scholarly journals Severe Aplastic Anemia as First Manifestation of Classical Hodgkin Lymphoma

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Cláudia L. Pedrosa ◽  
Patrícia Rosinha ◽  
Patrícia Seabra ◽  
Gisela Ferreira ◽  
Cláudia Rosado ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Prognostic Score ◽  
Classical Hodgkin Lymphoma ◽  
Stage Iiia ◽  
Left Shift ◽  
Hemorrhagic Event ◽  
Lymphoma Treatment ◽  
Progressive Pancytopenia ◽  
Autoimmune Cytopenia ◽  
Rare Instance

Autoimmune cytopenia, a known paraneoplastic complication of lymphoid neoplasms, may occur before, concurrently, at relapse, or even years after completion of lymphoma treatment. In the case of Hodgkin lymphoma (HL), it is thought that immune dysregulation, typical of this neoplasm, may be involved in the genesis of these manifestations. We report a 57-year-old male presenting with stage IIIA, International Prognostic Score (IPS) 4, nodular sclerosis HL, and severe AA (SAA) confirmed on the histologic exam of the bone marrow that showed severe marrow hypoplasia due to a decrease in the elements of the three cell linages with left shift of the myeloid maturation. Immunosuppression with steroids and cyclosporine A was started. Eltrombopag and G-CSF were also added. In spite of prompt initiation of immunosuppressive therapy, the patient presented an unfavorable outcome with progressive pancytopenia and severe acute cerebral hemorrhagic event. The patient died 59 days after admission. Although autoimmune disorders are described in HL, its concomitant diagnosis is extremely rare. Our case shows a rare instance of SAA as the first manifestation of HL.

scholarly journals Phase 2 study of rituximab plus ABVD in patients with newly diagnosed classical Hodgkin lymphoma

Blood ◽  
2012 ◽  
Vol 119 (18) ◽  
pp. 4123-4128 ◽  
Author(s):  
Anas Younes ◽  
Yasuhiro Oki ◽  
Peter McLaughlin ◽  
Amanda R. Copeland ◽  
Andre Goy ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Prognostic Score ◽  
Survival Rates ◽  
Clinical Activity ◽  
Advanced Stage ◽  
Phase 2 ◽  
Classical Hodgkin Lymphoma ◽  
Phase 2 Study ◽  
Standard Doxorubicin ◽  
Intent To Treat

Abstract In the present study, we evaluated the efficacy and safety of rituximab in combination with standard doxorubicin, bleomycin, vinblastine, and dacarbazine (RABVD) in patients with classical Hodgkin lymphoma (cHL). In this phase 2 study, patients with chemotherapy-naive, advanced-stage cHL were treated with rituximab 375 mg/m2 weekly for 6 weeks and standard ABVD for 6 cycles. The primary outcome was event-free survival (EFS) at 5 years. Eighty-five patients were enrolled, of whom 78 were eligible. With a median follow-up duration of 68 months (range, 26-110), and based on an intent-to-treat analysis, the 5-year EFS and overall survival rates were 83% and 96%, respectively. The 5-year EFS for patients with stage III/IV cHLwas 82%. Furthermore, the 5-year EFS for patients with an International Prognostic Score of 0-2 was 88% and for those with a score of > 2, it was 73%. The most frequent treatment-related grade 3 or 4 adverse events were neutropenia (23%), fatigue (9%), and nausea (8%). Our results demonstrate that the addition of rituximab to ABVD is safe and has a promising clinical activity in patients with advanced-stage cHL. These data are currently being confirmed in a multicenter randomized trial. This trial has been completed and is registered with www.clinicaltrials.gov as NCT00504504.

