agreement between raters was moderate to high. Compared to baseline scores, those at Time 3 were significantly lower for youth (β = - 2.83, p < 0.001) and parent-proxy raters (β = - 1.99, p < 0.001). CONCLUSIONS High completion rates at all time points indicated feasibility of eliciting youth and parent report. Psychometric performance of the FACT-GOG-Ntx revealed acceptable reliability, evidence of validity, and strong inter-rater agreement, supporting the use of this self- or proxy-reported measure of CIPN in youth with high-risk HL exposed to tubulin inhibitors, as part of a Phase 3 clinical trial. CLINICAL TRIAL INFORMATION Clinical Trials Registry, NCT02166463. Registered 18 June 2014, https://clinicaltrials.gov/ct2/show/study/NCT02166463.
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Affiliation(s)
- Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA.
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - Qinglin Pei
- Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA
| | - Frank G Keller
- Department of Pediatrics, Emory University School of Medicine; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30322, USA
| | - Yue Wu
- Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA
| | - Tara O Henderson
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, 5721 S Maryland Ave, Chicago, IL, 60637, USA
| | - David Cella
- Department of Medical Social Sciences, Institute for Public Health and Medicine, Center for Patient-Centered Outcomes, Northwestern University, 420 E. Superior St, Chicago, IL, 60611, USA
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 665 Elm St, Buffalo, NY, 14203, USA
| | - Sharon M Castellino
- Department of Pediatrics, Emory University School of Medicine; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30322, USA
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Mailhot Vega RB, Harker-Murray PD, Forlenza CJ, Cole P, Kelly KM, Milgrom SA, Parikh RR, Hodgson DC, Castellino SM, Kahn J, Roberts KB, Constine LS, Hoppe BS. Radiation Therapy Use in Refractory and Relapsed Adolescent and Young Adult Hodgkin Lymphoma: A Report from the Children's Oncology Group. Int J Radiat Oncol Biol Phys 2023; 117:400-403. [PMID: 37116589 PMCID: PMC10655744 DOI: 10.1016/j.ijrobp.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Raymond B Mailhot Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida.
| | - Paul D Harker-Murray
- Department of Pediatric Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christopher J Forlenza
- Department of Pediatric Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter Cole
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Kara M Kelly
- Department of Pediatric Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Rahul R Parikh
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - David C Hodgson
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Justine Kahn
- Department of Pediatrics Hematology-Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, New York
| | - Kenneth B Roberts
- Department of Therapeutic Radiology; Yale School of Medicine, New Haven, Connecticut
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
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Ehrhardt MJ, Krull KR, Bhakta N, Liu Q, Yasui Y, Robison LL, Hudson MM. Improving quality and quantity of life for childhood cancer survivors globally in the twenty-first century. Nat Rev Clin Oncol 2023; 20:678-696. [PMID: 37488230 DOI: 10.1038/s41571-023-00802-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/26/2023]
Abstract
The contributions of cooperative groups to performing large-cohort clinical trials and long-term survivorship studies have facilitated advances in treatment, supportive care and, ultimately, survival for patients with paediatric cancers. As a result, the number of childhood cancer survivors in the USA alone is expected to reach almost 580,000 by 2040. Despite these substantial improvements, childhood cancer survivors continue to have an elevated burden of chronic disease and an excess risk of early death compared with the general population and therefore constitute a large, medically vulnerable population for which delivery of high-quality, personalized care is much needed. Data from large survivorship cohorts have enabled the identification of compelling associations between paediatric cancers, cancer therapy and long-term health conditions. Effectively translating these findings into clinical care that improves the quality and quantity of life for survivors remains an important focus of ongoing research. Continued development of well-designed clinical studies incorporating dissemination and implementation strategies with input from patient advocates and other key stakeholders is crucial to overcoming these gaps. This Review highlights the global progress made and future efforts that will be needed to further increase the quality and quantity of life-years gained for childhood cancer survivors.
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Affiliation(s)
- Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nickhill Bhakta
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Global Paediatric Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Qi Liu
- Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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Castellino SM, Giulino-Roth L, Harker-Murray P, Kahn J, Forlenza C, Cho S, Hoppe B, Parsons SK, Kelly KM. Children's Oncology Group's 2023 blueprint for research: Hodgkin lymphoma. Pediatr Blood Cancer 2023; 70 Suppl 6:e30580. [PMID: 37505794 PMCID: PMC10660893 DOI: 10.1002/pbc.30580] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023]
Abstract
The goal of therapy in pediatric Hodgkin lymphoma (HL) is to maximize overall survival while minimizing the morbidity of curative therapy. Key findings from recent Children's Oncology Group (COG) trials include: (i) superior event-free survival with the addition of brentuximab vedotin (Bv) in frontline regimens for high-risk disease, (ii) successful reduction in myeloablative regimens with demonstrated safety and efficacy of Bv and checkpoint inhibitor therapy in relapsed disease, and (ii) the potential to select a population that can be salvaged after relapse without receiving a stem cell transplant. The COG HL committee will lead a National cancer Institute National Clinical Trials Network phase 3 trial to evaluate the combination of Bv/nivolumab in early-stage disease. Ongoing advances in technology and blood biomarkers are increasing the ability to deliver biologically driven, personalized treatment for HL.
