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Oertel M, Hering D, Kittel C, Nacke N, Kröger K, Kriz J, Fuchs M, Baues C, Vordermark D, Engenhart-Cabillic R, Herfarth KK, Lukas P, Schmidberger H, Marnitz-Schulze S, Borchmann P, Engert A, Haverkamp U, Eich HTT. Quality Analysis of Radiation Therapy for Hodgkin Lymphoma in the HD 16/17 Trials: A Final Report By the Reference Radiation Oncology Panel of the German Hodgkin Study Group. Int J Radiat Oncol Biol Phys 2023; 117:S62. [PMID: 37784540 DOI: 10.1016/j.ijrobp.2023.06.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The HD 16 and 17 trials by the German Hodgkin Study Group (GHSG) have evaluated the use of consolidative radiotherapy (RT) in early-favorable and -unfavorable stage Hodgkin lymphoma (HL), respectively (1, 2). Quality of RT planning and execution is pivotal for treatment outcome in HL with protocol violations jeopardizing prognosis (3). Consequently, the present work aims at a decisive analysis of quality and dosimetry in the modern era. MATERIALS/METHODS Random samples of 100 involved-field RT (IFRT) plans in HD16 and 176 plans in HD17 (134 involved-node RT (INRT) and 42 IFRT) were selected for analysis. Evaluation was performed systematically by the reference radiation oncology panel using pre-chemotherapy imaging, recommendation by the reference radiation oncology and RT planning imaging and graded as "correct", "minor" or "major deviation", respectively. RT doses to the target volume and organs at risks (OAR) were analyzed using dose-volume histograms. RESULTS Median RT doses were 20 Gy (19.8 Gy-21.6 Gy) in HD16 and 30 Gy in HD17 (IFRT: 18-30.6 Gy, INRT: 14 Gy-40 Gy). Overall, 84.0%, 69.0%, and 76.1% of RT series in HD16, the IFRT-group of HD17 and the INRT-group of HD17, respectively, were planned correctly. The main reason for major deviation was an insufficient coverage of an involved region (11 %-14.3 %). There was no significant difference in quality between IFRT and INRT in HD17 (p = 0.418 for any deviations; p = 0.466 for major deviations). In comparison to previous GHSG studies in the respective stages, a significant increase in correct RT-series (p<0.001) and decrease in major deviations (p<0.001) occurred. However, doses to OAR varied individually with median values of 4.3 Gy (0.2 Gy-9.2 Gy), 4.7 Gy (0.2 Gy-15.2 Gy) and 3.8 Gy (0.0 Gy-16.0 Gy) for mean doses to the right lung, left lung and heart in HD16, respectively. Correspondingly, values were 9.8 Gy (0.3 Gy-20.0 Gy), 10.5 Gy (0.2 Gy-26.5 Gy) and 13.1 Gy (0.5 Gy-30.4 Gy) for mean doses to the right lung, left lung and heart in HD17, respectively. The size of the planning target volume decreased significantly with INRT compared to IFRT (median values: 1163.1 ml vs. 1464.3 ml; p = 0.043). However, only some OAR-parameters (V25 of the right and left lung, respectively, thyroid and spinal cord) showed significant differences between INRT and IFRT in HD17. The use of intensity-modulated techniques in HD 17 resulted in an increase in V5 and V10 of the lungs with a concomitant decrease in V20-V30. CONCLUSION Quality of RT in the planning and treatment of HL has improved significantly with the latest GHSG study generation. Future analyses will focus on a further individualization of treatment fields. LITERATURE
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Affiliation(s)
- M Oertel
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - D Hering
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - C Kittel
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - N Nacke
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - K Kröger
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - J Kriz
- Department of Radiation Oncology, Alexianer Clemenshospital Muenster, Muenster, Germany
| | - M Fuchs
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - C Baues
- Department of Radiation Oncology and CyberKnife Center, University Hospital of Cologne, Cologne, Germany
| | - D Vordermark
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - R Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, University Hospital Giessen-Marburg, Marburg, Germany
| | - K K Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - P Lukas
- Department of Radiooncology, Medical University Innsbruck, Innsbruck, Austria
| | - H Schmidberger
- Department of Radiotherapy and Radiation Oncology, University Hospital Mainz, Mainz, Germany
| | - S Marnitz-Schulze
- Department of Radiation Oncology and CyberKnife Center, University Hospital of Cologne, Cologne, Germany
| | - P Borchmann
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - A Engert
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - U Haverkamp
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - H T T Eich
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
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2
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Ansell SM, Bröckelmann PJ, Keudell G, Lee HJ, Santoro A, Zinzani PL, Collins GP, Cohen JB, Boer JP, Kuruvilla J, Savage KJ, Trneny M, Provencio M, Jaeger U, Willenbacher W, Swanink R, Sacchi M, Shipp MA, Engert A, Armand P. NIVOLUMAB FOR RELAPSED OR REFRACTORY (R/R) CLASSICAL HODGKIN LYMPHOMA (CHL) AFTER AUTOLOGOUS TRANSPLANTATION: 5‐YEAR OVERALL SURVIVAL FROM THE PHASE 2 CHECKMATE 205 STUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.74_2879] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- S. M. Ansell
- Mayo Clinic Division of Hematology Rochester Minnesota USA
| | - P. J. Bröckelmann
- University Hospital of Cologne Department of Internal Medicine Cologne Germany
| | - G. Keudell
- Memorial Sloan Kettering Cancer Center Department of Hematology New York New York USA
| | - H. J. Lee
- University of Texas MD Anderson Cancer Center Department of Lymphoma and Myeloma Houston Texas USA
| | - A. Santoro
- Humanitas University Humanitas Cancer Center Rozzano Milan Italy
| | - P. L. Zinzani
- University of Bologna Institute of Hematology L. e A. Seràgnoli Bologna Italy
| | - G. P. Collins
- Churchill Hospital Oxford Cancer and Haematology Centre Oxford UK
| | - J. B. Cohen
- Emory University Winship Cancer Institute Atlanta Georgia USA
| | - J. P. Boer
- Antoni van Leeuwenhoek Hospital Netherlands Cancer Institute Amsterdam Netherlands
| | - J. Kuruvilla
- University of Toronto and Princess Margaret Cancer Centre Division of Medical Oncology and Hematology Toronto Canada
| | - K. J. Savage
- BC Cancer Department of Medical Oncology Vancouver Canada
| | - M. Trneny
- Charles University in Prague and General University Hospital in Prague Department of Haematology Prague Czech Republic
| | - M. Provencio
- Hospital Universitario Puerta de Hierro Department of Medical Oncology Madrid Spain
| | - U. Jaeger
- Medical University of Vienna Clinical Department for Hematology and Hemostaseology Vienna Austria
| | - W. Willenbacher
- Innsbruck Medical University Department of Internal Medicine V Innsbruck Austria
| | - R. Swanink
- Bristol Myers Squibb Global Biometrics and Data Sciences Braine l’Alleud Belgium
| | - M. Sacchi
- Bristol Myers Squibb, Global Drug Development Princeton New Jersey USA
| | - M. A. Shipp
- Dana‐Farber Cancer Institute Department of Medical Oncology Boston Massachusetts USA
| | - A. Engert
- University Hospital of Cologne Department of Internal Medicine Cologne Germany
| | - P. Armand
- Dana‐Farber Cancer Institute Department of Medical Oncology Boston Massachusetts USA
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3
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Bröckelmann PJ, Müller H, Gillessen S, Yang X, Koeppel L, Pilz V, Marinello P, Kaskel P, Raut M, Fuchs M, Borchmann P, Engert A, Tresckow B. CLINICAL OUTCOMES OF RELAPSED HODGKIN LYMPHOMA PATIENTS AFTER CONTEMPORARY FIRST‐LINE TREATMENT: RESULTS FROM THE GERMAN HODGKIN STUDY GROUP. Hematol Oncol 2021. [DOI: 10.1002/hon.107_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- P. J. Bröckelmann
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) University of Cologne Department I of Internal Medicine and German Hodgkin Study Group (GHSG) Cologne Germany
| | - H. Müller
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) University of Cologne Department I of Internal Medicine and German Hodgkin Study Group (GHSG) Cologne Germany
| | - S. Gillessen
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) University of Cologne Department I of Internal Medicine and German Hodgkin Study Group (GHSG) Cologne Germany
| | - X. Yang
- Merck & Co., Inc. Kenilworth USA
| | | | - V. Pilz
- MSD Sharp & Dohme GmbH Haar Germany
| | | | | | - M. Raut
- Merck & Co., Inc. Kenilworth USA
| | - M. Fuchs
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) University of Cologne Department I of Internal Medicine and German Hodgkin Study Group (GHSG) Cologne Germany
| | - P. Borchmann
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) University of Cologne Department I of Internal Medicine and German Hodgkin Study Group (GHSG) Cologne Germany
| | - A. Engert
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) University of Cologne Department I of Internal Medicine and German Hodgkin Study Group (GHSG) Cologne Germany
| | - B. Tresckow
- University Hospital Essen University of Duisburg‐Essen Department of Hematology and Stem Cell Transplantation West German Cancer Center Essen Germany
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4
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Eichenauer DA, Kreissl S, Bühnen I, Baues C, Kobe C, van Heek L, Goergen H, Fuchs M, Hartmann S, von Tresckow B, Engert A, Borchmann P. PET-2-guided escalated BEACOPP for advanced nodular lymphocyte-predominant Hodgkin lymphoma: a subgroup analysis of the randomized German Hodgkin Study Group HD18 study. Ann Oncol 2021; 32:807-810. [PMID: 33667668 DOI: 10.1016/j.annonc.2021.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- D A Eichenauer
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany.