Tumor-infiltrating CD163-positive macrophages, clinicopathological parameters, and prognosis in classical Hodgkin lymphoma

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 8528-8528
Author(s):  
P. Kamper ◽  
K. Bendix ◽  
S. Hamilton-Dutoit ◽  
B. Honoré ◽  
F. d'Amore
Keyword(s):  
Hodgkin Lymphoma ◽  
Prognostic Score ◽  
Alternative Activation ◽  
Clinicopathological Parameters ◽  
Type I ◽  
Classical Hodgkin Lymphoma ◽  
Neoplastic Cells ◽  
Chl A ◽  
Cd163 Expression ◽  
Clinical Records

8528 Background: Classical Hodgkin lymphoma (cHL) is characterized by a minority of neoplastic cells surrounded by a heterogeneous background of non-neoplastic cells. A possible prognostic role of LAMs in cHL and follicular lymphomas has been suggested. CD163 is a haemoglobin scavenger receptor expressed by monocytes/macrophages. A high CD163 expression has been observed in macrophages belonging to the “alternative activation” pathway suggested to have pro-tumoral effect. The aim of the present study was to correlate the expression of the tumor-infiltrating CD163+ LAMs with clinico-pathological features and prognosis in a cohort of previously untreated HL patients (pts). Methods: A tissue microarray (TMA) was constructed with paraffin embedded tissue specimens from 286 cHL cases. CD163 expression was assessed immunohistochemically and the degree of intratumoral LAM infiltration was scored semi-quantitatively. Clinical data were obtained from the Danish population-based lymphoma registry and clinical records. All pts were homogeneously treated with either chemo-radiotherapy (localised disease) or ABVD chemotherapy (advanced disease). Results: The median age was 37 yrs (range: 6–86 yrs). The M:F ratio was 1.2. The histological subtypes were: nodular sclerosis (NS)-type I, 167 cases (59 %); NS-type II, 71 (25%); mixed cellularity (MC), 44 (15 %); lymphocyte-rich, lymphocyte-depleted and cHL-NOS, each one case. Of 253 pts with assessable International Prognostic Score (IPS), 204 had a low-risk (≤ 2) and 49 a high risk (>2) profile. A high number of tumour-infiltrating CD163+ cells was associated with a significantly poorer overall and event-free survival (p=0.029 and p=0.018, respectively). Furthermore, a high expression of CD163 strongly correlated to stage IV disease (p=0.035), presence of B-symptoms (p=0.008), lymphocytopenia (p=0.003), hypersedimentation (p=0.009). In a multivariate analysis, IPS score > 2 remained the strongest predictor. Conclusions: In cHL, a high number of intratumoral CD163+ monocytes/macrophages correlates with adverse outcome and with clinical parameters reflecting underlying aggressive disease biology. No significant financial relationships to disclose.

scholarly journals Evaluation of Absolute Lymphocytes: Absolute Monocytes (ALC:AMC) Ratio As Prognostic Marker in Classical Hodgkin Lymphoma Patients Treated with ABVD Chemotherapy at a Single Center in Saudi Arabia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5005-5005
Author(s):  
Syed Ziauddin A. Zaidi ◽  
Ibraheem H Motabi ◽  
Shahid Iqbal ◽  
Atta Munawar Gill ◽  
Imran Khan Tailor ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Conflicts Of Interest ◽  
Early Stage ◽  
Prognostic Score ◽  
Daily Practice ◽  
Histopathological Diagnosis ◽  
Monocyte Count ◽  
Classical Hodgkin Lymphoma ◽  
Bulky Disease ◽  
Pre Treatment

