scholarly journals Outcome of patients older than 60 years with classical Hodgkin lymphoma treated with front line ABVD chemotherapy: frequent pulmonary events suggest limiting the use of bleomycin in the elderly

2015 ◽  
Vol 170 (2) ◽  
pp. 179-184 ◽  
Author(s):  
Aspasia Stamatoullas ◽  
Pauline Brice ◽  
Reda Bouabdallah ◽  
Sylvain Mareschal ◽  
Vincent Camus ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
The Elderly ◽  
Classical Hodgkin Lymphoma ◽  
Front Line ◽  
Abvd Chemotherapy

scholarly journals Febrile Hypotensive Reactions Following ABVD Chemotherapy in Patients With EBV-associated Classical Hodgkin Lymphoma

2019 ◽  
Vol 19 (3) ◽  
pp. e123-e128
Author(s):  
David A. Bond ◽  
Emily Dotson ◽  
Farrukh T. Awan ◽  
Robert A. Baiocchi ◽  
Kristie A. Blum ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Classical Hodgkin Lymphoma ◽  
Abvd Chemotherapy

Clinicopathological Features of Nodular Sclerosis-Type Classical Hodgkin Lymphoma In the Elderly: Multicenter Study of Hodgkin Lymphoma In Japan

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2677-2677
Author(s):  
Naoko Asano ◽  
Tomohiro Kinoshita ◽  
Koichi Ohshima ◽  
Tadashi Yoshino ◽  
Nozomi Niitsu ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Hodgkin Lymphoma ◽  
Research Funding ◽  
The Elderly ◽  
Clinicopathological Features ◽  
Line Treatment ◽  
Classical Hodgkin Lymphoma ◽  
First Line ◽  
Advisory Committees ◽  
First Line Treatment

Abstract Abstract 2677 Background: Classical Hodgkin lymphoma (CHL), which is characterized by the presence of Hodgkin and Reed Sternberg (H-RS) cells in a background of non-neoplastic inflammatory cells, is divided into four histological subgroups, nodular sclerosis (NSCHL), mixed cellularity (MCCHL), lymphocyte-rich, and lymphocyte depletion. While NSCHL in young adults is characterized by a mediastinal mass and good prognosis, the clinicopathological characteristics of NSCHL in the elderly (NSCHL-e) remain uncertain. Patients and methods: Enrolled patients were diagnosed with CHL between 1986 and 2006 as part of the Hodgkin Lymphoma's Multicenter Study Group. To better characterize NSCHL-e, we compared the clinicopathological profiles of 84 NSCHL-e patients aged 50 or over with 237 NSCHL-y patients aged 49 or younger and 302 with MCCHL. Results: The total of 743 CHL patients consisted of 496 men and 247 women with a median age of 48 years (range, 15– 89 years). The pathological diagnoses were NSCHL in 324 patients (43%) and MCCHL in 303 (41%). NSCHL patients showed a bimodal age distribution, with an initial peak in their 20s and a second small peak in their 60s. We categorized the former as NSCHL-y (49 or younger) and the latter as NSCHL-e (50 and over). NSCHL-e patients were characterized by male predominance and a more advanced clinical stage (53%) than NSCHL-y. Immunophenotypically, H-RS cells had the prototypic immunophenotype of CD15+ CD30+ and Pax5+. NSCHL-e cases showed a significantly higher rate of CD20 (24%) than NSCHL-y (8%, P = 0.001). Furthermore, H-RS cells in 29 of 75 (39%) patients with NSCHL-e were positive for EBV RNA transcripts by in situ hybridization, whereas only 7% of NSCHL-y cases were EBER-positive (P < 0.0001) (Table). Regarding NSCHL-e and MCCHL, no significant difference between these patients was seen in clinical characteristics. Immunophenotypically, NSCHL-e patients showed significantly higher rates for CD3 and TIA-1, while MCCHL patients showed higher EBV positivity (75%). Fifty-five of 63 patients received systemic multi-agent chemotherapy as first-line treatment, consisting of doxorubicin, bleomycin, vinblastine, and dacarbacin (ABVD) in 38 patients; CHOP in 8; C-MOPP in 8; and BEACOPP in 1. Overall, 51 patients responded to first-line treatment, 39 with complete response and 12 with partial response. Disease-specific survival of NSCHL-e was poorer than that of NSCHL-y (P < 0.001) but similar to that of MCCHL (P = 0.43) (Figure). Conclusion: NSCHL-e is characterized by an unfavorable prognosis and different clinicopathological features to NSCHL-y, which is considered as typical NSCHL. A number of cases of NSCHL-e might have been associated with MCCHL, with most being EBV-positive. These results suggest the limitations of current histological subgroupings for CHL. Disclosures: Matsushita: Pfizer CO.: Membership on an entity's Board of Directors or advisory committees, Research Funding; Baxter Co.: Membership on an entity's Board of Directors or advisory committees, Research Funding.