| | - S Kreissl
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - I Bühnen
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - C Baues
- German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany; Department of Radiation Oncology, University of Cologne, Cologne, Germany
| | - C Kobe
- German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany; Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - L van Heek
- German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany; Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - H Goergen
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - M Fuchs
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - S Hartmann
- Senckenberg Institute of Pathology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - B von Tresckow
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany; Clinic for Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - A Engert
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
| | - P Borchmann
- First Department of Internal Medicine, Center for Integrated Oncology Aachen, Bonn, Cologne and Dusseldorf, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), University Hospital Cologne, Cologne, Germany
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Oertel M, Elsayad K, Engenhart-Cabillic R, Reinartz G, Baues C, Schmidberger H, Vordermark D, Marnitz S, Lukas P, Ruebe C, Engert A, Lenz G, Eich HT. Radiation treatment of hemato-oncological patients in times of the COVID-19 pandemic : Expert recommendations from the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance. Strahlenther Onkol 2020; 196:1096-1102. [PMID: 33125504 PMCID: PMC7596809 DOI: 10.1007/s00066-020-01705-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/22/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The coronavirus pandemic is affecting global health systems, endangering daily patient care. Hemato-oncological patients are particularly vulnerable to infection, requiring decisive recommendations on treatment and triage. The aim of this survey amongst experts on radiation therapy (RT) for lymphoma and leukemia is to delineate typical clinical scenarios and to provide counsel for high-quality care. METHODS A multi-item questionnaire containing multiple-choice and free-text questions was developed in a peer-reviewed process and sent to members of the radiation oncology panels of the German Hodgkin Study Group and the German Lymphoma Alliance. Answers were assessed online and analyzed centrally. RESULTS Omission of RT was only considered in a minority of cases if alternative treatment options were available. Hypofractionated regimens and reduced dosages may be used for indolent lymphoma and fractures due to multiple myeloma. Overall, there was a tendency to shorten RT rather than to postpone or omit it. Even in case of critical resource shortage, panelists agreed to start emergency RT for typical indications (intracranial pressure, spinal compression, superior vena cava syndrome) within 24 h. Possible criteria to consider for patient triage are the availability of (systemic) options, the underlying disease dynamic, and the treatment rationale (curative/palliative). CONCLUSION RT for hemato-oncological patients receives high-priority and should be maintained even in later stages of the pandemic. Hypofractionation and shortened treatment schedules are feasible options for well-defined constellations, but have to be discussed in the clinical context.
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Affiliation(s)
- M Oertel
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - K Elsayad
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - R Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, University Hospital Giessen-Marburg, Marburg, Germany
| | - G Reinartz
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany
| | - C Baues
- Department of Radiation Oncology and Cyberknife Center, University Hospital of Cologne, Cologne, Germany
| | - H Schmidberger
- Department of Radiotherapy and Radiation Oncology, University Hospital Mainz, Mainz, Germany
| | - D Vordermark
- Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - S Marnitz
- Department of Radiation Oncology and Cyberknife Center, University Hospital of Cologne, Cologne, Germany
| | - P Lukas
- Department of Radiooncology, Medical University Innsbruck, Innsbruck, Austria
| | - C Ruebe
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - A Engert
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, Cologne, Germany
| | - G Lenz
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Muenster, Germany
| | - H T Eich
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1 building A1, 48149, Muenster, Germany.
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6
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Borchmann S, Müller H, Hude I, Fuchs M, Borchmann P, Engert A. Thrombosis as a treatment complication in Hodgkin lymphoma patients: a comprehensive analysis of three prospective randomized German Hodgkin Study Group (GHSG) trials. Ann Oncol 2020; 30:1329-1334. [PMID: 31132094 DOI: 10.1093/annonc/mdz168] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The prognosis of Hodgkin lymphoma (HL) is excellent rendering research into treatment complications highly important. An important complication of cancer and its treatment is thrombosis. Thrombotic events are regularly observed in HL patients but precise information on incidence and risk factors is lacking and the value of prophylactic anticoagulation unclear. PATIENTS AND METHODS Thus, we comprehensively studied thrombotic events in 5773 patients from the German Hodgkin Study Group (GHSG) HD13-15 trials in early-favorable, intermediate and advanced HL. We estimated the incidence of and identified risk factors for thrombotic events. Additionally, we provide detailed data on the time course and characteristics of thrombotic events. RESULTS A total of 193 thrombotic events occurred for an incidence of 3.3%. Out of these, 175 (90.7%) were venous thromboses, 3 (1.5%) newly emerging post-thrombotic syndromes and 15 (7.8%) arterial thromboses. There were 11 (0.7%) events in early-favorable, 27 (1.3%) in early-unfavorable and 155 (7.3%) in advanced patients, the latter incidence being significantly higher (P < 0.001). The most common locations were deep vein thrombosis of the arm (46.3%) and leg (24.6%). Most venous thrombotic events occurred during chemotherapy (78.9%). We observed 59 (30.6%) catheter-associated events and a descriptively increased risk of venous thrombotic events in patients with oral contraception use during treatment (6.8% versus 3.9%). In advanced HL, the incidence of venous thrombotic events was increased upon treatment with BEACOPP-14 (9.4%, P = 0.0079) compared with 5.1% with 6×BEACOPPesc and 5.7% with 8×BEACOPPesc. Among commonly applied risk factors, including the Khorana score, only age and smoking were prognostic. CONCLUSIONS The incidence of thrombotic events in advanced stage HL is comparable to other high-risk cancer patients, especially if treated with dose-dense regimens. Additional risk factors are higher age and smoking. Selected HL patients could benefit from prophylactic anticoagulation, however, further interventional studies are needed before general recommendations can be made.
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Affiliation(s)
- S Borchmann
- Faculty of Medicine, Department I of Internal Medicine, GHSG; Faculty of Medicine, Center for Molecular Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany; Faculty of Medicine, Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - H Müller
- Faculty of Medicine, Department I of Internal Medicine, GHSG
| | - I Hude
- Faculty of Medicine, Department I of Internal Medicine, GHSG; Division of Hematology, Department of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - M Fuchs
- Faculty of Medicine, Department I of Internal Medicine, GHSG
| | - P Borchmann
- Faculty of Medicine, Department I of Internal Medicine, GHSG
| | - A Engert
- Faculty of Medicine, Department I of Internal Medicine, GHSG.
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7
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Voltin CA, Goergen H, Baues C, Fuchs M, Mettler J, Kreissl S, Oertl J, Klaeser B, Moccia A, Drzezga A, Engert A, Borchmann P, Dietlein M, Kobe C. Value of bone marrow biopsy in Hodgkin lymphoma patients staged by FDG PET: results from the German Hodgkin Study Group trials HD16, HD17, and HD18. Ann Oncol 2019; 29:1926-1931. [PMID: 30010775 DOI: 10.1093/annonc/mdy250] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Bone marrow (BM) involvement defines advanced-stage Hodgkin lymphoma and thus has impact on the assignment to treatment. Our aim was to evaluate whether the established BM biopsy may be omitted in patients if 18F-fluorodeoxyglucose positron emission tomography (PET) scanning is carried out during staging. Patients and methods Our analysis set consisted of 832 Hodgkin lymphoma patients from the German Hodgkin Study Group trials HD16, HD17, and HD18 who underwent both PET scanning and BM biopsy before treatment. All PET studies were centrally reviewed and BM was categorized as showing focal involvement or not. Results Taking BM biopsy as reference standard, baseline PET showed a negative predictive value of 99.9% [95% confidence interval (CI) 99.2% to 100%] with true-negative results in 702 of 703 cases. The sensitivity of PET for detecting BM involvement was 95.0% (95% CI 75.1% to 99.9%) as it could identify 19 out of 20 patients with positive BM biopsy. Moreover, PET found 110 additional subjects with focal BM lesions who would have been considered negative by biopsy. Conclusions When compared with BM biopsy, PET was able to detect focal BM lesions in a large number of additional patients. This indicates that conventional BM biopsy may substantially underestimate the actual incidence of BM involvement. Given the high negative predictive value, baseline PET scanning can safely be used to exclude BM involvement in Hodgkin lymphoma. BM biopsy should be considered only in such patients in whom PET-detected lesions lead to a change of treatment protocol. Registered trials The trials included in this analysis were registered at ClinicalTrials.gov: HD16-NCT00736320, HD17-NCT01356680, and HD18-NCT00515554.