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Affiliation(s)
- Sharon M. Castellino
- Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta/ Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Lisa Giulino-Roth
- Department of Pediatrics, Weill Cornell Medical College, New York, NY
| | | | - Justine Kahn
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Medical Center, New York, New York
| | | | - Steve Cho
- Department of Radiology, University of Wisconsin/ University of Wisconsin Carbone Comprehensive Cancer Center, Madison, WI
| | - Bradford Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - Susan K. Parsons
- Department of Medicine, Tufts University School of Medicine/ Department of Pediatrics, Tufts University School of Medicine/ Institute for Clinical Research and Health Policy Studies, Reid R. Sacco AYA Cancer Program/ Division of Hematology/Oncology, Tufts Medical Center, Boston, MA
| | - Kara M. Kelly
- Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center/ Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
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Perrone S, Lopedote P, De Sanctis V, Iamundo De Cumis I, Pulsoni A, Strati P. Novel Drugs and Radiotherapy in Relapsed Lymphomas: Abscopal Response and Beyond. Cancers (Basel) 2023; 15:2751. [PMID: 37345088 DOI: 10.3390/cancers15102751] [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: 03/20/2023] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 06/23/2023] Open
Abstract
Combined modality has represented a mainstay of treatment across many lymphoma histologies, given their sensitivity to both multi-agent chemotherapy and intermediate-dose radiotherapy. More recently, several new agents, including immunotherapies, have reshaped the therapeutic panorama of some lymphomas. In parallel, radiotherapy techniques have witnessed substantial improvement, accompanied by a growing understanding that radiation itself comes with an immune-mediated effect. Six decades after a metastatic lesion regression outside the irradiated field was first described, there is increasing evidence that a combination of radiotherapy and immunotherapy could boost an abscopal effect. This review focuses on the mechanisms underlying this interaction in the setting of lymphomas, and on the results of pivotal prospective studies. Furthermore, the available evidence on the concomitant use of radiotherapy and small molecules (i.e., lenalidomide, venetoclax, and ibrutinib), as well as brentuximab vedotin, and chimeric antigen receptor (CAR) T-cell therapy, is summarized. Currently, combining radiotherapy with new agents in patients who are affected by lymphomas appears feasible, particularly as a bridge to anti-CD19 autologous CAR T-cell infusion. However, more studies are required to assess these combinations, and preliminary data suggest only a synergistic rather than a curative effect.
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Affiliation(s)
- Salvatore Perrone
- Department of Hematology, S.M. Goretti Hospital, Polo Universitario Pontino, 04100 Latina, Italy
| | - Paolo Lopedote
- Department of Medicine, St Elizabeth's Medical Center, Boston University, Boston, MA 02135, USA
| | - Vitaliana De Sanctis
- Department of Radiation Oncology, Faculty of Medicina e Psicologia, Sant'Andrea Hospital, University of Rome "La Sapienza", 00185 Rome, Italy
| | - Ilenia Iamundo De Cumis
- Department of Radiation Oncology, A. Businco Hospital, ARNAS G. Brotzu, 09121 Cagliari, Italy
| | - Alessandro Pulsoni
- Department of Hematology, S.M. Goretti Hospital, Polo Universitario Pontino, 04100 Latina, Italy
| | - Paolo Strati
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Dixon SB, Liu Q, Chow EJ, Oeffinger KC, Nathan PC, Howell RM, Leisenring WM, Ehrhardt MJ, Ness KK, Krull KR, Mertens AC, Hudson MM, Robison LL, Yasui Y, Armstrong GT. Specific causes of excess late mortality and association with modifiable risk factors among survivors of childhood cancer: a report from the Childhood Cancer Survivor Study cohort. Lancet 2023; 401:1447-1457. [PMID: 37030315 PMCID: PMC10149583 DOI: 10.1016/s0140-6736(22)02471-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 04/10/2023]
Abstract
BACKGROUND 5-year survival after childhood cancer does not fully describe life-years lost due to childhood cancer because there are a large number of deaths occurring beyond 5-years (late mortality) related to cancer and cancer treatment. Specific causes of health-related (non-recurrence, non-external) late mortality and risk reduction through modifiable lifestyle and cardiovascular risk factors are not well described. Through using a well-characterised cohort of 5-year survivors of the most common childhood cancers, we evaluated specific health-related causes of late mortality and excess deaths compared with the general US population and identified targets to reduce future risk. METHODS In this multi-institutional, hospital-based, retrospective cohort study, late mortality (death ≥5 years from diagnosis) and specific causes of death were evaluated in 34 230 5-year survivors of childhood cancer diagnosed at an age younger than 21 years from 1970 to 1999 at 31 institutions in the USA and Canada; median follow-up from diagnosis was 29 years (range 5-48) in the Childhood Cancer Survivor Study. Demographic, self-reported modifiable lifestyle (ie, smoking, alcohol, physical activity, and BMI) and cardiovascular risk factors (ie, hypertension, diabetes, and dyslipidaemia) associated with health-related mortality (which excludes death from primary cancer and external causes and includes death from late effects of cancer therapy) were evaluated. FINDINGS 40-year cumulative all-cause mortality was 23·3% (95% CI 22·7-24·0), with 3061 (51·2%) of 5916 deaths from health-related causes. Survivors 40 years or more from diagnosis experienced 131 excess health-related deaths per 10 000 person-years (95% CI 111-163), including those due to the top three causes of health-related death in the general population: cancer (absolute excess risk per 10 000 person-years 54, 95% CI 41-68), heart disease (27, 18-38), and cerebrovascular disease (10, 5-17). Healthy lifestyle and absence of hypertension and diabetes were each associated with a 20-30% reduction in health-related mortality independent of other factors (all p values ≤0·002). INTERPRETATION Survivors of childhood cancer are at excess risk of late mortality even 40 years from diagnosis, due to many of the leading causes of death in the US population. Modifiable lifestyle and cardiovascular risk factors associated with reduced risk for late mortality should be part of future interventions. FUNDING US National Cancer Institute and the American Lebanese Syrian Associated Charities.