Impact of Treatment on IL-10, CTLA-4 and PD-L1 Gene Expression in Patients with Classical Hodgkin Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5290-5290
Author(s):  
Priscilla Brito Silva ◽  
Juliana Monte Real ◽  
Ludmila Rodrigues Pinto Ferreira ◽  
Gustavo Henrique Esteves ◽  
Joao Garibaldi Junior ◽  
...  
Keyword(s):  
Gene Expression ◽  
Immune Response ◽  
Hodgkin Lymphoma ◽  
Gene Expression Profile ◽  
Expression Profile ◽  
Peripheral Blood ◽  
Immune Gene ◽  
Classical Hodgkin Lymphoma ◽  
Immune Gene Expression ◽  
Abvd Chemotherapy

Abstract Introduction: Interleukin (IL)-10 is an anti-inflammatory cytokine with potent inhibitory effects in immune response. Higher expression of IL-10 has also been detected in classical Hodgkin lymphoma (cHL), and it has been suggested that the cytokine is involved in the pathogenesis of these tumors. CTLA-4 has long been recognized as regulatory function, potentially decreasing antitumor immune response. Augmentation of the immune response via blockade of CTLA-4 has shown an improvement in survival for patients with metastatic melanoma, Overexpression of PD-L1 on Reed-Sternberg cells is related with downregulation of effector T cell function and represents a potent mechanism of tumor evasion. PD-L1 inhibitors have shown excellent results in refractory cHL patients. Objectives: The aim of the study was to evaluate the immune gene expression profile in peripheral blood of cHL patients at diagnosis and post-treatment and correlate these findings with clinical and epidemiological aspects. Patient and Methods: This is an open multicenter study and, so far, we included 51 patients consecutively from February 2011 to November 2015. Twenty consecutively diagnosed cHL patients, with whole blood RNA extracted at diagnosis and after treatment, were recruited for this study and prospectively evaluated. The general expression of 96 messengers RNAs present in the peripheral blood and involved in immune response was performed by a customized quantitative real-time PCR array (TaqMan¨Low Density Array). The data was normalized with B2M mRNAs levels and relative gene expression was calculated by the 2^DDCt method, considering Wilcoxon test and Benjamini-Hochberg adjustment to correct p-values. In this study, only cHL patients whose histology could be confirmed were studied. All patients were HIV negative and received ABVD chemotherapy protocol and radiotherapy if necessary. Results: From the 20 patients included in this study, 12 (60%) were male, 5 (31%) had Epstein Barr virus related cHL, 18 (90%) patients presented with B symptoms, 19 (95%) patients had advanced disease at diagnosis (stage IIBX, III and IV). Results of immune gene expression profile in paired samples from 15 patients before (pre) treatment and after (post) treatment are summarized in the following table: We observed higher expression of CD274 (PD-L1), CTLA-4 and IL-10 mRNAs in patients at diagnosis compared to expression after treatment. We found no association between relapse and immune gene expression or epidemiological and clinical characteristics. Conclusions: In this study we showed that IL-10, CD274 (PD-L1) and CTLA4 are downregulated after therapy, which suggests a mechanism for tumor immune evasion that was reverted by ABVD chemotherapy and radiotherapy. Understanding cHL associated immunosuppression and the immune reconstitution after treatment maybe the key to develop new prognostic factors and treatment strategies. Table Table. Disclosures No relevant conflicts of interest to declare.