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Affiliation(s)
- C-A Voltin
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - H Goergen
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - C Baues
- Departments of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - M Fuchs
- German Hodgkin Study Group (GHSG), Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - J Mettler
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - S Kreissl
- Departments of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - J Oertl
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - B Klaeser
- Department of Nuclear Medicine, Inselspital, Bern University Hospital and University of Bern, Bern; Swiss Group for Clinical Cancer Research (SAKK), Bern
| | - A Moccia
- Swiss Group for Clinical Cancer Research (SAKK), Bern; Department of Medical Oncology, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
| | - A Drzezga
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - A Engert
- Departments of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - P Borchmann
- Departments of Internal Medicine I, University Hospital of Cologne, Cologne, Germany
| | - M Dietlein
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - C Kobe
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany.
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Eich H, Baues C, Fuchs M, Kobe C, Greil R, Sasse S, Zijlstra J, Lohri A, Rosenwald A, Tresckow B, Diehl V, Kuhnert G, Dietlein M, Borchmann P, Engert A. PET-Guided Treatment of Early-Stage Favorable Hodgkin Lymphoma: Final Results of the International, Randomized Phase 3 Trial HD16 by the GHSG. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Baues C, Goergen H, Fuchs M, Kobe C, Dietlein M, Rosenbrock J, Celik E, Eich H, Kriz J, Semrau R, Borchmann P, Engert A, Marnitz S. Consolidating Involved Field Radiotherapy Prevents Early and Local Recurrences in Early Stage Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Bröckelmann P, Müller H, Kücüksarioglan E, Kaskel P, Metterlein V, Giezek H, Balakumaran A, Raut M, Engert A, von Tresckow B. Outcomes of patients with the third or higher relapsed classical Hodgkin lymphoma: results from the German Hodgkin Study Group. Ann Oncol 2019; 30:490-491. [DOI: 10.1093/annonc/mdz004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Eichenauer DA, Aleman BMP, André M, Federico M, Hutchings M, Illidge T, Engert A, Ladetto M. Hodgkin lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv19-iv29. [PMID: 29796651 DOI: 10.1093/annonc/mdy080] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- D A Eichenauer
- First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - B M P Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M André
- Université Catholique de Louvain, Yvoir
- Department of Hematology, CHU UCL Namur, Yvoir, Belgium
| | - M Federico
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - M Hutchings
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - T Illidge
- Division of Cancer Sciences, University of Manchester, Manchester
- The Christie NHS Foundation Trust, Manchester, UK
| | - A Engert
- First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - M Ladetto
- Hematology Division, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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12
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Müller H, Kreissl S, Görgen H, Mayer A, Behringer K, Bürkle C, Scheuvens R, Fuchs M, Diehl V, Engert A, Borchmann P. Verlauf und Einflussfaktoren von Tumor-assoziierter Fatigue bei Hodgkin-Lymphom: eine longitudinale Studie der deutschen Hodgkin-Studiengruppe. Psychother Psychosom Med Psychol 2018. [DOI: 10.1055/s-0038-1667890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- H Müller
- Universitätsklinikum Köln, Klinik I für Innere Medizin, Deutsche Hodgkin Studiengruppe (GHSG), Köln, Deutschland
| | - S Kreissl
- German Hodgkin Study Group, Köln, Deutschland
| | | | - A Mayer
- RWTH Aachen, Institut für Psychologie, Philosophische Fakultät, Köln, Deutschland
| | - K Behringer
- German Hodgkin Study Group, Köln, Deutschland
| | - C Bürkle
- German Hodgkin Study Group, Köln, Deutschland
| | | | - M Fuchs
- German Hodgkin Study Group, Köln, Deutschland
| | - V Diehl
- German Hodgkin Study Group, Köln, Deutschland
| | - A Engert
- German Hodgkin Study Group, Köln, Deutschland
| | - P Borchmann
- Universitätsklinikum Köln, Klinik I für Innere Medizin, Deutsche Hodgkin Studiengruppe (GHSG), Köln, Deutschland
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13
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Börner SM, Fischer T, Hansen H, Schnell R, Zimmermanns B, Tawadros S, Engert A, Staak O, Pogge von Strandmann E, Kobe C, Schicha H, Schomäcker K, Dietlein M. Development of anti-CD30 radioimmunoconstructs (RICs) for treatment of Hodgkin's lymphoma. Nuklearmedizin 2018; 49:97-105. [DOI: 10.3413/nukmed-0258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2009] [Accepted: 01/22/2010] [Indexed: 11/20/2022]
Abstract
Summary
Objectives: Comparison of the binding affinity to a CD30-positive Hodgkin lymphoma (HL) cell line and biodistribution in HL bearing mice of new anti-CD30 radioimmunoconjugates (RICs) of varying structure and labelling nuclides. Methods: The antibodies Ki-4 and 5F11 were radioiodinated by the chloramine T method or labelled with 111In via p-NCSBenzyl- DOTA. In addition, the Ki-4-dimer was investigated in the iodinated form. The RICs were analyzed for retained immunoreactivity by immunochromatography. In-vitro binding studies were performed on CD30-positive L540 cell lines. For in-vivo biodistribution studies, SCID mice bearing human HL xenografts were injected with the various radioimmunoconjugates. After 24 h, activities in the organs and tumour were measured for all 5 RICs. Tumour-free animals were studied in the same way with 131I- Ki-4 24 h p. i. The three RICs with the highest tumour/background ratios 24 h p.i. (131I-Ki-4, 131I–5F11, 111In-bz- DOTA-Ki-4) were analysed further at 48 h and 72 h. Results: All the RICs were successfully labelled with high specific activities (28–47 TBq/ mmol) and sufficient radiochemical yields (> 80%). Scatchard plot analysis proved high tumour affinity (KD = 20–220 nmol/l). In-vivo tumour accumulation in % of injected dose per g tissue (%ID/g) lay between 2.6 (131I-5F11) and 12.3 % ID/g (131I-Ki-4) with permanently high background in blood. Tumour/blood-ratios of all RICs were below one at all time points. Conclusions: In-vitro tumour cell affinities of all RICs were promising. However, in-vivo biokinetics tested in the mouse model did not meet expectations. This highlights the importance of developing and testing further new anti-CD30 conjugates.
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14
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Dietlein M, Schnell R, Pinkert J, Eschner W, Zimmermanns B, Fischer T, Engert A, Schicha H, Schomäcker K. Radioimmunotherapy with yttrium-90 ibritumomab tiuxetan. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1625104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
90Y-ibritumomab tiuxetan (Zevalin®) is currently approved for radioimmunotherapy of patients with relapsed or refractory follicular non-Hodgkin’s lymphoma pretreated with rituximab. Future directions are the combined use of 90Y-ibritumomab tiuxetan as part of the initial treatment and as first-line multi-agent therapy of relapsed disease. Current studies investigate patients with other than follicular indolent histologies, e. g. diffuse large cell lymphoma. Labelling of 90Y ibritumomab tiuxetan is a safe procedure, the radiochemical purity is not disturbed by a higher room temperature or by metallic impurity. Quality control is recommended by thin layer chromatography (TLC), strips >15 cm are favourable. TLC cannot distinguish between the correctly radiolabelled antibodies and radiocolloid impurity. If necessary, additional HPLC should be performed. Radiocolloid impurities are absorbed to the solid phase and do not reach the eluate. If the radiochemical purity test is insufficient (<95%), the additional cleaning using EconoPac 10 DG columns (Biorad, Hercules, CA, USA) is a reliable procedure to reduce the percentage of free radionuclide. However, this procedure is not part of the approval.
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15
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Dietlein M, Mauz-Körholz C, Engert A, Borchmann P, Sabri O, Schober O, Schicha H, Kluge R, Kobe C. FDG-PET in Hodgkin lymphoma. Nuklearmedizin 2018; 47:235-8; quiz N75-6. [DOI: 10.3413/nukmed-0216] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
SummaryThe high negative predictive value of FDG-PET in therapy control of Hodgkin lymphoma is proven by the data acquired up to now. Thus, the analysis of the HD15 trial has shown that consolidation radiotherapy might be omitted in PET negative patients after effective chemotherapy. Further response adapted therapy guided by PET seems to be a promising approach in reducing the toxicity for patients undergoing chemotherapy. The criteria used for the PET interpretation have been standardized by the German study groups for Hodgkin lymphoma patients and will be reevaluated in the current studies.
