scholarly journals Optimal Therapy of Advanced Hodgkin Lymphoma

Hematology ◽  
2011 ◽  
Vol 2011 (1) ◽  
pp. 310-316 ◽  
Author(s):  
Ranjana Advani
Keyword(s):  
Hodgkin Lymphoma ◽  
Standard Of Care ◽  
Disease Status ◽  
Emission Tomography ◽  
Advanced Stage ◽  
Positron Emission ◽  
Frontline Therapy ◽  
Expanding Population

AbstractAdvanced-stage Hodgkin lymphoma (HL) has become a curable disease in the majority of patients. Research during the last decade has challenged chemotherapy with Adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) as the standard of care and debates continue regarding the role of radiation therapy (RT) in this patient population. The incorporation of interim positron emission tomography (PET) imaging and, recently, further characterization of HL on cellular and molecular levels are emerging as tools for treatment stratification and predictors of disease status. Newer targeted therapies have emerged that are very effective in the relapsed setting and are actively being explored as frontline therapy. Lastly, the expanding population of survivors cured of HL outnumbers patients with the disease and needs to be monitored for therapy-related late effects.

Assessment of Tumor Size Reduction Improves Outcome Prediction of Positron Emission Tomography/Computed Tomography After Chemotherapy in Advanced-Stage Hodgkin Lymphoma

2014 ◽  
Vol 32 (17) ◽  
pp. 1776-1781 ◽  
Author(s):  
Carsten Kobe ◽  
Georg Kuhnert ◽  
Deniz Kahraman ◽  
Heinz Haverkamp ◽  
Hans-Theodor Eich ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Hodgkin Lymphoma ◽  
Hodgkin's Disease ◽  
Outcome Prediction ◽  
Hodgkin’S Disease ◽  
Emission Tomography ◽  
Advanced Stage ◽  
Positron Emission ◽  
Risk Of Progression

Purpose Positron emission tomography (PET) after chemotherapy can guide consolidating radiotherapy in advanced-stage Hodgkin lymphoma (HL). This analysis aims to improve outcome prediction by integrating additional criteria derived by computed tomography (CT). Patients and Methods The analysis set consisted of 739 patients with residues ≥ 2.5 cm after chemotherapy from a total of 2,126 patients treated in the HD15 trial (HD15 for advanced stage Hodgkin's disease: Quality assurance protocol for reduction of toxicity and the prognostic relevance of fluorodeoxyglucose-positron-emission tomography [FDG-PET] in the first-line treatment of advanced-stage Hodgkin's disease) performed by the German Hodgkin Study Group. A central panel performed image analysis and interpretation of CT scans before and after chemotherapy as well as PET scans after chemotherapy. Prognosis was evaluated by using progression-free survival (PFS); groups were compared with the log-rank test. Potential prognostic factors were investigated by using receiver operating characteristic analysis and logistic regression. Results In all, 548 (74%) of 739 patients had PET-negative residues after chemotherapy; these patients did not receive additional radiotherapy and showed a 4-year PFS of 91.5%. The 191 PET-positive patients (26%) receiving additional radiotherapy had a 4-year PFS of 86.1% (P = .022). CT alone did not allow further separation of patients in partial remission by risk of recurrence (P = .9). In the subgroup of the 54 PET-positive patients with a relative reduction of less than 40%, the risk of progression or relapse within the first year was 23.1% compared with 5.3% for patients with a larger reduction (difference, 17.9%; 95% CI, 5.8% to 30%). Conclusion Patients with HL who have PET-positive residual disease after chemotherapy and poor tumor shrinkage are at high risk of progression or relapse.

Positive Positron Emission Tomography (PET) Scan in Non-Hodgkin Lymphoma Pre-Transplant Had No Impact On Relapse and Survival After Allogenenic Transplantation

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1999-1999
Author(s):  
Veronika Bachanova ◽  
Celalettin Ustun ◽  
Qing Cao ◽  
Froelich Jerry ◽  
Linda J Burns
Keyword(s):  
Positron Emission Tomography ◽  
Follicular Lymphoma ◽  
Hodgkin Lymphoma ◽  
Relapse Rate ◽  
Pet Imaging ◽  
Pet Scan ◽  
Emission Tomography ◽  
Non Hodgkin Lymphoma ◽  
Positron Emission

