scholarly journals Evens AM, Kostakoglu L. The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease. Blood. 2014;124(23):3356-3364.

Blood ◽  
2015 ◽  
Vol 125 (15) ◽  
pp. 2450-2450
Keyword(s):  
Hodgkin Lymphoma ◽  
Fdg Pet ◽  
Early Stage ◽  
Early Stage Disease ◽  
Stage Disease

Lymphocyte-predominant Hodgkin lymphoma: what is the optimal treatment?

Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 406-413 ◽  
Author(s):  
Michelle Fanale
Keyword(s):  
B Cell ◽  
Hodgkin Lymphoma ◽  
Radiation Treatment ◽  
Early Stage ◽  
B Cell Lymphoma ◽  
B Cell Lymphomas ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Relapsed Disease

AbstractNodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a unique diagnostic entity, with only ∼ 500 new cases in the United States per year with a similar infrequent incidence worldwide. NLPHL also has distinctive pathobiology and clinical characteristics compared with the more common classical Hodgkin lymphoma (cHL), including CD20 positivity of the pathognomic lymphocytic and histiocytic cells and an overall more indolent course with a higher likelihood of delayed relapses. Given the limited numbers of prospective NLPHL-focused trials, management algorithms historically have typically been centered on retrospective data with guidelines often adopted from cHL and indolent B-cell lymphoma treatment approaches. Key recent publications have delineated that NLPHL has a higher level of pathological overlap with cHL and the aggressive B-cell lymphomas than with indolent B-cell lymphomas. Over the past decade, there has been a series of NLPHL publications that evaluated the role of rituximab in the frontline and relapsed setting, described the relative incidence of transformation to aggressive B-cell lymphomas, weighed the benefit of addition of chemotherapy to radiation treatment for patients with early-stage disease, considered what should be the preferred chemotherapy regimen for advanced-stage disease, and even assessed the potential role of autologous stem cell transplantation for the management of relapsed disease. General themes within the consensus guidelines include the role for radiation treatment as a monotherapy for early-stage disease, the value of large B-cell lymphoma–directed regimens for transformed disease, the utility of rituximab for treatment of relapsed disease, and, in the pediatric setting, the role of surgical management alone for patients with early-stage disease.

EARLY Interim FDG-PET Scan in Localised Hodgkin Lymphoma: Evaluation of Practice in 5 French Centers

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4935-4935
Author(s):  
Olivier Fitoussi ◽  
Pauline Brice ◽  
Sandrine Hirt ◽  
Philippe Solal-Celigny ◽  
Marie-Sarah Dilhuydy ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Fdg Pet ◽  
Early Stage ◽  
Dose Intensity ◽  
Pet Scan ◽  
Treatment Intensification ◽  
Term Survival ◽  
Early Stage Disease ◽  
Fdg Pet Scan ◽  
Pre Treatment

Abstract Background: Long-term survival from Hodgkin lymphoma (HL) in early-stage (I–II) patients is more than 85%. However, certain patients have a primary refractory disease with a worse evolution. Early interim FDG-PET scan performed after 2 courses of chemotherapy (PET-2) provides an early and accurate assessment of response and a correlation has been demonstrated between normalization of PET-2 and patient outcome. Aim: To evaluate the percentage of negative PET-2 in early-stage patients, and to seek clinical or biological factors predictive of positive PET-2. Methods: Sixty-five patients from five French centers with early-stage Hodgkin lymphoma received ABVD as firstline chemotherapy. PET-2 was performed 3 weeks after the second course of ABVD. Radiotherapy and changes in management according to FDG-PET scan result could be decided by the clinician. Evaluation was retrospective. Results: The median age was 36 years (range17–77). Thirty-nine patients were male. Seventy-three percent of patients were in unfavorable group according to EORTC criteria (one or more of the following criteria: age > 50, systemic symptoms, elevated ESR >50 mm, bulk disease and more than three lymph node areas involved). Fifty-seven patients had a pre-treatment FDGPET scan with a modification of staging in 6 cases. Initial staging according to CT scan or FDG-PET scan was as follows: IA: 5 patients, IB: no patient, IIA: 35 patients and IIB: 25 patients. Fifty-three patients (82%) had a negative PET-2 whereas 12 patients (18%) had a clearly positive PET-2. Among the 53 patients with negative PET-2, 47 patients underwent radiation therapy after completion of four courses of ABVD. Among the 12 patients with positive PET-2, treatment intensification (BEACOPP) occurred for 7 patients with a negative FDG-PET scan for 6 of them after two courses. For the 5 PET+ patients pursuing with ABVD: three had a negative FDG-PET scan and two had a positive FDGPET scan after four cycles of ABVD. At a median follow-up of 30 months, 6 patients relapsed early after the end of the treatment (2 in the negative PET-2 group and 4 in the positive PET-2 group). Out of the 7 patients of the positive PET-2 group receiving an increase dose intensity of chemotherapy (BEACOPP), 3 of them relapsed. The 59 other patients did not presented any failure or relapse at the present time. Conclusion: We showed in this series that negative PET-2 is obtained in 82% of patients with early stage disease. These results are similar to those expected in the EORTC H10 trial which evaluates PET-2 guided treatment adaptation and expect about 85–90% of negative PET-2. This retrospective study augurs that positive TEP2 is a pejorative prognostic factor and the utilisation of the BEACOPP treatment in these population remains to define. Prospective studies, like H10 EORTC trial are warranted to confirm these results and find predictive factors for a positive PET-2.