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16
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Younes A, Hilden P, Coiffier B, Hagenbeek A, Salles G, Wilson W, Seymour JF, Kelly K, Gribben J, Pfreunschuh M, Morschhauser F, Schoder H, Zelenetz AD, Rademaker J, Advani R, Valente N, Fortpied C, Witzig TE, Sehn LH, Engert A, Fisher RI, Zinzani PL, Federico M, Hutchings M, Bollard C, Trneny M, Elsayed YA, Tobinai K, Abramson JS, Fowler N, Goy A, Smith M, Ansell S, Kuruvilla J, Dreyling M, Thieblemont C, Little RF, Aurer I, Van Oers MHJ, Takeshita K, Gopal A, Rule S, de Vos S, Kloos I, Kaminski MS, Meignan M, Schwartz LH, Leonard JP, Schuster SJ, Seshan VE. International Working Group consensus response evaluation criteria in lymphoma (RECIL 2017). Ann Oncol 2017; 28:1436-1447. [PMID: 28379322 PMCID: PMC5834038 DOI: 10.1093/annonc/mdx097] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Indexed: 12/20/2022] Open
Abstract
In recent years, the number of approved and investigational agents that can be safely administered for the treatment of lymphoma patients for a prolonged period of time has substantially increased. Many of these novel agents are evaluated in early-phase clinical trials in patients with a wide range of malignancies, including solid tumors and lymphoma. Furthermore, with the advances in genome sequencing, new "basket" clinical trial designs have emerged that select patients based on the presence of specific genetic alterations across different types of solid tumors and lymphoma. The standard response criteria currently in use for lymphoma are the Lugano Criteria which are based on [18F]2-fluoro-2-deoxy-D-glucose positron emission tomography or bidimensional tumor measurements on computerized tomography scans. These differ from the RECIST criteria used in solid tumors, which use unidimensional measurements. The RECIL group hypothesized that single-dimension measurement could be used to assess response to therapy in lymphoma patients, producing results similar to the standard criteria. We tested this hypothesis by analyzing 47 828 imaging measurements from 2983 individual adult and pediatric lymphoma patients enrolled on 10 multicenter clinical trials and developed new lymphoma response criteria (RECIL 2017). We demonstrate that assessment of tumor burden in lymphoma clinical trials can use the sum of longest diameters of a maximum of three target lesions. Furthermore, we introduced a new provisional category of a minor response. We also clarified response assessment in patients receiving novel immune therapy and targeted agents that generate unique imaging situations.
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Affiliation(s)
| | - P. Hilden
- Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - B. Coiffier
- Hematology, Université Lyon-1, Lyon-Sud Charles Mérieux, Lyon, France
| | - A. Hagenbeek
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - G. Salles
- Hematology, Université Lyon-1, Lyon-Sud Charles Mérieux, Lyon, France
| | - W. Wilson
- Lymphoid Malignancies Branch, National Cancer Institute, Bethesda, USA
| | - J. F. Seymour
- Peter MacCallum Cancer Centre and University of Melbourne, Australia
| | - K. Kelly
- Pediatrics Department, Roswell-Park Cancer Institute, Buffalo, USA
| | - J. Gribben
- Department of Haemato-Oncology, Barts Cancer Institute, London, UK
| | - M. Pfreunschuh
- Department of Internal Medicine, Universität des Saarlandes, Homburg, Germany
| | - F. Morschhauser
- Department of Hematology, Université de Lille 2, Lille, France
| | - H. Schoder
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York
| | | | - J. Rademaker
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York
| | - R. Advani
- Department of Oncology, Stanford University, Stanford
| | | | | | | | - L. H. Sehn
- British Columbia Cancer Agency, Vancouver, Canada
| | - A. Engert
- Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | | | - P.-L. Zinzani
- Department of Hematology, University of Bologna, Bologna
| | - M. Federico
- Department of Diagnostic Medicine, University of Modena, Modena, Italy
| | - M. Hutchings
- Department of Hematology, University of Copenhagen, Denmark
| | - C. Bollard
- Children’s National Health System, Washington, USA
| | - M. Trneny
- Lymphoma and Stem Cell Transplantation Program, Charles University, Prague, Czech Republic
| | | | - K. Tobinai
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - J. S. Abramson
- Massachusetts General Hospital, Center for Lymphoma, Boston
| | - N. Fowler
- U.T. M.D.Anderson Cancer Center, Houston
| | - A. Goy
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack
| | - M. Smith
- Cleveland Clinic, Cleveland, USA
| | | | - J. Kuruvilla
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada
| | - M. Dreyling
- Medicine Clinic III, Ludwig Maximilian University, Munich, Germany
| | | | - R. F. Little
- Divisions of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - I. Aurer
- Department of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | | | - A. Gopal
- Fred Hutchinson Cancer Research Center, Seattle, USA
| | - S. Rule
- Haematology Department, Plymouth University, UK
| | | | - I. Kloos
- Servier, Neuilly sur Seine, France
| | - M. S. Kaminski
- University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
| | - M. Meignan
- Nuclear Medicine, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - L. H. Schwartz
- Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York
| | - J. P. Leonard
- Weill Cornell Medicine and and New York Presbyterian Hospital, New York
| | - S. J. Schuster
- University of Pennsylvania School of Medicine, Philadelphia, USA
| | - V. E. Seshan
- Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, USA
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17
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Fanale M, Engert A, Younes A, Armand P, Ansell S, Zinzani P, Timmerman J, Collins G, Ramchandren R, Cohen J, De Boer J, Kuruvilla J, Savage K, Trneny M, Rodig S, Shipp M, Kato K, Sumbul A, Farsaci B, Santoro A. NIVOLUMAB FOR RELAPSED/REFRACTORY CLASSICAL HODGKIN LYMPHOMA AFTER AUTOLOGOUS TRANSPLANT: FULL RESULTS AFTER EXTENDED FOLLOW-UP OF THE PHASE 2 CHECKMATE 205 TRIAL. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_124] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- M. Fanale
- Department of Lymphoma/Myeloma; University of Texas MD Anderson Cancer Center; Houston USA
| | - A. Engert
- Department of Internal Medicine I; University Hospital of Cologne; Cologne Germany
| | - A. Younes
- Lymphoma Service; Memorial Sloan Kettering Cancer Center; New York USA
| | - P. Armand
- Medical Oncology; Dana-Farber Cancer Institute; Boston USA
| | - S. Ansell
- Division of Hematology; Mayo Clinic; Rochester USA
| | - P.L. Zinzani
- Institute of Hematology “L. e A. Seràgnoli; University of Bologna; Bologna Italy
| | - J.M. Timmerman
- Division of Hematology and Oncology; University of California, Los Angeles; Los Angeles USA
| | - G.P. Collins
- Oxford Cancer and Haematology Center; Churchill Hospital; Headington Oxford UK
| | - R. Ramchandren
- Department of Hematology/Oncology; Barbara Ann Karmanos Cancer Institute; Detroit USA
| | - J.B. Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute; Emory University; Atlanta USA
| | - J.P. De Boer
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital; Amsterdam Netherlands
| | - J. Kuruvilla
- Department of Medical Oncology and Hematology; University of Toronto and Princess Margaret Cancer Centre; Toronto Canada
| | - K.J. Savage
- Department of Medical Oncology; British Columbia Cancer Agency; Vancouver Canada
| | - M. Trneny
- Department of Hematology; Charles University in Prague and General University Hospital in Prague; Prague Czech Republic
| | - S. Rodig
- Department of Pathology; Brigham and Women's Hospital; Boston USA
| | - M. Shipp
- Center for Hematologic Oncology; Dana-Farber Cancer Institute; Boston USA
| | - K. Kato
- Global Clinical Research; Bristol-Myers Squibb; Lawrenceville USA
| | - A. Sumbul
- Global Biostatistics; Bristol-Myers Squibb; Lawrenceville USA
| | - B. Farsaci
- Oncology Biomarkers; Bristol-Myers Squibb; Lawrenceville USA
| | - A. Santoro
- Department of Medical Oncology and Hematology, Humanitas Cancer Center; Humanitas University; Rozzano Milan Italy
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18
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Borchmann P, Goergen H, Kobe C, Eichenauer D, Greil R, Lohri A, Novak U, Markova J, Beck H, Meissner J, Zijlstra J, Ostermann H, Feuring-Buske M, Dierlamm J, Eich H, Baues C, Rosenwald A, Fuchs M, Diehl V, Kuhnert G, Dietlein M, Engert A. EBEACOPP WITH OR WITHOUT RITUXIMAB IN INTERIM-PET-POSITIVE ADVANCED-STAGE HODGKIN LYMPHOMA: UPDATED RESULTS OF THE INTERNATIONAL, RANDOMIZED PHASE 3 GHSG HD18 TRIAL. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_52] [Citation(s) in RCA: 5] [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] [Indexed: 11/10/2022]
Affiliation(s)
- P. Borchmann
- Department I of Internal Medicine, German Hodgkin Study Group (GHSG); University Hospital of Cologne; Cologne Germany
| | - H. Goergen
- Department I of Internal Medicine, German Hodgkin Study Group (GHSG); University Hospital of Cologne; Cologne Germany
| | - C. Kobe
- Department of Nuclear Medicine; University Hospital of Cologne; Cologne Germany
| | - D. Eichenauer
- Department I of Internal Medicine, German Hodgkin Study Group (GHSG); University Hospital of Cologne; Cologne Germany
| | - R. Greil
- IIIrd Medical Department; Paracelsus Medical University and Salzburg Cancer Research Institute and AGMT (Arbeitsgemeinschaft Medikamentöse Tumortherapie); Salzburg Austria
| | - A. Lohri
- Oncology; Cantonal Hospital Baselland; Liestal Switzerland
| | - U. Novak
- Swiss Group for Clinical Cancer Research (SAKK); Inselspital Bern; Bern Switzerland