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Affiliation(s)
- Stephanie B Dixon
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Qi Liu
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Eric J Chow
- Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Paul C Nathan
- Division of Hematology and Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Rebecca M Howell
- Radiation Physics Department, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Wendy M Leisenring
- Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Clinical Statistics Programs, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Matthew J Ehrhardt
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kirsten K Ness
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kevin R Krull
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA; Psychology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Leslie L Robison
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Yutaka Yasui
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
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Belsky JA, Hochberg J, Giulino-Roth L. Diagnosis and management of Hodgkin lymphoma in children, adolescents, and young adults. Best Pract Res Clin Haematol 2023; 36:101445. [PMID: 36907636 DOI: 10.1016/j.beha.2023.101445] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
Advances in the management of Hodgkin lymphoma in children, adolescents and young adult have resulted in survival outcomes exceeding 90%. The risk of late toxicity, however, remains a significant concern for survivors of HL and the focus of modern trials have been to advance cure rates while reducing long term toxicity. This has been accomplished through response-adapted treatment approaches and the incorporation of novel agents, many of which target the unique interaction between the Hodgkin and Reed Sternberg cells and the tumor microenvironment. In addition, an improved understanding of prognostic markers, risk stratification, and the biology of this entity in children and AYAs may allow us to further tailor therapy. This review focuses on the current management of HL in the upfront and relapsed settings, recent advances in novel agents that target HL and the tumor microenvironment, and promising prognostic markers that may help guide the future management of HL.
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Prince HM, Hutchings M, Domingo-Domenech E, Eichenauer DA, Advani R. Anti-CD30 antibody-drug conjugate therapy in lymphoma: current knowledge, remaining controversies, and future perspectives. Ann Hematol 2023; 102:13-29. [PMID: 36512081 DOI: 10.1007/s00277-022-05054-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022]
Abstract
CD30 is overexpressed in several lymphoma types, including classic Hodgkin lymphoma (cHL), some peripheral T-cell lymphomas (PTCL), and some cutaneous T-cell lymphomas. The antibody-drug conjugate brentuximab vedotin targets CD30-positive cells and has been evaluated for the treatment of various lymphoma entities. This narrative review summarizes 10 years of experience with brentuximab vedotin for the treatment of CD30-positive lymphomas, discusses novel therapies targeting CD30 in development, and highlights remaining controversies relating to CD30-targeted therapy across lymphoma types. The collective body of evidence for brentuximab vedotin demonstrates that exploitation of CD30 can provide sustained benefits across a range of different CD30-positive lymphomas, in both clinical trials and real-world settings. Preliminary experience with brentuximab vedotin in combination with immune checkpoint inhibitors for relapsed/refractory cHL is encouraging, but further exploration is required. The optimal use of brentuximab vedotin for first-line therapy of PTCL remains to be determined. Further research is required on brentuximab vedotin treatment in high-risk patient populations, and in rare lymphoma subtypes, for which no standard of care exists. Novel therapies targeting CD30 include chimeric antigen receptor therapies and bispecific antibody T-cell engagers, which may be expected to further improve outcomes for patients with CD30-positive lymphomas in the coming years.
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Simonin M, Jardin F, Leblanc T, Latour S, Landman Parker J. An update on molecular features and therapeutic perspectives of pediatric classical Hodgkin Lymphoma. What the clinician needs to know? Eur J Med Genet 2022; 66:104672. [PMID: 36423786 DOI: 10.1016/j.ejmg.2022.104672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/07/2022] [Revised: 11/06/2022] [Accepted: 11/19/2022] [Indexed: 11/23/2022]
Abstract
Our understanding of Hodgkin lymphoma (HL) molecular biology has been radically transformed over recent years due to the advent and the spreading of the new generation sequencing approaches. These advances offer new insights about genetic predisposition to HL in children and are currently being translated into promising and more selective drugs (brentuximab and checkpoint inhibitors) offering the perspective to reduce treatment-related toxicity. Thus, as more than 90% of pediatric patients are cured after the first line treatment, a major emphasis is placed on survivorship by reducing treatment intensity, in particular, the use of radiotherapy and chemotherapy associated with long-term toxicities. The purposes of this review are to summarize the recent advances performed in the field of molecular biology of HL, in particular the promising development of liquid biopsies. We also provide an update review of immunodeficiencies associated to HL in children recently identified. Finally, we report the recent studies supporting the efficacy of new targeted therapeutics in adult and pediatric cHL (anti-CD30 and anti-PD1).