Abstract In our clinical practice, international prognostic score (IPS) comprising of seven parameters has been in use for prognostication of advance stage Hodgkin's lymphoma (HL). Simple scoring system, that can stratify patients and or predict outcome both in early stage and advance stage HL, would be both helpful and practical to apply in daily practice. This is a retrospective study to find out whether recently reported absolute monocyte count (AMC) and absolute lymphocyte : monocyte ratio (LMR) at diagnosis are valid parameters for predicting prognosis of classical Hodgkin lymphoma (cHL) patients treated with ABVD at our center. Among many cut-off values for ALC/AMC ratio reported in literature (1.1, 1.5, 2.1, 2.8, 3.5) we chose the cut off of ≥2.1 as reported in the largest series by Tadmore et al. Data from patients' records were collected after approval by local institutional review board. All studies were performed in accordance with the principles of the Declaration of Helsinki. Patients were included into this study if they had histopathological diagnosis of cHL, no human immunodeficiency virus infection, availability of data on all clinical and laboratory features and treatments given, as well as outcome, and follow-up. Only patients treated with ABVD as initial chemotherapy with or without subsequent radiation therapy were included as this chemotherapy regimen is currently considered the standard of care in North America and at our institution. Response criteria were based on the guidelines from the International Harmonization Project on Lymphoma revised by Cheson et al. We excluded 4 patients with Nodular Lymphocyte Predominant HL(NLPHL), as NLPHL is considered to be a different disease entity. Hence we found 164 patients with cHL treated at King Fahad Medical City, Riyadh from 2006, through July 2015 with ABVD. Out of 164 patients we identified nodular sclerosis 116/164 (70%) and mixed cellularity 31/164 (19%) were the most common. The median age of the patients was 26 years (range, 14-86 years); 70 (41.6%) patients had bulky disease, 84 (52.1%) had extranodal disease; Median IPS was 3; Pre-Treatment ALC median was 1635/ul (range 192-825), AMC median was 841/ul (range 60-9600), and Pre-Treatment ALC/AMC Ratio (LMR) median was 2.168 (range 0.28-19.81). Overall survival was for ALC/AMC Ratio of >=2.1 was 97.5% and 92.8% for ALC/AMC Ratio of <2.1 (p=0.172) indicating some trend for better outcome. This study confirms that L/M ratio has prognostic value in cHL. However we plan to define our own best cut off value by ROC and AUC analysis as ALC/AMC Ratio of ≥2.1 did not discriminate survival advantage clearly in our patients. In addition to geographical and genetic differences, variations in hematology cell counters may be a plausible contributing factor.Table.VariablesNumber(%)Age(yr)<=45140(85.4)> 4524(14.6)GenderMale88(53.7)Female76(46.3)Stage of diseaseEarly15(9.1)Advanced149(90.9)BulkyNo94(57.3)Yes70(42.7)Stage IVNo92(56.1)Yes72(43.9)HistopathologyLymphocyte Rich6(3.7)Classical11(6.7)Mixed Cellularity31(18.9)Nodular Sclerosis116(70.7)ExtranodalNo80(48.8)Yes84(51.2)Albumin<40134(85.4)>=4023(14.6)Hemoglobin<10.559(36.0)>=10.5105(64.0)WBC<15127(77.4)>=1537(22.6)IPS Score05(3.0)134(20.7)242(25.6)342(25.6)432(19.5)57(4.3)62(1.2)ALC<60016(10.3)>=600140(89.7)ALC<0.622(14.1)>=0.6134(85.9)AMC<75070(44.9)>=75086(55.1)ALC/AMC Ratio<2.172(46.2)>=2.184(53.8) Disclosures No relevant conflicts of interest to declare.

scholarly journals A New Prognostic Score for Patients Older Than 60 Years with a Classical Hodgkin Lymphoma: A Retrospective Analysis on 165 Patients

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1721-1721
Author(s):  
Violaine Safar ◽  
Nadia Oussaid ◽  
Alexandra Traverse-Glehen ◽  
Catherine Chassagne-Clement ◽  
Catherine Sebban ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Multivariate Analysis ◽  
Hodgkin Lymphoma ◽  
Median Duration ◽  
Lymphocyte Count ◽  
Roc Analysis ◽  
Prognostic Score ◽  
Bone Marrow Involvement ◽  
Classical Hodgkin Lymphoma ◽  
Ann Arbor