| | - J. Markova
- Third Faculty of Medicine; Charles University, University Hospital Kralovske Vinohrady; Prague Czech Republic
| | - H. Beck
- IIIrd Medical Department; University Hospital Mainz; Mainz Germany
| | - J. Meissner
- Center for Internal Medicine; University of Heidelberg; Heidelberg Germany
| | - J.M. Zijlstra
- Oncology; VU University Medical Center; Amsterdam The Netherlands
| | - H. Ostermann
- Department of Internal Medicine III; University Hospital of Munich; Munich Germany
| | - M. Feuring-Buske
- Department of Internal Medicine III; University Hospital of Ulm; Ulm Germany
| | - J. Dierlamm
- Department II; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - H. Eich
- Department of Radiotherapy; University Hospital of Muenster; Muenster Germany
| | - C. Baues
- Department of Radiotherapy, Germany x Berlin Reference Center for Lymphoma and 17 Berlin; University Hospital of Cologne; Cologne Germany
| | - A. Rosenwald
- 1Institute of Pathology; University of Wuerzburg; Wuerzburg Germany
| | - M. Fuchs
- Department I of Internal Medicine, German Hodgkin Study Group (GHSG); University Hospital of Cologne; Cologne Germany
| | - V. Diehl
- Department I of Internal Medicine, German Hodgkin Study Group (GHSG); University Hospital of Cologne; Cologne Germany
| | - G. Kuhnert
- Department of Nuclear Medicine; University Hospital of Cologne; Cologne Germany
| | - M. Dietlein
- Department of Nuclear Medicine; University Hospital of Cologne; Cologne Germany
| | - A. Engert
- Department I of Internal Medicine, German Hodgkin Study Group (GHSG); University Hospital of Cologne; Cologne Germany
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19
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Bröckelmann P, Müller H, Casasnovas O, Hutchings M, von Tresckow B, Jürgens M, McCall S, Morschhauser F, Fuchs M, Borchmann P, Moskowitz C, Engert A. Risk factors and a prognostic score for survival after autologous stem-cell transplantation for relapsed or refractory Hodgkin lymphoma. Ann Oncol 2017; 28:1352-1358. [DOI: 10.1093/annonc/mdx072] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Baues C, Semrau R, Gaipl US, Bröckelmann PJ, Rosenbrock J, Engert A, Marnitz S. Checkpoint inhibitors and radiation treatment in Hodgkin's lymphoma : New study concepts of the German Hodgkin Study Group. Strahlenther Onkol 2016; 193:95-99. [PMID: 27704149 DOI: 10.1007/s00066-016-1050-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 07/03/2016] [Accepted: 09/01/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with classical Hodgkin's lymphoma (cHL) have a good prognosis even in advanced stages. However, combined chemo- and radiotherapy, as the standard of care, is also associated with treatment-related toxicities such as organ damage, secondary neoplasias, infertility, or fatigue and long-term fatigue. Many patients suffer from this burden although their cHL was cured. Therefore, the efficacy of immune checkpoint inhibitors like anti-PD1/PD-L1 antibodies in the treatment of solid cancers and also in HL offers new options. A remarkable and durable response rate with a favorable toxicity profile was observed in heavily pretreated cHL patients. METHODS Planning to perform prospective randomized clinical trials in the content of radio-immune treatment in patients with Hodgkin's lymphoma (HL), we transferred the results of preliminary clinical studies and basic research in clinical relevant study concepts. RESULTS Based on these promising early phase trial data, the German Hodgkin Study Group (GHSG) will investigate innovative treatment regimens in upcoming phase II trials. CONCLUSION The therapeutic efficacy and potential synergies of anti-PD1 antibodies in combination with chemo- or radiotherapy will be investigated in various settings of HL.
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Affiliation(s)
- C Baues
- Medical Faculty, Department of Radiooncology, University of Cologne, Cologne, Germany. .,German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany.
| | - R Semrau
- Medical Faculty, Department of Radiooncology, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
| | - U S Gaipl
- Department of Radiooncology, University hospital Erlangen, Erlangen, Germany
| | - P J Bröckelmann
- German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany.,Medical Faculty, Department of Internal Medicine I, University of Cologne, Cologne, Germany
| | - J Rosenbrock
- Medical Faculty, Department of Radiooncology, University of Cologne, Cologne, Germany
| | - A Engert
- German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany.,Medical Faculty, Department of Internal Medicine I, University of Cologne, Cologne, Germany
| | - S Marnitz
- Medical Faculty, Department of Radiooncology, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), University of Cologne, Cologne, Germany
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21
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Kriz J, Baues C, Engenhart-Cabillic R, Haverkamp U, Herfarth K, Lukas P, Schmidberger H, Marnitz-Schulze S, Fuchs M, Engert A, Eich HT. New quality assurance program integrating "modern radiotherapy" within the German Hodgkin Study Group. Strahlenther Onkol 2016; 193:100-108. [PMID: 27678010 DOI: 10.1007/s00066-016-1048-y] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/29/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Field design changed substantially from extended-field RT (EF-RT) to involved-field RT (IF-RT) and now to involved-node RT (IN-RT) and involved-site RT (IS-RT) as well as treatment techniques in radiotherapy (RT) of Hodgkin's lymphoma (HL). The purpose of this article is to demonstrate the establishment of a quality assurance program (QAP) including modern RT techniques and field designs within the German Hodgkin Study Group (GHSG). METHODS In the era of modern conformal RT, this QAP had to be fundamentally adapted and a new evaluation process has been intensively discussed by the radiotherapeutic expert panel of the GHSG. RESULTS The expert panel developed guidelines and criteria to analyse "modern" field designs and treatment techniques. This work is based on a dataset of 11 patients treated within the sixth study generation (HD16-17). CONCLUSION To develop a QAP of "modern RT", the expert panel defined criteria for analysing current RT procedures. The consensus of a modified QAP in ongoing and future trials is presented. With this schedule, the QAP of the GHSG could serve as a model for other study groups.
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Affiliation(s)
- J Kriz
- Department of Radiation Oncology, University of Muenster, Albert-Schweitzer Campus 1, Gebäude 1 A, 48419, Muenster, Germany
| | - C Baues
- Department of Radiation Oncology, University of Cologne, Köln, Deutschland
| | | | - U Haverkamp
- Department of Radiation Oncology, University of Muenster, Albert-Schweitzer Campus 1, Gebäude 1 A, 48419, Muenster, Germany
| | - K Herfarth
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Deutschland
| | - P Lukas
- Department of Radiation Oncology, University of Innsbruck, Innsbruck, Deutschland
| | - H Schmidberger
- Department of Radiation Oncology, University of Mainz, Mainz, Deutschland
| | - S Marnitz-Schulze
- Department of Radiation Oncology, University of Cologne, Köln, Deutschland
| | - M Fuchs
- Department of Internal Medicine, University of Cologne, Köln, Deutschland
| | - A Engert
- Department of Internal Medicine, University of Cologne, Köln, Deutschland
| | - H T Eich
- Department of Radiation Oncology, University of Muenster, Albert-Schweitzer Campus 1, Gebäude 1 A, 48419, Muenster, Germany.
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22
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Kriz J, Baues C, Engenhart-Cabillic R, Haverkamp U, Herfart K, Lukas P, Plütschow A, Schmidberger H, Staar S, Fuchs M, Engert A, Eich HT. Quality control of involved field radiotherapy in the HD 13 and HD 14 trials : Report of the radiotherapy panel of the German Hodgkin Study Group (GHSG). Strahlenther Onkol 2016; 193:109-115. [PMID: 27596217 DOI: 10.1007/s00066-016-1036-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/02/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION As part of the foundation of the German Hodgkin Study Group (GHSG) in 1978, a central radiotherapy (RT) reference centre was established to evaluate and to improve the quality of treatment. During the study generations, the quality assurance programs (QAP) were continued and adapted to the demands of each study. The purpose of this article is to demonstrate the results of the fifth study generation and to compare them to the previous findings. METHODS With the start of the fourth GHSG study generation (HD10-12), a central prospective review of all diagnostic images was established to create an individual treatment plan for each early stage study patient. The quality of involved field RT was retrospectively evaluated by an expert panel of radiation oncologists. In the fifth study generation (HD13-15), the retrospective review of radiotherapy performed was refined and the results were compared with the findings of the fourth generation. RESULTS The expert panel analyzed the RT planning and application of 1037 (28 %) patients (HD13 n = 465, HD14 n = 572). Simulation films were available in 85 % of cases and verification films in 87 %. RT was assessed as major violation in 46 % (HD13 = 38 %, HD14 = 52 %), minor violation in 9 % (HD13 = 9 %, HD14 = 9 %) and according to the protocol in 45 % (HD13 = 52 %, HD14 = 38 %). CONCLUSION The value for QAP of RT within the GHSG trials is well known. Still there were several protocol violations. In the future, the QAP program has to be adapted to the requirements of "modern RT" in malignant lymphoma.