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Affiliation(s)
- Mathieu Simonin
- Department of Pediatric Hematology and Oncology, AP-HP, Armand Trousseau Hospital, Sorbonne University, Paris, France; Laboratory of Normal and Pathological Lymphoid Differentiation, Institut Necker Enfants Malades (INEM), INERM UMR1151, Paris, France; Laboratory of Lymphocyte Activation and Susceptibility to EBV Infection, INSERM UMR1163, Imagine Institute, Paris, France; Université de Paris, Paris, France.
| | - Fabrice Jardin
- Department of Hematology, Center Henri Becquerel, University of Rouen, INSERM UMR1245, Rouen, France
| | - Thierry Leblanc
- Department of Pediatric Hematology, AP-HP, Robert Debré Hospital, University Paris Diderot, Paris, France
| | - Sylvain Latour
- Laboratory of Lymphocyte Activation and Susceptibility to EBV Infection, INSERM UMR1163, Imagine Institute, Paris, France; Université de Paris, Paris, France
| | - Judith Landman Parker
- Department of Pediatric Hematology and Oncology, AP-HP, Armand Trousseau Hospital, Sorbonne University, Paris, France
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Castellino SM, Pei Q, Parsons SK, Hodgson D, McCarten K, Horton T, Cho S, Wu Y, Punnett A, Dave H, Henderson TO, Hoppe BS, Charpentier AM, Keller FG, Kelly KM. Brentuximab Vedotin with Chemotherapy in Pediatric High-Risk Hodgkin's Lymphoma. N Engl J Med 2022; 387:1649-1660. [PMID: 36322844 PMCID: PMC9945772 DOI: 10.1056/nejmoa2206660] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In adults with advanced-stage Hodgkin's lymphoma, the CD30-directed antibody-drug conjugate brentuximab vedotin combined with multiagent chemotherapy has been shown to have greater efficacy, but also more toxic effects, than chemotherapy alone. The efficacy of this targeted therapy approach in children and adolescents with Hodgkin's lymphoma is unclear. METHODS We conducted an open-label, multicenter, randomized, phase 3 trial involving patients 2 to 21 years of age with previously untreated Hodgkin's lymphoma of stage IIB with bulk tumor or stage IIIB, IVA, or IVB. Patients were assigned to receive five 21-day cycles of brentuximab vedotin with doxorubicin, vincristine, etoposide, prednisone, and cyclophosphamide (brentuximab vedotin group) or the standard pediatric regimen of doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (standard-care group). Slow-responding lesions, defined by a score of 4 or 5 (on a 5-point scale, with scores of 1 to 3 indicating rapid-responding lesions), were identified on centrally reviewed positron-emission tomography-computed tomography after two cycles. Involved-site radiation therapy was administered after the fifth cycle of therapy to slow-responding lesions and to large mediastinal adenopathy that was present at diagnosis. The primary end point was event-free survival, defined as the time until disease progression occurred, relapse occurred, a second malignant neoplasm developed, or the patient died. Safety and overall survival were assessed. RESULTS Of 600 patients who were enrolled across 153 institutions, 587 were eligible. At a median follow-up of 42.1 months (range, 0.1 to 80.9), the 3-year event-free survival was 92.1% (95% confidence interval [CI], 88.4 to 94.7) in the brentuximab vedotin group, as compared with 82.5% (95% CI, 77.4 to 86.5) in the standard-care group (hazard ratio for event or death, 0.41; 95% CI, 0.25 to 0.67; P<0.001). The percentage of patients who received involved-site radiation therapy did not differ substantially between the brentuximab vedotin group and the standard-care group (53.4% and 56.8%, respectively). Toxic effects were similar in the two groups. Overall survival at 3 years was 99.3% (95% CI, 97.3 to 99.8) in the brentuximab vedotin group and 98.5% (95% CI, 96.0 to 99.4) in the standard-care group. CONCLUSIONS The addition of brentuximab vedotin to standard chemotherapy resulted in superior efficacy, with a 59% lower risk of an event or death, and no increase in the incidence of toxic effects at 3 years. (Funded by the National Institutes of Health and others; AHOD1331 ClinicalTrials.gov number, NCT02166463.).
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Affiliation(s)
- Sharon M Castellino
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Qinglin Pei
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Susan K Parsons
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - David Hodgson
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Kathleen McCarten
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Terzah Horton
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Steve Cho
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Yue Wu
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Angela Punnett
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Hema Dave
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Tara O Henderson
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Bradford S Hoppe
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Anne-Marie Charpentier
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Frank G Keller
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
| | - Kara M Kelly
- From the Department of Pediatrics, Emory University School of Medicine (S.M.C., F.G.K.), and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta (S.M.C., F.G.K.) - both in Atlanta; the Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, Gainesville (Q.P., Y.W.), and the Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville (B.S.H.); the Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, Boston (S.K.P.); the Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto (D.H.), and the Division of Hematology-Oncology, Hospital for Sick Children and University of Toronto (A.P.), Toronto, and the Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal (A.-M.C.) - all in Canada; Imaging and Radiation Oncology Core Rhode Island, Lincoln (K.M.); the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (T.H.); the Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (S.C.); the Department of Pediatrics, Children's National Hospital, and George Washington School of Medicine and Health Sciences, Washington, DC (H.D.); the Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, Chicago (T.O.H.); and the Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (K.M.K.)
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15
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Roschewski M, Bollard CM. Are We Too Reliant on Radiation Therapy for Children with Hodgkin's Lymphoma? N Engl J Med 2022; 387:1710-1712. [PMID: 36322850 DOI: 10.1056/nejme2211587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mark Roschewski
- From the Lymphoid Malignancies Branch, Clinical Cancer Research, National Cancer Institute, Bethesda, MD (M.R.); and the Center for Cancer and Immunology Research, Children's National Hospital, and George Washington Cancer Center, George Washington University, Washington, DC (C.M.B.)
| | - Catherine M Bollard
- From the Lymphoid Malignancies Branch, Clinical Cancer Research, National Cancer Institute, Bethesda, MD (M.R.); and the Center for Cancer and Immunology Research, Children's National Hospital, and George Washington Cancer Center, George Washington University, Washington, DC (C.M.B.)