scholarly journals The role of perioperative radiotherapy in gastric cancer

2012 ◽  
Vol 6 (2) ◽  
pp. 23 ◽  
Author(s):  
Thales Paulo Batista ◽  
Lucas Marque De Mendonça ◽  
Ana Luiza Fassizoli-Fonte
Keyword(s):  
Gastric Cancer ◽  
Therapeutic Strategy ◽  
Multimodal Therapy ◽  
Early Stage ◽  
Locally Advanced ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Locally Advanced Tumors ◽  
Related Mortality

Gastric cancer is one of the most common neoplasms and a main cause of cancer-related mortality worldwide. Surgery remains the mainstay for cure and is considered for all patients with potentially curable disease. However, despite the fact that surgery alone usually leads to favorable outcomes in early stage disease, late diagnosis usually means a poor prognosis. In these settings, multimodal therapy has become the established treatment for locally advanced tumors, while the high risk of locoregional relapse has favored the inclusion of radiotherapy in the comprehensive therapeutic strategy. We provide a critical, non-systematic review of gastric cancer and discuss the role of perioperative radiation therapy in its treatment.

Evaluation of treatment outcome in 175 patients with Hodgkin lymphoma aged 60 years or over: the SHIELD study

Blood ◽  
2012 ◽  
Vol 119 (25) ◽  
pp. 6005-6015 ◽  
Author(s):  
Stephen J. Proctor ◽  
Jennifer Wilkinson ◽  
Gail Jones ◽  
Gillian C. Watson ◽  
Helen H. Lucraft ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Cox Regression ◽  
Early Stage ◽  
Univariate Analysis ◽  
Central Element ◽  
Disease Stage ◽  
Advanced Stage ◽  
Early Stage Disease ◽  
Large Patient ◽  
Stage Disease

Abstract The SHIELD program for Hodgkin lymphoma in patients 60 years of age or older, prospectively evaluated clinical features and outcome in a large patient cohort (n = 175). The central element was a phase 2 study of VEPEMB chemotherapy (n = 103, median age 73 years) incorporating comorbidity assessment. A total of 72 other patients were treated off-study but registered prospectively and treated concurrently with: ABVD (n = 35); CLVPP (n = 19), or other (n = 18). Of VEPEMB patients, 31 had early-stage disease (stage 1A/2A) and received VEPEMB 3 times plus radiotherapy. Median follow-up was 36 months. Complete remission (CR) rate (intention-to-treat) was 74% and 3-year overall survival (OS) and progression-free survival (PFS) were 81% and 74%, respectively. A total of 72 patients had advanced-stage disease (stage 1B/2B/3 or 4) and received VEPEMB 6 times. CR rate was 61% with 3-year OS and PFS of 66% and 58%, respectively. Of patients achieving CR, 13% with early-stage and 5% with advanced-stage disease progressed. Overall treatment-related mortality was 7%. In patients treated with curative intent with VEPEMB, ABVD, and CLVPP (n = 157), CR linked to several factors in univariate analysis. In a Cox regression model only, obtaining CR remained significant for OS and CR plus comorbidity and age for PFS. RS-EBV status had no significant effect on outcome.