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Affiliation(s)
- J Kriz
- Department of Radiation Oncology, University of Muenster, Albert-Schweitzer Campus 1, Gebäude 1 A, 48419, Muenster, Germany
| | - C Baues
- Department of Radiation Oncology, University of Cologne, Cologne, Germany
| | | | - U Haverkamp
- Department of Radiation Oncology, University of Muenster, Albert-Schweitzer Campus 1, Gebäude 1 A, 48419, Muenster, Germany
| | - K Herfart
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - P Lukas
- Department of Radiation Oncology, University of Innsbruck, Innsbruck, Austria
| | - A Plütschow
- Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - H Schmidberger
- Department of Radiation Oncology, University of Mainz, Mainz, Germany
| | - S Staar
- Department of Radiation Oncology, Bremen Mitte, Bremen, Germany
| | - M Fuchs
- Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - A Engert
- Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - H T Eich
- Department of Radiation Oncology, University of Muenster, Albert-Schweitzer Campus 1, Gebäude 1 A, 48419, Muenster, Germany.
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Eichenauer DA, Goergen H, Plütschow A, Wongso D, Behringer K, Kreissl S, Thielen I, Halbsguth T, Bröckelmann PJ, Fuchs M, Böll B, von Tresckow B, Borchmann P, Engert A. Ofatumumab in relapsed nodular lymphocyte-predominant Hodgkin lymphoma: results of a phase II study from the German Hodgkin study group. Leukemia 2015; 30:1425-7. [DOI: 10.1038/leu.2015.321] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kriz J, Plütschow A, Engenhart-Cabillic R, Herfarth K, Lukas P, Schmidberger H, Staar S, Haverkamp U, Baues C, Engert A, Eich H. Quality Assurance of Involved Field Radiation Therapy Within the HD13 and HD14 Trial (early stages) of the German Hodgkin Study Group. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kriz J, Engenhart-Cabillic R, Haverkamp U, Herfarth K, Lukas P, Schmidberger H, Staar S, Engert A, Eich H. Establishing a New Quality Assurance Program of “Modern” Radiation Therapy Within the German Hodgkin Study Group. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kobe C, Kuhnert G, Haverkamp H, Fuchs M, Kahraman D, Eich HT, Kriz J, Baues C, Nast-Kolb B, Bröckelmann PJ, Borchmann P, Drzezga A, Engert A, Dietlein M. Concordance in the interpretation of PET after chemotherapy in advanced stage Hodgkin lymphoma. Nuklearmedizin 2015; 54:241-6. [PMID: 26388152 DOI: 10.3413/nukmed-0746-15-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 06/01/2015] [Accepted: 09/16/2015] [Indexed: 01/27/2023]
Abstract
UNLABELLED The aim was to analyze the degree of agreement between the central review panel and the local PET interpretation within the HD15 trial and its impact on subsequent treatment and progression free survival. PATIENTS, METHODS The analysis set consisted of 739 patients with residues ≥ 2.5 cm after 6 or 8 cycles of BEACOPPesc from the HD15 trial performed by the German Hodgkin Study Group. The recommendation for or against further radiotherapy was based on the central [(18)F]FDG-PET interpretation. Central PET interpretation was compared to the local PET interpretation and concordance was measured using Cohen's Kappa coefficient. Prognostic impact of the analysis of concordance between local and central PET interpretations was evaluated using progression free survival (PFS); groups were compared with the log rank test. RESULTS The central panel rated 548 of 739 patients (74%) as PET negative. Of these, 513 were also rated as PET negative in the local PET interpretation. PET positivity was seen by central reviewers in the remaining 191 patients (26%), in concordance with local reviewers in 155 cases. Even though substantial agreement was found (Cohen's Kappa 0.81), the interpretation of the central PET review panel led to a different therapeutic recommendation in 71/739 (10%) patients. PFS was equally high in groups in which the therapeutic regime had been changed on the basis of the central panel decision. CONCLUSION High concordance is found between local and central reviewers with regard to PET interpretation in residual tissue after intense chemotherapy. The existence of the central PET review panel allows the identification of additional patients as PET negative so that radiotherapy can be safely omitted (35 of 548 patients = 4.7%).
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Affiliation(s)
- C Kobe
- Carsten Kobe, Department of Nuclear Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany, Tel. +49/(0)221/478-50 24, Fax -67 77,
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Eichenauer DA, Engert A, André M, Federico M, Illidge T, Hutchings M, Ladetto M. Hodgkin's lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25 Suppl 3:iii70-5. [PMID: 25185243 DOI: 10.1093/annonc/mdu181] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D A Eichenauer
- First Department of Internal Medicine, University Hospital Cologne and German Hodgkin Study Group (GHSG), Cologne, Germany
| | - A Engert
- First Department of Internal Medicine, University Hospital Cologne and German Hodgkin Study Group (GHSG), Cologne, Germany
| | - M André
- CHU Dinant-Godinne, UCL Namur, Yvoir, Belgium
| | - M Federico
- Department of Oncology, Hematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - T Illidge
- Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - M Hutchings
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - M Ladetto
- Divisione di Ematologia, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Rancea M, Will A, Borchmann P, Monsef I, Engert A, Skoetz N. Sixteenth Biannual Report of the Cochrane Haematological Malignancies Group: Focus on Non-Hodgkin's Lymphoma. J Natl Cancer Inst 2014; 106:dju170. [DOI: 10.1093/jnci/dju170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Klimm B, Goergen H, Fuchs M, von Tresckow B, Böll B, Meissner J, Glunz A, Diehl V, Eich HT, Engert A, Borchmann P. Impact of risk factors on outcomes in early-stage Hodgkin's lymphoma: an analysis of international staging definitions. Ann Oncol 2013; 24:3070-6. [PMID: 24148816 DOI: 10.1093/annonc/mdt413] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In early-stage Hodgkin's lymphoma (HL), treatment according to the early favorable or unfavorable subgroup is guided by staging definitions, which differ between various study groups worldwide. We analyzed risk factors used in different international staging systems and their impact on the outcome of early-stage HL patients. PATIENTS AND METHODS In 1173 early-stage HL patients treated homogenously within the German Hodgkin Study Group (GHSG) trials HD10 and HD11, the impact of three staging systems developed and used by the GHSG, the European Organization for Research and Treatment of Cancer (EORTC), and the National Comprehensive Cancer Network (NCCN) in discriminating risk groups for progression-free survival (PFS) and overall survival (OS) was assessed and the relevance of their single risk factors was investigated. RESULTS All the three staging systems defined an unfavorable risk group out of early-stage patients of comparable size (56%, 55%, and 57%), having a significantly poorer PFS and OS as compared with the corresponding favorable group; 5-year differences between early favorable and early unfavorable in terms of PFS were 9.4% (HR 2.61, 95% CI 1.74-3.91), 6.7% (HR 2.10, 95% CI 1.41-3.13), and 8.6% (HR 2.14, 95% CI 1.45-3.16) with the GHSG, EORTC, and NCCN definition, respectively. Sensitivity was high for all systems (84%, 79%, and 83%); however, there was a low specificity with high rates of false-positive results (1-specificity 54%, 53%, and 55%, respectively). Models of high sensitivity included risk factors associated with large tumor burden and high tumor activity. Most risk factors for tumor-specific end points were also predictive of OS. CONCLUSIONS Differentiating between a favorable and an unfavorable risk group has significant impact on PFS and OS in early-stage HL patients in the modern treatment era. Risk-adapted treatment strategies using new risk factors with higher specificity are needed.
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Affiliation(s)
- B Klimm
- Department I of Internal Medicine, German Hodgkin Study Group (GHSG), University Hospital Cologne
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Hay AE, Klimm B, Chen BE, Goergen H, Shepherd LE, Fuchs M, Gospodarowicz MK, Borchmann P, Connors JM, Markova J, Crump M, Lohri A, Winter JN, Dörken B, Pearcey RG, Diehl V, Horning SJ, Eich HT, Engert A, Meyer RM. An individual patient-data comparison of combined modality therapy and ABVD alone for patients with limited-stage Hodgkin lymphoma. Ann Oncol 2013; 24:3065-9. [PMID: 24121121 DOI: 10.1093/annonc/mdt389] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Treatment options for patients with nonbulky stage IA-IIA Hodgkin lymphoma include combined modality therapy (CMT) using doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) plus involved-field radiation therapy (IFRT), and chemotherapy with ABVD alone. There are no mature randomized data comparing ABVD with CMT using modern radiation techniques. PATIENTS AND METHODS Using German Hodgkin Study Group HD10/HD11 and NCIC Clinical Trials Group HD.6 databases, we identified 588 patients who met mutually inclusive eligibility criteria from the preferred arms of HD10 or 11 (n = 406) and HD.6 (n = 182). We evaluated time to progression (TTP), progression-free (PFS) and overall survival, including in three predefined exploratory subset analyses. RESULTS With median follow-up of 91 (HD10/11) and 134 (HD.6) months, respective 8-year outcomes were for TTP, 93% versus 87% [hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.24-0.78]; for PFS, 89% versus 86% (HR 0.71, 95% CI 0.42-1.18) and for overall survival, 95% versus 95% (HR 1.09, 95% CI 0.49-2.40). In the exploratory subset analysis including HD10 eligible patients who achieved complete response (CR) or unconfirmed complete response (CRu) after two cycles of ABVD, 8-year PFS was 87% (HD10) versus 95% (HD.6) (HR 2.8; 95% CI 0.64-12.5) and overall survival 96% versus 100%. In contrast, among those without CR/CRu after two cycles of ABVD, 8-year PFS was 88% versus 74% (HR 0.35; 95% CI 0.16-0.79) and overall survival 95% versus 91%, respectively (HR 0.42; 95% CI 0.12-1.44). CONCLUSIONS In patients with nonbulky stage IA-IIA Hodgkin lymphoma, CMT provides better disease control than ABVD alone, especially among those not achieving complete response after two cycles of ABVD. Within the follow-up duration evaluated, overall survivals were similar. Longer follow-up is required to understand the implications of radiation and chemotherapy-related late effects. CLINICAL TRIALS The trials included in this analysis were registered at ClinicalTrials.gov: HD10 - NCT00265018, HD11 - NCT00264953, HD.6 - NCT00002561.