Abstract Abstract 1999 Allogeneic donor hematopoetic stem cell transplantation (HCT) is increasingly used for patients with non-Hodgkin lymphoma (NHL). Positron emission tomography (PET) has become a standard for lymphoma evaluation and a valuable prognostic tool to risk-stratify treatment and time of the autologous HCT. Role of PET imaging in allogeneic HCT setting is controversial. We sought to investigate the value of PET status pre-transplantation and at day 100 post donor HCT as an indicator predictive of relapse and survival post allograft. Seventy-three patients (median age 50 years [range 2–69 years]) with NHL received allogeneic HCT at University of Minnesota from 2004–2010 and had PET imaging within 4 weeks pre-transplant. All PET and CT images were reviewed centrally by nuclear medicine radiologist. Follicular lymphoma (n=26) was more common than large cell, mantle cell lymphoma and others. PET scan pre-transplant was positive in 44 patients (PET+ group 57% vs PET- group 43%). Two thirds of PET+ group were in partial remission (PR), 7% CR and 16% were chemo-refractory prior to transplant compared to 25% in PR, 68% in CR and 7% refractory in PET+ cohort (p<0.01). Forty percent had PET-avid extra-nodal involvement. In both PET positive and negative groups the two thirds received reduced intensity conditioning and related donor (52% and 51%) or umbilical cord blood grafts (55% and 41%, respectively). 5-years disease-free survival (DFS) and overall survival (OS) of the cohort was 51% (95%CI 35– 64%) and 60% (95%CI 44–73%). DFS and OS of PET+ group was similar to PET- group (DFS: 50% vs 52%, p=0.31; OS: 63% vs 56%, p=0.63). In univariate analysis, the lymphoma subtype, disease status at transplant, extranodal disease, elevated LDH, high B2 macroglobulin or marrow involvement at the time of transplant had no impact on survival or relapse rate. At median follow-up of 3.33 years (range 1.00–6.74) the cumulative 2 year relapse rate was 17%; similar in PET+ and PET- groups (19% [95% CI 7– 31%] vs 15% [95% CI 1– 28%]; p=0.48). Transplant mortality at 1-year was low for entire cohort (11% [95% CI 3–18%]) and particularly low in follicular lymphoma (4% [95%CI 0–10%]) compared to DL/MCL (10% [95%CI 0–21%]) and other NHL (25% [95%CI 4–46%]; p=0.51). PET status (pos vs neg) had no impact on grade III-IV acute GVHD and chronic GVHD. Fifty-four patients with available surveillance PET evaluation at day 100 post-transplant. The 1-year relapse rate and 5 yr DFS was significantly improved for those patient who were PET-negative (day 100 PET- vs PET+ group: relapse 9% vs 42%; p<0.01; DFS 57% vs 25%, p<0.01 and OS 68% vs 59%, p=0.63). In conclusion, pre-allo HCT PET scan for NHL does not predict transplant outcomes, however negative PET scan 100 days post-allo SCT is a valuable tool predictive of superior transplant DFS. Future studies evaluating role of PET in patients with specific lymphoma subsets and development of novel peri-transplant or post-transplant interventions for patients at high relapse risk are warranted. Disclosures: Off Label Use: decitabine for relapsed ALL vorinostat for relapsed ALL.

scholarly journals Advanced Hodgkin lymphoma in the East of England: a 10-year comparative analysis of outcomes for real-world patients treated with ABVD or escalated-BEACOPP, aged less than 60 years, compared with 5-year extended follow-up from the RATHL trial

2021 ◽  
Vol 100 (4) ◽  
pp. 1049-1058 ◽  
Author(s):  
James Russell ◽  
Angela Collins ◽  
Alexis Fowler ◽  
Mamatha Karanth ◽  
Chandan Saha ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Real World ◽  
Prognostic Score ◽  
Intensive Therapy ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Advanced Stage ◽  
Ct Guided ◽  
Positron Emission

AbstractTreatment with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) or escalated(e)-BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone) remains the international standard of care for advanced-stage classical Hodgkin lymphoma (HL). We performed a retrospective, multicentre analysis of 221 non-trial (“real-world”) patients, aged 16–59 years, diagnosed with advanced-stage HL in the Anglia Cancer Network between 2004 and 2014, treated with ABVD or eBEACOPP, and compared outcomes with 1088 patients in the Response-Adjusted Therapy for Advanced Hodgkin Lymphoma (RATHL) trial, aged 18–59 years, with median follow-up of 87.0 and 69.5 months, respectively. Real-world ABVD patients (n=177) had highly similar 5-year progression-free survival (PFS) and overall survival (OS) compared with RATHL (PFS 79.2% vs 81.4%; OS 92.9% vs 95.2%), despite interim positron-emission tomography-computed tomography (PET/CT)-guided dose-escalation being predominantly restricted to trial patients. Real-world eBEACOPP patients (n=44) had superior PFS (95.5%) compared with real-world ABVD (HR 0.20, p=0.027) and RATHL (HR 0.21, p=0.015), and superior OS for higher-risk (international prognostic score ≥3 [IPS 3+]) patients compared with real-world IPS 3+ ABVD (100% vs 84.5%, p=0.045), but not IPS 3+ RATHL patients. Our data support a PFS, but not OS, advantage for patients with advanced-stage HL treated with eBEACOPP compared with ABVD and suggest higher-risk patients may benefit disproportionately from more intensive therapy. However, increased access to effective salvage therapies might minimise any OS benefit from reduced relapse rates after frontline therapy.

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