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16
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Li Y, Liu L, Sun H, Li N, Huang S, Olinger A, Xu X, Wang X, Duan Y. Complete remission of Hodgkin’s lymphoma in a pediatric patient with TTN gene mutation treated with brentuximab vedotin combined chemotherapy without anthracyclines: A case report. Front Oncol 2022; 12:1006166. [PMID: 36324585 PMCID: PMC9618631 DOI: 10.3389/fonc.2022.1006166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/26/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction There is no guideline for the treatment of Hodgkin’s lymphoma (HL) in pediatric patients with titin (TTN) gene mutation and heart failure. We explored the feasibility of using brentuximab vedotin (BV) plus chemotherapy without anthracyclines to treat one pediatric HL patient with TTN mutation. Case presentation A 5-year and 7-month male patient was admitted to the hospital due to high fever and shortness of breath. He was diagnosed with stage IV IVB high-risk Hodgkin’s lymphoma (lymphocyte-depleted type) at admission. Echocardiography showed that the left ventricular ejection fraction (LVEF) was 27%. The gene sequencing revealed a pathogenic variant in the TTN gene. Due to the risk of cardiotoxicity of anthracycline, he received 6 cycles of chemotherapy (no anthracyclines), 4 cycles of them plus BV with dosing 1.8 mg/kg, q3w. The tumor was reduced by 77% after 2 cycles of BV and 4 cycles of chemotherapy. At the end of 4 cycles of BV and six courses of chemotherapy, with complete remission achieved, the tumor was reduced by 85%. After 11 months of follow-up, the patient was still in complete remission with no adverse events reported, and his LVEF improved to 62%. Conclusion The combination of BV with chemotherapy is effective and well-tolerated for pediatric HL patients with TTN gene mutation.
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17
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Kyriakidis I, Mantadakis E, Stiakaki E, Groll AH, Tragiannidis A. Infectious Complications of Targeted Therapies in Children with Leukemias and Lymphomas. Cancers (Basel) 2022; 14:cancers14205022. [PMID: 36291806 PMCID: PMC9599435 DOI: 10.3390/cancers14205022] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Targeted therapies in children with hematological malignancies moderate the effects of cytotoxic therapy, thus improving survival rates. They have emerged over the last decade and are used in combination with or after the failure of conventional chemotherapy and as bridging therapy prior to hematopoietic stem cell transplantation (HSCT). Nowadays, there is a growing interest in their efficacy and safety in pediatric patients with refractory or relapsed disease. The compromised immune system, even prior to therapy, requires prompt monitoring and treatment. In children with hematological malignancies, targeted therapies are associated with a comparable incidence of infectious complications to adults. The exact impact of these agents that have different mechanisms of action and are used after conventional chemotherapy or HSCT is difficult to ascertain. Clinicians should be cautious of severe infections after the use of targeted therapies, especially when used in combination with chemotherapy. Abstract The aim of this review is to highlight mechanisms of immunosuppression for each agent, along with pooled analyses of infectious complications from the available medical literature. Rituximab confers no increase in grade ≥3 infectious risks, except in the case of patients with advanced-stage non-Hodgkin lymphoma. Gemtuzumab ozogamicin links with high rates of grade ≥3 infections which, however, are comparable with historical cohorts. Pembrolizumab exhibits a favorable safety profile in terms of severe infections. Despite high rates of hypogammaglobulinemia (HGG) with blinatumomab, low-grade ≥3 infection rates were observed, especially in the post-reinduction therapy of relapsed B-acute lymphoblastic leukemia. Imatinib and nilotinib are generally devoid of severe infectious complications, but dasatinib may slightly increase the risk of opportunistic infections. Data on crizotinib and pan-Trk inhibitors entrectinib and larotrectinib are limited. CAR T-cell therapy with tisagenlecleucel is associated with grade ≥3 infections in children and is linked with HGG and the emergence of immune-related adverse events. Off-label therapies inotuzumab ozogamicin, brentuximab vedotin, and venetoclax demonstrate low rates of treatment-related grade ≥3 infections, while the addition of bortezomib to standard chemotherapy in T-cell malignancies seems to decrease the infection risk during induction. Prophylaxis, immune reconstitution, and vaccinations for each targeted agent are discussed, along with comparisons to adult studies.
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Affiliation(s)
- Ioannis Kyriakidis
- Department of Pediatric Hematology-Oncology & Autologous Hematopoietic Stem Cell Transplantation Unit, University Hospital of Heraklion & Laboratory of Blood Diseases and Childhood Cancer Biology, School of Medicine, University of Crete, 70013 Heraklion, Greece
| | - Elpis Mantadakis
- Department of Paediatrics, Paediatric Hematology/Oncology Unit, Faculty of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology & Autologous Hematopoietic Stem Cell Transplantation Unit, University Hospital of Heraklion & Laboratory of Blood Diseases and Childhood Cancer Biology, School of Medicine, University of Crete, 70013 Heraklion, Greece
| | - Andreas H. Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology, University Children’s Hospital Münster, D-48149 Münster, Germany
| | - Athanasios Tragiannidis
- Pediatric and Adolescent Hematology-Oncology Unit, 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
- Correspondence: ; Fax: +30-2310-994803
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18
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Zijtregtop EAM, Tromp I, Dandis R, Zwaan CM, Lam KH, Meyer-Wentrup FAG, Beishuizen A. The Prognostic Value of Eight Immunohistochemical Markers Expressed in the Tumor Microenvironment and on Hodgkin Reed-Sternberg Cells in Pediatric Patients With Classical Hodgkin Lymphoma. Pathol Oncol Res 2022; 28:1610482. [PMID: 36032657 PMCID: PMC9402887 DOI: 10.3389/pore.2022.1610482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022]
Abstract
Immunohistochemical markers are associated with treatment outcome in adults with classical Hodgkin Lymphoma (cHL). Studies in children are scarce and inconsistent. We investigated in 67 children with cHL, whether the expression of CD15, CD30, PAX5, PD-1, PD-L1, CD68, CD163 and TARC at diagnosis is associated with disease free survival (DFS) and with interim remission status. Low CD15 and low TARC expression were associated with relapsed disease. Low expression of PD-L1 was associated with complete remission at interim PET-scan. Our data suggest a difference between pediatric and adult cHL. This underlines the importance of future research into specific prognostic factors in pediatric cHL, indispensable for improvement of treatment in this population.