Abstract Background: Patients (pts) with classical Hodgkin Lymphoma (CHL) older than 60 years represent about 15% to 20% of CHL pts in population registries. Elderly CHL treated with standard protocols always have a poorer outcome as compared to younger pts. The aim of this retrospective study is to identify specific prognostic factors in a cohort of 165 CHL pts aged over 60 years. Methods: From two hospital registries in Lyon (France), we analyzed 165 CHL pts older than 60 years and treated between 1981 and 2012. None were HIV positive. The following clinical characteristics were recorded: age, gender, presence of B-symptoms, ECOG performance status (PS), Cumulative Illness Rating Scale (CIRS), Ann Arbor stage, bone marrow involvement, complete blood counts, lactate deshydrogenase(LDH), C-reactive protein (CRP), fibrinogen, serum albumin level and protein electrophoresis. International Prognostic Score (IPS) was collected for 116 pts (70%). A total of 136 pts (82%) were treated with an anthracycline based chemotherapy (CT) and 53 pts (32%) received radiation therapy. Clinical and biological characteristics at diagnosis were assessed by a Cox regression for univariate and multivariate analysis for progression free survival (PFS) and overall survival (OS). We then designed a prognostic score for PFS and OS based on significant variables from multivariate analysis at threshold p-value < 0.5 and compared the effectiveness of these scores to IPS by a receiver operating characteristic (ROC) analysis. Results: The median age at diagnosis was 69 years (range, 60-89). 60% were male, 65% presented with B-symptoms, 38% had a PS> 2 and 16% had at least one comorbidity scored 3 or 4 on CIRS. 56% had an Ann Arbor stage III-IV.65% of pts achieved a complete or a partial response, 16% were refractory or progressed within 6 months after the start of treatment and 19% died during treatment. Median follow up is 65 months (1.1-207.6). 47 pts (29%) have progressed or relapsed. Median duration of PFS is 39.6 months (95%CI: 23.9-73.3) with a 4-year PFS rate of 49% (95%CI: 40-56). 78 pts (47%) died, 22% within the first year after treatment initiation. Median duration of OS is 73.3 months (95%CI: 38.5-129.8) and the 4-year OS rate is 55% (95%CI: 47-63). The main causes of death were HL progression (39%), infection (17%), treatment toxicity (13%) and second cancer (10%). Pts treated with or without an anthracycline based CT did not have significantly different 4-year PFS (50% vs. 43%, P=0.55) or OS (57% vs. 47%, P=0.22). In univariate analysis, age, B-symptoms, PS, CIRS, albumin, hemoglobin, lymphocyte count, bone marrow involvement, Ann Arbor stage, protein, gammaglobulin, fibrinogen, LDH and CRP were associated with a shortened PFS. Factors associated with a shortened OS were: sex, age, PS , CIRS, albumin, hemoglobin, lymphocyte count, bone marrow involvement, Ann Arbor stage, protein, CRP, gammaglobulin and fibrinogen. In multivariate analysis, age>69 years (HR=3.97; 95%CI: 2.11-7.47, P<0.0001), bone marrow involvement (HR=2.09; 95%CI: 1.11-3.91, P=0.02), gammaglobulin level<10g/L (HR=2.43; 95%CI: 1.31-4.50, P=0.005) and fibrinogen level>5g/L (HR=2.29; 95%CI: 1.25-4.19, P=0.007) were independently associated with a shortened PFS. Pts with 0-1, 2 and 3-4 adverse factors had a median duration of PFS of 180, 37 and 4.6 months respectively (Figure, P=<0.0001). In multivariate analysis, factors independently associated with a poor OS were age>69 years (HR=3.66; 95%CI: 1.95-6.85, P<0.0001), PS > 2 (HR=3.04; 95%CI: 1.69-5.45, P=0.0002) and gammaglobulin level<10g/L (HR=2.26; 95%CI: 1.25-4.07, P=0.007). Pts with 0, 1, 2 and 3 adverse factors had a median duration of OS of 180, 73, 21.5 and 3 months respectively (P<0.0001). Eventually, evaluation of our model by ROC analysis showed a better predictive value than IPS for PFS (0.69 vs. 0.54, P=0.01) and OS (0.74 vs. 0.60, P=0.02) . Conclusion: This prognostic score identifies subgroups of elderly CHL pts at high risk of progression and early death, using simple biological and clinical parameters at diagnosis. Bone marrow involvement is one of the factors independently associated with PFS. This result supports bone marrow evaluation at diagnosis. This score better discriminates elderly CHL pts’ outcome compared to IPS. Our results should be confirmed in independent and prospective studies in combination with complete geriatric assessment. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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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