Economic impact of disease progression following front-line therapy in classical Hodgkin lymphoma

2015 ◽  
Vol 56 (11) ◽  
pp. 3143-3149 ◽  
Author(s):  
Christopher A. Yasenchak ◽  
Wan-Yu Tseng ◽  
Mark Yap ◽  
Debra Rembert ◽  
Debra A. Patt
Keyword(s):  
Economic Impact ◽  
Disease Progression ◽  
Hodgkin Lymphoma ◽  
Classical Hodgkin Lymphoma ◽  
Front Line ◽  
Line Therapy

Rituximab + ABVD Improves Event-Free Survival (EFS) in Patients with Classical Hodgkin Lymphoma in All International Prognostic Score (IPS) Groups and in Patients Who Have PET Positive Disease after 2–3 Cycles of Therapy.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 215-215 ◽  
Author(s):  
Amanda R. Wedgwood ◽  
Michelle A. Fanale ◽  
Luis E. Fayad ◽  
Peter McLaughlin ◽  
Fredrick B. Hagemeister ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
B Cells ◽  
Hodgkin Lymphoma ◽  
Prognostic Score ◽  
Newly Diagnosed ◽  
Classical Hodgkin Lymphoma ◽  
Event Free Survival ◽  
Free Survival ◽  
Abvd Chemotherapy

Abstract The use of rituximab in classical Hodgkin lymphoma (HL) has been proposed to have a therapeutic value by several mechanisms; to The malignant Hodgkin and Reed-Sternberg (HRS) cells of Hodgkin lymphoma (HL) rarely survive outside their microenvironment of reactive B-cells, and therefore we hypothesized that depleting B-cells from HL microenvironment by rituximab may deprive HRS cells from critical survival and resistance factors and therefore improving the efficacy of chemotherapy, Rituximab may have a direct killing effect on HRS cells that express CD20, and recent data from Johns Hopkins Medical Center suggested that HRS stem cells are CD20+ cells. With this background, we evaluated the safety and efficacy the combination of rituximab and ABVD (R-ABVD) chemotherapy in newly diagnosed patients with classical HL. In addition, PET after 2–3 cycles of ABVD has been shown to confer poor prognosis and therefore proposed to guide future therapy. (Hutchings et al, Blood, 2006) reported a negative PET scan after two cycles of ABVD to be a good predictor of outcome with 96% 2-year progression free survival (PFS). Those with PET positive after 2 cycles had a 0% PFS at 2 years. Thus, we examined the effect of RABVD on early PET imaging and determined whether PET status remains predictive of treatment outcome in patients receiving RABVD. To date 70 newly diagnosed pts are enrolled, of whom 65 pts had at least 12 months of follow up and are evaluable for treatment response. Median age 28 years (Range; 18–72 years). Patients had stage II (50%), stage III (31%), stage IV (19%) disease. Using the IPS prognostic score model, 36 patients (55%) had a score of 2 or higher. With a median follow up of 32 months, the estimated event-free survival (EFS) is for the entire group is 85% and overall survival 98%. EFS for patients with IPS 0–1, 2, and &gt;2 are 95%, 76%, and 77%, respectively, suggesting that R-ABVD improved EFS in all IPS scores with the biggest impact seen in patients with IPS &gt; 2. 55 patients had PET after 2–3 cycles and were included in the predictive analysis of PET on treatment outcome. PET became negative in 43 patients (78%) after completing 2–3 cycles of RABVD and positive in the remaining 12 patients (22%). 5-year EFS for those with negative PET was 93% and 75% for those who remained PET positive (p=0.05). We conclude that in patients with classical HL, the addition of 6 weekly doses of rituximab to standard dose and schedule of ABVD chemotherapy is effective in terms of remission rate and remission duration irrespective of IPS category. Our data confirmed prior reports that patients who remain PET positive after 2–3 cycles have worse prognosis when compared to those that achieve PET negativity. However, the outcome for those who remained PET positive after 2–3 cycles of RABVD seems to be significantly better than what has been previously reported when using ABVD alone. A randomized trial comparing ABVD with RABVD is planned to confirm these observations.

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