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Affiliation(s)
- Eline A. M. Zijtregtop
- Department of Hemato-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Pediatric Hematology and Oncology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Ilse Tromp
- Department of Pediatric Hematology and Oncology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Rana Dandis
- Department of Hemato-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Christian M. Zwaan
- Department of Hemato-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Pediatric Hematology and Oncology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - King H. Lam
- Department of Pathology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Auke Beishuizen
- Department of Hemato-Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Pediatric Hematology and Oncology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
- *Correspondence: Auke Beishuizen,
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19
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Zhang Y, Xing Z, Mi L, Li Z, Zhu J, Wei T, Wu W. Novel Agents For Relapsed and Refractory Classical Hodgkin Lymphoma: A Review. Front Oncol 2022; 12:929012. [PMID: 35928877 PMCID: PMC9344040 DOI: 10.3389/fonc.2022.929012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/22/2022] [Indexed: 12/23/2022] Open
Abstract
Classical Hodgkin lymphoma (cHL) is the most common type of HL that occurs mainly in people aged between 15–30 and over 55 years. Although its general prognosis is favorable, 10%–30% of patients with cHL will ultimately develop relapsed or refractory disease (r/r cHL). Improving the cure rate of r/r cHL has proven to be challenging. Some novel agents, such as brentuximab vedotin and immune checkpoint inhibitors, which have been used in conventional regimens for patients with r/r cHL in the past decade, have been shown to have good curative effects. This paper reviews the conventional regimens for patients with r/r cHL and focuses on the newest clinical trials and treatment measures to prolong prognosis and reduce adverse events. The evaluation of prognosis plays a vital role in analyzing the risk of relapse or disease progression; thus, finding new predictive strategies may help treat patients with r/r cHL more efficaciously.
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Affiliation(s)
- Yujie Zhang
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Zhichao Xing
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Li Mi
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Zhihui Li
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Jingqiang Zhu
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Wei
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Wenshuang Wu, ; Tao Wei,
| | - Wenshuang Wu
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Thyroid and Parathyroid Disease, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Wenshuang Wu, ; Tao Wei,
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20
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Hochberg J, Basso J, Shi Q, Klejmont L, Flower A, Bortfeld K, Harrison L, van de Ven C, Moorthy C, Islam H, Gerard P, Voss S, Cairo MS. Risk-adapted chemoimmunotherapy using brentuximab vedotin and rituximab in children, adolescents, and young adults with newly diagnosed Hodgkin's lymphoma: a phase II, non-randomized controlled trial. J Immunother Cancer 2022; 10:jitc-2021-004445. [PMID: 35584865 PMCID: PMC9119160 DOI: 10.1136/jitc-2021-004445] [Citation(s) in RCA: 1] [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] [Accepted: 04/06/2022] [Indexed: 12/04/2022] Open
Abstract
Background Cure rates for Hodgkin’s lymphoma are excellent, but excess short-term and long-term morbidities from treatment remain a concern. Immunotherapy targeting both tumor antigens and the immunosuppressive tumor microenvironment in children, adolescents, and young adults with Hodgkin’s lymphoma may improve early response rates and eliminate toxic chemotherapy and radiation, thus minimizing toxicity. We conducted a phase II study to evaluate the safety and overall response rate of brentuximab vedotin and rituximab in combination with risk-adapted chemotherapy in children, adolescents, and young adults with newly diagnosed classic Hodgkin’s lymphoma (cHL). Methods This is a prospective, phase II, non-randomized, risk-assigned study. Patients were treated and evaluated between 2012 and 2020. Eligible patients were aged ≥1 and ≤30 years old with advanced stage, intermediate-risk, and high-risk newly diagnosed cHL. Patients received four or six cycles of brentuximab vedotin (1.2 mg/kg), doxorubicin (25 mg/m2), vinblastine (6 mg/m2), dacarbazine (375 mg/m2), and rituximab (375 mg/m2). Early response was evaluated following two cycles of therapy. Involved field radiotherapy (IFRT) was restricted to high-risk patients with both bulky disease and slow response or those not in complete response at the end of chemoimmunotherapy. Results Thirty patients were enrolled, with a median age of 15 years (4–23). There were 18 intermediate-risk and 12 high-risk patients. Toxicities included grade III mucositis (3%), infusion reaction (3%), and peripheral neuropathy (6%). There was a 100% complete response rate on completion of chemoimmunotherapy. Eighteen patients (60%) achieved a rapid early response. Four patients (13%) required IFRT. The 5-year event-free and overall survival rates were 100%, with a median follow-up of 62 months (18–105). Conclusions Immunotherapy with brentuximab vedotin, rituximab, and risk-adapted chemotherapy is safe in children, adolescents, and young adults with newly diagnosed cHL. We have demonstrated 100% complete response and 100% event-free and overall survival rates at a median 5-year follow-up, with a significant reduction in use of more toxic chemotherapy and IFRT. A larger cohort is required to confirm these preliminary findings. Trial registration number NCT02398240.