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Affiliation(s)
- A E Hay
- NCIC Clinical Trials Group and Queen's University, Kingston, Ontario, Canada
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Eich H, Kriz J, Reinartz G, Kobe C, Kuhnert G, Haverkamp U, Haverkamp H, Hegerfeld K, Baues C, Engert A. Relapse Analysis After Radiation Therapy of PET-Positive Residual Tumors of Patients With Advanced Stage Hodgkin Lymphoma Treated in the HD15 Trial of the German Hodgkin Study Group (GHSG). Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rancea M, Will A, Borchmann P, Monsef I, Engert A, Skoetz N. Fifteenth Biannual Report of the Cochrane Haematological Malignancies Group--Focus on Non-Hodgkin's Lymphoma. J Natl Cancer Inst 2013; 105:1159-70. [DOI: 10.1093/jnci/djt165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Eich HT, Kriz J, Schmidberger H, Böll B, Klimm B, Rancea M, Müller RP, Engert A. The German evidence-based guidelines for Hodgkin's lymphoma. Aspects for radiation oncologists. Strahlenther Onkol 2013; 189:445-7. [PMID: 23604187 DOI: 10.1007/s00066-013-0331-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 02/13/2013] [Indexed: 11/29/2022]
Abstract
This report reviews aspects of the German evidence-based guidelines for Hodgkin's lymphoma relevant to radiation oncologists. Stage-adapted treatment is discussed with the focus on radiotherapy. Up-to-date literature citations provide an overview of current recommendations.
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Affiliation(s)
- H T Eich
- Department of Radiation Oncology, University of Muenster, Albert-Schweitzer-Campus 1, Münster, Germany.
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Behringer K, Müller H, Görgen H, Flechtner HH, Brillant C, Halbsguth TV, Thielen I, Eichenauer DA, Schober T, Nisters-Backes H, Fuchs M, Engert A, Borchmann P. Sexual quality of life in Hodgkin Lymphoma: a longitudinal analysis by the German Hodgkin Study Group. Br J Cancer 2013; 108:49-57. [PMID: 23321510 PMCID: PMC3553532 DOI: 10.1038/bjc.2012.550] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Health-related quality of life (HRQoL) comprises different domains of physical, mental, and social well-being. In this analysis, we focus on sexual quality of life in Hodgkin Lymphoma (HL) patients. Methods: Four-thousand one-hundred and sixty patients enroled in the HD10–HD12 trials underwent HRQoL assessment. Instruments included the Quality of Life Questionnaire for survivors (QLQ-S), combining the European Organisation for Research and Treatment of Cancer QLQ-C30, Multidimensional fatigue (FA) inventory (MFI-20) and an additional sexual functioning (SX) scale. We describe SX up to 27 months after therapy and analyse relationship to stage, age, gender, FA, social functioning, and therapy. Statistical methods range from descriptive statistics to a classification of SX courses, and a longitudinal structural equations model with full information maximum likelihood estimation of missing data. In the analysis, a score below 50 was used to describe severe sexual dysfunction. Results: Three-thousand two-hundred and eight patients provided data on SX. Patients in advanced stages reported lower SX than patients in early stages both, before and after the treatment. During follow-up, an improvement of SX compared with baseline was detected, except for those ⩾50 years. Patients in early stages reached normal SX, whereas advanced-stage patients remained below the reference value for healthy controls. Sexual functioning during follow-up was significantly and strongly related to previous SX, other HRQoL measures, age, and stage, and to lesser degree with gender and chemotherapy. Conclusion: Overall, HL patients have a decreased sexual quality of life at baseline, which improves after therapy and normalises in early-stage patients. Importantly, long-term SX is more closely related to patient characteristics and SX at baseline than to the intensity of treatment.
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Affiliation(s)
- K Behringer
- First Department of Internal Medicine, German Hodgkin Study Group (GHSG), University of Cologne, Kerpener Street 62, D-50924 Cologne, Germany
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Eich H, Kriz J, Klimm B, Sasse S, Görgen H, Diehl V, Borchmann P, Mueller R, Engert A. Involved-field (IF) Versus Extended-field (EF) Radiation Therapy (RT) for Patients in Early Unfavorable Stages of Hodgkin Lymphoma: 10-year Update of the HD8 Trial of the German Hodgkin Study Group (GHSG). Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sasse S, Klimm B, Görgen H, Fuchs M, Heyden-Honerkamp A, Lohri A, Koch O, Wilhelm M, Trenn G, Finke J, Müller RP, Diehl V, Eich HT, Borchmann P, Engert A. Comparing long-term toxicity and efficacy of combined modality treatment including extended- or involved-field radiotherapy in early-stage Hodgkin's lymphoma. Ann Oncol 2012; 23:2953-2959. [PMID: 22767583 DOI: 10.1093/annonc/mds110] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND To evaluate long-term toxicity and efficacy of a combined modality strategy including extended-field radiotherapy (EF-RT) or involved-field radiotherapy (IF-RT), the German Hodgkin Study Group carried out a follow-up analysis in patients with early unfavorable Hodgkin's lymphoma (HL). PATIENTS AND METHODS One thousand two hundred and four patients were randomized to four cycles of chemotherapy followed by either 30 Gy EF- or 30 Gy IF-RT (HD8 trial); 532 patients in each treatment arm were eligible. RESULTS At 10 years, no arm differences were revealed with respect to freedom from treatment failure (FFTF) (79.8% versus 79.7%), progression-free survival (79.8% versus 80.0%), and overall survival (86.4% versus 87.3%). Non-inferiority of IF-RT was demonstrated for the primary end point FFTF (95% confidence interval for hazard ratio 0.72-1.25). Elderly patients had a poorer outcome when treated with EF-RT. So far, 15.0% of patients in arm A and 12.2% in arm B died, mostly due to secondary malignancies (5.3% versus 3.4%) or HL (3.2% versus 3.4%). After EF-RT, there were more secondary malignancies overall (58 versus 45), especially acute myeloid leukemias (11 versus 4). CONCLUSION Radiotherapy intensity reduction to IF-RT does not result in poorer long-term outcome but is associated with less acute toxicity and might be associated with less secondary malignancies.
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Affiliation(s)
- S Sasse
- First Department of Internal Medicine, University Hospital Cologne, Cologne; German Hodgkin Study Group, Cologne, Germany
| | - B Klimm
- First Department of Internal Medicine, University Hospital Cologne, Cologne; German Hodgkin Study Group, Cologne, Germany
| | - H Görgen
- German Hodgkin Study Group, Cologne, Germany
| | - M Fuchs
- German Hodgkin Study Group, Cologne, Germany
| | | | - A Lohri
- Department of Internal Medicine, Kantonsspital Liestal, Liestal, Switzerland
| | - O Koch
- Third Department of Internal Medicine, Klinikum Osnabrück, Osnabrück
| | - M Wilhelm
- Fifth Department of Internal Medicine, Klinikum Nuernberg, Nuernberg
| | - G Trenn
- Department of Internal Medicine, Knappschaftskrankenhaus Bottrop, Bottrop
| | - J Finke
- First Department of Internal Medicine, University Hospital Freiburg, Freiburg
| | - R P Müller
- Department of Radiotherapy, University Hospital Cologne, Cologne
| | - V Diehl
- German Hodgkin Study Group, Cologne, Germany
| | - H T Eich
- Department of Radiotherapy, University Hospital Muenster, Muenster, Germany
| | - P Borchmann
- German Hodgkin Study Group, Cologne, Germany
| | - A Engert
- First Department of Internal Medicine, University Hospital Cologne, Cologne; German Hodgkin Study Group, Cologne, Germany.