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Affiliation(s)
| | - Jaclyn Basso
- Pediatrics, New York Medical College, Valhalla, New York, USA
| | - Qiuhu Shi
- Epidemiology and Community Health, New York Medical College, Valhalla, NY, USA
| | - Liana Klejmont
- Pediatrics, New York Medical College, Valhalla, New York, USA
| | - Allyson Flower
- Pediatrics, New York Medical College, Valhalla, New York, USA
| | | | - Lauren Harrison
- Pediatrics, New York Medical College, Valhalla, New York, USA
| | | | - Chitti Moorthy
- Radiology, New York Medical College, Valhalla, New York, USA
| | - Humayun Islam
- Pathology, New York Medical College, Valhalla, New York, USA
| | - Perry Gerard
- Radiology, New York Medical College, Valhalla, New York, USA
| | - Stephan Voss
- Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mitchell S Cairo
- Pediatrics, New York Medical College, Valhalla, New York, USA .,Pathology, New York Medical College, Valhalla, New York, USA.,Medicine, New York Medical College, Valhalla, New York, USA.,Microbiology & Immunology, New York Medical College, Valhalla, New York, USA.,Cell Biology & Anatomy, New York Medical College, Valhalla, New York, USA
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21
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Williams AM, Mirzaei Salehabadi S, Xing M, Phillips NS, Ehrhardt MJ, Howell R, Yasui Y, Oeffinger KC, Gibson T, Chow EJ, Leisenring W, Srivastava D, Hudson MM, Robison LL, Armstrong GT, Krull KR. Modifiable risk factors for neurocognitive and psychosocial problems after Hodgkin lymphoma. Blood 2022; 139:3073-3086. [PMID: 34861035 PMCID: PMC9121843 DOI: 10.1182/blood.2021013167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/12/2021] [Indexed: 11/20/2022] Open
Abstract
Long-term survivors of childhood Hodgkin lymphoma (HL) experience a high burden of chronic health morbidities. Correlates of neurocognitive and psychosocial morbidity have not been well established. A total of 1760 survivors of HL (mean ± SD age, 37.5 ± 6.0 years; time since diagnosis, 23.6 ± 4.7 years; 52.1% female) and 3180 siblings (mean age, 33.2 ± 8.5 years; 54.5% female) completed cross-sectional surveys assessing neurocognitive function, emotional distress, quality of life, social attainment, smoking, and physical activity. Treatment exposures were abstracted from medical records. Chronic health conditions were graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events version 4.3 (1 = mild, 2 = moderate, 3 = severe/disabling, and 4 = life-threatening). Multivariable analyses, adjusted for age, sex, and race, estimated relative risk (RR) of impairment in survivors vs siblings and, among survivors, risk of impairment associated with demographic, clinical, treatment, and grade 2 or higher chronic health conditions. Compared with siblings, survivors had significantly higher risk (all, P < .05) of neurocognitive impairment (eg, memory, 8.1% vs 5.7%), anxiety (7.0% vs 5.4%), depression (9.1% vs 7%), unemployment (9.6% vs 4.4%), and impaired physical/mental quality of life (eg, physical function, 11.2% vs 3.0%). Smoking was associated with a higher risk of impairment in task efficiency (RR, 1.56; 95% confidence interval [CI], 1.02-2.39), emotional regulation (RR, 1.84; 95% CI, 1.35-2.49), anxiety (RR, 2.43; 95% CI, 1.51-3.93), and depression (RR, 2.73; 95% CI, 1.85-4.04). Meeting the exercise guidelines of the Centers for Disease Control and Prevention was associated with a lower risk of impairment in task efficiency (RR, 0.70; 95% CI, 0.52-0.95), organization (RR, 0.60; 95% CI, 0.45-0.80), depression (RR, 0.66; 95% CI, 0.48-0.92), and multiple quality of life domains. Cardiovascular and neurologic conditions were associated with impairment in nearly all domains. Survivors of HL are at elevated risk for neurocognitive and psychosocial impairment, and risk is associated with modifiable factors that provide targets for interventions to improve long-term functional outcomes.
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Affiliation(s)
| | | | | | | | - Matthew J Ehrhardt
- Department of Epidemiology and Cancer Control
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Rebecca Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Kevin C Oeffinger
- Department of Medicine, Duke University and Duke Cancer Institute, Durham, NC
| | - Todd Gibson
- Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, National Cancer Institute, Rockville, MD
| | - Eric J Chow
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA; and
| | - Wendy Leisenring
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA; and
| | | | - Melissa M Hudson
- Department of Epidemiology and Cancer Control
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | | | | | - Kevin R Krull
- Department of Epidemiology and Cancer Control
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
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22
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Abstract
Since the initial treatment with radiation therapy in the 1950s, the treatment of Hodgkin lymphoma has continued to evolve, balancing cure and toxicity. This approach has resulted in low rates of relapse and death and fewer short and late toxicities from the treatments used in pursuit of cure. To achieve this balance, the field has continued to progress into an exciting era where the advent of more targeted therapies such as brentuximab vedotin, immunotherapies such as PD-1 inhibitors, and chimeric antigen receptor T-cells (CAR-T) targeted at CD30 are changing the landscape. As in the past, cooperative group and international collaborations are key to continuing to drive the science forward. Increased focus on patient-reported outcomes can further contribute to the goal of improved outcomes by examining the impact on the individual patient in the acute phase of therapy and on long-term implications for survivors. The goals of this review are to summarize recent and current clinical trials including reduction or elimination of radiation, immunotherapies and biologically-targeted agents, and discuss the use of patient-reported outcomes to help discern directions for new therapeutic regimens and more individualized evaluation of the balance of cure and toxicity.
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Affiliation(s)
- Christine Moore Smith
- Division of Pediatric Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Debra L Friedman
- Division of Pediatric Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, United States
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23
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Metzger ML. All eyes on the EuroNet-PHL-C1 trial for paediatric classical Hodgkin lymphoma. Lancet Oncol 2022; 23:11-13. [PMID: 34895480 DOI: 10.1016/s1470-2045(21)00544-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Monika L Metzger
- Departments of Oncology and Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN 38105, USA.
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24
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Milgrom SA, Bakst RL, Campbell BA. Clinical Outcomes Confirm Conjecture: Modern Radiation Therapy Reduces the Risk of Late Toxicity in Survivors of Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2021; 111:841-850. [PMID: 34655558 DOI: 10.1016/j.ijrobp.2021.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Sarah A Milgrom
- University of Colorado, Department of Radiation Oncology, Aurora, Colorado.
| | - Richard L Bakst
- Mount Sinai Hospital, Department of Radiation Oncology, New York, New York
| | - Belinda A Campbell
- Peter MacCallum Cancer Centre, Department of Radiation Oncology, Melbourne, Victoria, Australia; University of Melbourne, Department of Clinical Pathology, Parkville, Victoria, Australia; University of Melbourne, The Sir Peter MacCallum Department of Oncology, Parkville, Victoria, Australia
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25
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Škubník J, Pavlíčková VS, Ruml T, Rimpelová S. Vincristine in Combination Therapy of Cancer: Emerging Trends in Clinics. Biology (Basel) 2021; 10:849. [PMID: 34571726 PMCID: PMC8468923 DOI: 10.3390/biology10090849] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 02/07/2023]
Abstract
Treatment of blood malignancies and other cancer diseases has been mostly unfeasible, so far. Therefore, novel treatment regimens should be developed and the currently used ones should be further elaborated. A stable component in various cancer treatment regimens consists of vincristine, an antimitotic compound of natural origin. Despite its strong anticancer activity, mostly, it cannot be administered as monotherapy due to its unspecific action and severe side effects. However, vincristine is suitable for combination therapy. Multidrug treatment regimens including vincristine are standardly applied in the therapy of non-Hodgkin lymphoma and other malignancies, in which it is combined with drugs of different mechanisms of action, mainly with DNA-interacting compounds (for example cyclophosphamide), or drugs interfering with DNA synthesis (for example methotrexate). Besides, co-administration of vincristine with monoclonal antibodies has also emerged, the typical example of which is the anti-CD20 antibody rituximab. Although in some combination anticancer therapies, vincristine has been replaced with other drugs exhibiting lesser side effects, though, in most cases, it is still irreplaceable. This is strongly evidenced by the number of active clinical trials evaluating vincristine in combination cancer therapy. Therefore, in this article, we have reviewed the most common cancer treatment regimens employing vincristine and bring an overview of current trends in the clinical development of this compound.
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Affiliation(s)
| | | | | | - Silvie Rimpelová
- Department of Biochemistry and Microbiology, University of Chemistry and Technology Prague, Technická 3, 166 28 Prague, Czech Republic; (J.Š.); (V.S.P.); (T.R.)
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Loap P, De Marzi L, Mirandola A, Dendale R, Iannalfi A, Vitolo V, Barcellini A, Filippi AR, Jereczek-Fossa BA, Kirova Y, Orlandi E. Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives. Cancers (Basel) 2021; 13:3744. [PMID: 34359644 DOI: 10.3390/cancers13153744] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 01/15/2023] Open
Abstract
Simple Summary Hodgkin lymphoma (HL) is a highly curable disease; proton therapy for mediastinal HL irradiation might theoretically reduce late toxicities compared with classical radiotherapy techniques. However, optimal patient selection for this technique is subject to debate. While implementation at a larger scale of proton therapy for HL may face organizational, political, and societal challenges, new highly effective systematic drugs are being widely evaluated for this disease. Abstract Consolidative radiation therapy for early-stage Hodgkin lymphoma (HL) improves progression-free survival. Unfortunately, first-generation techniques, relying on large irradiation fields, were associated with an increased risk of secondary cancers, and of cardiac and lung toxicity. Fortunately, the use of smaller target volumes combined with technological advances in treatment techniques currently allows efficient organs-at-risk sparing without altering tumoral control. Recently, proton therapy has been evaluated for mediastinal HL treatment due to its potential to significantly reduce the dose to organs-at-risk, such as cardiac substructures. This is expected to limit late radiation-induced toxicity and possibly, second-neoplasm risk, compared with last-generation intensity-modulated radiation therapy. However, the democratization of this new technique faces multiple issues. Determination of which patient may benefit the most from proton therapy is subject to intense debate. The development of new effective systemic chemotherapy and organizational, societal, and political considerations might represent impediments to the larger-scale implementation of HL proton therapy. Based on the current literature, this critical review aims to discuss current challenges and controversies that may impede the larger-scale implementation of mediastinal HL proton therapy.
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