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Kriz J, Mueller RP, Mueller H, Kuhnert G, Engert A, Kobe C, Haverkamp U, Eich H. Large mediastinal tumor mass as a prognostic factor in Hodgkin’s lymphoma. Strahlenther Onkol 2012; 188:1020-4. [DOI: 10.1007/s00066-012-0163-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rancea M, Skoetz N, Monsef I, Hubel K, Engert A, Bauer K. Fourteenth Biannual Report of the Cochrane Haematological Malignancies Group--Focus on Autologous Stem Cell Transplantation in Hematological Malignancies. J Natl Cancer Inst 2012; 104:NP. [DOI: 10.1093/jnci/djs278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kriz J, Bangard C, Haverkamp U, Bongartz R, Baues C, Engert A, Mueller RP, Eich HT. Quality control of involved-field radiotherapy for patients with early stage Hodgkin's lymphoma based on a central prospective review. Comparison of the results between two study generations of the German Hodgkin Study Group. Strahlenther Onkol 2012; 188:660-5. [PMID: 22692351 DOI: 10.1007/s00066-012-0103-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 03/07/2012] [Accepted: 03/08/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Based on experience in trials HD10 and HD11 (1998-2003), the radiotherapy reference center of the German Hodgkin Study Group (GHSG) continued their central prospective radiation oncological review in trials HD13 and HD14. The purpose of this analysis was to identify the impact of this procedure on radiotherapeutic management and to compare findings with former trials. METHODS Between 2003 and 2009, 1,710 patients were enrolled in the HD13 trial (early favorable stages) and 2,039 patients in the HD14 trial (early unfavorable stages). All patients received a total of 30 Gy involved-field (IF) radiotherapy within a combined modality approach. RESULTS For patients in HD13, there was a correction of disease involvement in 847/1,518 patients (56%), and for patients in HD14 in 1,370/1,905 patients (72%). Most discrepancies were observed in the lower mediastinum (19.2%), infraclavicular (31.7%), upper cervical (12.7%), and supraclavicular (10.8%) lymph nodes. This resulted in a change of disease stage in 241 (7%) patients and a shift into another study protocol in 66 (2%) patients. Due to the incorrect lymph node documentation of the participating study centers, the IF radiotherapy volume had to be enlarged in 1,063/3,423 patients (31%) and reduced in 244/3,423 patients (7.1%). These findings are comparable to the results of the quality control in the trials HD10 and HD11 (2,611 patients reviewed). CONCLUSION Central review of the diagnostic imaging and clinical findings of Hodgkin's lymphoma patients shows a considerable number of discrepancies compared with the local evaluation. Thus, meticulous evaluation of all imaging information in close collaboration between the radiation oncologist and diagnostic radiologist is mandatory.
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Affiliation(s)
- J Kriz
- Department of Radiation Oncology, University of Muenster, Albert-Schweitzer Campus 1, Gebäude 1A, 48419, Muenster, Germany
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Elter T, James R, Busch R, Winkler D, Ritgen M, Böttcher S, Kahl C, Gassmann W, Stauch M, Hasan I, Staib P, Fischer K, Fink AM, Bahlo J, Bühler A, Döhner H, Wendtner CM, Stilgenbauer S, Engert A, Hallek M. Fludarabine and cyclophosphamide in combination with alemtuzumab in patients with primary high-risk, relapsed or refractory chronic lymphocytic leukemia. Leukemia 2012; 26:2549-52. [DOI: 10.1038/leu.2012.129] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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41
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Kobe C, Engert A, Markova J, Haverkamp H, Eich HT, Müller RP, Holstein A, Kahraman D, Dietlein M, Borchmann P, Diehl V. Assessment of residual bulky tumor using FDG-PET in patients with advanced stages after completion of chemotherapy. Final report of the GHSG HD15 trial. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Behringer K, Thielen I, Mueller H, Goergen H, Eibl AD, Rosenbrock J, Halbsguth T, Eichenauer DA, Fuchs M, Reiners KS, Renno JH, van der Ven K, Kuehr M, von Wolff M, Diehl V, Engert A, Borchmann P. Fertility and gonadal function in female survivors after treatment of early unfavorable Hodgkin lymphoma (HL) within the German Hodgkin Study Group HD14 trial. Ann Oncol 2012; 23:1818-25. [PMID: 22228451 DOI: 10.1093/annonc/mdr575] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the HD14 trial, 2×BEACOPPescalated+2×ABVD (2+2) has improved the primary outcome. Compared with 4×ABVD, this benefit might be compromised by more infertility in women. Therefore, we analyzed gonadal function and fertility. PATIENTS AND METHODS Women≤45 years in ongoing remission at least 1 year after therapy were included. Hormone parameters, menopausal symptoms, measures to preserve fertility, menstrual cycle, pregnancies, and offspring were evaluated. RESULTS Three hundred and thirty one of 579 women addressed participated (57.2%) and 263 per-protocol treated patients qualified (A=ABVD: 137, B=2+2: 126, mean time after therapy 42 and 43 months, respectively). Regular menstrual cycle after treatment (A: 87%, B: 83%) and time to recovery (≤12 months) were not different. Follicle-stimulating hormone and anti-Muellerian hormone were significantly better in arm A. However, pregnancies after therapy favored arm B (A: 15%, B: 26%, P=0.043) and motherhood rates were equivalent to the German normal population. Multivariate analysis revealed prophylactic use of gonadotropin-releasing hormone (GnRH) analogues as highly significant prognostic factor for preservation of fertility (odds ratio=12.87, P=0.001). Severe menopausal symptoms were frequent in women≥30 years (A: 21%, B: 25%). CONCLUSIONS Hormonal levels after 2+2 indicate a reduced ovarian reserve. However, 2+2 in combination with GnRH analogues does not compromise fertility within the evaluated observation time.
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Affiliation(s)
- K Behringer
- First Department of Internal Medicine, University Hospital of Cologne, and Institute for Clinical Chemistry, University of Cologne, Cologne, Germany
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Eichenauer DA, Engert A, Dreyling M. Hodgkin's lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2011; 22 Suppl 6:vi55-8. [PMID: 21908505 DOI: 10.1093/annonc/mdr378] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D A Eichenauer
- First Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
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Eich H, Kobe C, Dietlein M, Kriz J, Haverkamp H, Fuchs M, Borchmann P, Engert A, Mueller R. Role of Radiotherapy after Assessment of Residual Bulky Tumor using FDG-PET in Patients with Advanced-stage Hodgkin Lymphoma: Final Report of the GHSG HD15 Trial. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Kobe C, Dietlein M, Borchmann P, Engert A, Kuhnert G, Fuchs M, Haverkamp H, Eich H, Kriz J, Diehl V. 57 INVITED PET-Response Adapted Therapy in Hodgkin Lymphoma. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70272-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Deckert M, Engert A, Brück W, Ferreri AJM, Finke J, Illerhaus G, Klapper W, Korfel A, Küppers R, Maarouf M, Montesinos-Rongen M, Paulus W, Schlegel U, Lassmann H, Wiestler OD, Siebert R, DeAngelis LM. Modern concepts in the biology, diagnosis, differential diagnosis and treatment of primary central nervous system lymphoma. Leukemia 2011; 25:1797-807. [PMID: 21818113 DOI: 10.1038/leu.2011.169] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recent studies addressing the molecular characteristics of PCNSL, which is defined as malignant B-cell lymphoma with morphological features of DLBCL, have significantly improved our understanding of the pathogenesis of this lymphoma entity, which is associated with an inferior prognosis as compared with DLBCL outside the CNS. This unfavorable prognosis stimulated intense efforts to improve therapy and induced recent series of clinical studies, which addressed the role of radiotherapy and various chemotherapeutic regimens. This review combines the discussion of diagnosis, differential diagnosis and recent progress in studies addressing the molecular pathogenesis as well as therapeutic options in PCNSL.
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Affiliation(s)
- M Deckert
- Department of Neuropathology, University Hospital of Cologne, Cologne, Germany.
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Chen RW, Gopal AK, Smith SE, Ansell SM, Rosenblatt JD, Savage KJ, Connors JM, Engert A, Larsen EK, Kennedy DA, Sievers EL, Younes A. Results from a pivotal phase II study of brentuximab vedotin (SGN-35) in patients with relapsed or refractory Hodgkin lymphoma (HL). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Harrison SJ, Hsu AK, Neeson PJ, Younes A, Sureda A, Engert A, Li M, Savage P, Bugarini R, Le Corre C, Williams DE, Gallagher JD, Shen A, Ritchie D. Biomarker analysis of pivotal phase II study of oral panobinostat (PAN) in relapsed/refractory Hodgkin lymphoma (HL) patients following autologous stem cell transplant (ASCT). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Scholz M, Engert A, Franklin J, Josting A, Diehl V, Hasenclever D, Loeffler M. Impact of first- and second-line treatment for Hodgkin’s lymphoma on the incidence of AML/MDS and NHL—experience of the German Hodgkin’s Lymphoma Study Group analyzed by a parametric model of carcinogenesis. Ann Oncol 2011; 22:681-688. [DOI: 10.1093/annonc/mdq408] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mueller R, Eich H, Plütschow A, Debus J, Bamberg M, Wilborn K, Eble M, Müller-Hermelink H, Diehl V, Engert A. Two Cycles of ABVD Followed by Involved Field Radiotherapy with 20 Gray (Gy) is the New Standard of Care in the Treatment of Patients with Early Stage Hodgkin Lymphoma: Final Analysis of the Randomized German Hodgkin Study Group (GHSG) Trial HD10. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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