scholarly journals The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease

Hematology ◽  
2014 ◽  
Vol 2014 (1) ◽  
pp. 135-143 ◽  
Author(s):  
Andrew M. Evens ◽  
Lale Kostakoglu
Keyword(s):  
Hodgkin Lymphoma ◽  
Fdg Pet ◽  
Early Stage ◽  
Combined Modality Therapy ◽  
Imaging Biomarkers ◽  
Predictive Tool ◽  
Early Stage Disease ◽  
Combined Modality ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Given the excellent survival rates for early-stage Hodgkin lymphoma (HL), the young age of many patients, and concerns regarding acute and late treatment-related toxicities, there is a desire to have a predictive tool that enables therapy to be tailored toward the individual patient. Early (or interim) 18F-fluorodeoxyglucose positron emission tomography with computerized tomography (FDG-PET/CT), as a test of tumor sensitivity to ongoing/planned therapy, has been shown to be prognostic for survival in HL. Based on results of interim FDG-PET/CT, therapy may be subsequently modified through minimization or via intensification for low- and high-risk patient populations, respectively (ie, response-adapted therapy). Important data have been generated to standardize the interpretability and reproducibility of interim FDG-PET/CT (eg, the Deauville 5-point system), and observational and noncontrolled prospective studies have produced evidence supporting the hypothesis that response-adapted therapy may potentially serve as a predictive tool. Furthermore, results from noninferiority phase 3 clinical trials randomizing early-stage HL patients with negative interim FDG-PET/CT to combined modality therapy versus chemotherapy alone have been reported. The current collective findings from these randomized early-stage HL studies have shown that acute relapse rates are lower with combined modality therapy, even in patients with negative interim FDG-PET/CT. Additional randomized response-adapted studies are ongoing and novel FDG-PET/CT applications involving quantitative techniques and innovative imaging modalities are being investigated to identify more robust imaging biomarkers. Treatment of early-stage HL remains a clinical management choice for physicians and patients to make with consideration of acute and long-term outcomes.

scholarly journals HODGKIN LYMPHOMA IN OLDER PATIENTS: AN ORPHAN DISEASE?

2014 ◽  
Vol 6 (1) ◽  
pp. e2014050 ◽  
Author(s):  
Antoine Thyss ◽  
Esma Saada ◽  
Lauris Gastaud ◽  
Frédéric Peyrade ◽  
Daniel Ré
Keyword(s):  
Hodgkin Lymphoma ◽  
Prospective Studies ◽  
Older Patients ◽  
Early Stage ◽  
The Elderly ◽  
Study Group ◽  
Advanced Stage ◽  
Early Stage Disease ◽  
Younger Patients ◽  
Stage Disease

Hodgkin Lymphoma HL ica be  cured in the large majority of younger patients, but prognosis for older patients, especially those with advanced-stage disease, has not improved substantially. The percentage of HL patients aged over 60 ranges between 15% and 35%.A minority of them is enrolled into clinical trials. HL in the elderly have some specificities: more frequent male sex, B-symptoms, advanced stage, sub diaphragmatic presentation, higher percentage of mixed cellularity, up to 50% of advanced cases associated to EBV. Very old age (>70) and comorbidities are factor of further worsening prognosis. Like in younger patients, ABVD is the most used protocol, but treatment outcome remains much inferior with more frequent, severe and sometimes specific toxicities. Few prospective studies with specific protocols are available. The main data have been published by the Italian Lymphoma Group with the VEPEMB schedule and the German Hodgkin Study Group with the PVAG regimen. Recently, the Scotland and Newcastle Lymphoma Study Group published the SHIELD program associating a prospective phase 2 trial with VEPEMB and a prospective registration of others patients. Patients over 60y with early-stage disease received three cycles plus radiotherapy and had 81% of 3-year overall survival (OS).Those with advanced-stage disease received six cycles, with 3-year OS of 66%.The role of geriatric and comorbidity assessment in the treatment’s choice for HL in the elderly is a major challenge. The combination of loss of activities of daily living combined with the age stratification more or less 70y has been shown as a simple and effective survival model. Hopes come from promising new agents like brentuximab-vedotin (BV) a novel antibody-drug conjugate. The use of TEP to adapt the combination of chemotherapy and radiotherapy according to the metabolic response could also be way for prospective studies.  

scholarly journals The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease

Blood ◽  
2014 ◽  
Vol 124 (23) ◽  
pp. 3356-3364 ◽  
Author(s):  
Andrew M. Evens ◽  
Lale Kostakoglu
Keyword(s):  
Hodgkin Lymphoma ◽  
Fdg Pet ◽  
Early Stage ◽  
Combined Modality Therapy ◽  
Imaging Biomarkers ◽  
Predictive Tool ◽  
Early Stage Disease ◽  
Combined Modality ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Given the excellent survival rates for early-stage Hodgkin lymphoma (HL), the young age of many patients, and concerns regarding acute and late treatment-related toxicities, there is a desire to have a predictive tool that enables therapy to be tailored toward the individual patient. Early (or interim) 18F-fluorodeoxyglucose positron emission tomography with computerized tomography (FDG-PET/CT), as a test of tumor sensitivity to ongoing/planned therapy, has been shown to be prognostic for survival in HL. Based on results of interim FDG-PET/CT, therapy may be subsequently modified through minimization or via intensification for low- and high-risk patient populations, respectively (ie, response-adapted therapy). Important data have been generated to standardize the interpretability and reproducibility of interim FDG-PET/CT (eg, the Deauville 5-point system), and observational and noncontrolled prospective studies have produced evidence supporting the hypothesis that response-adapted therapy may potentially serve as a predictive tool. Furthermore, results from noninferiority phase 3 clinical trials randomizing early-stage HL patients with negative interim FDG-PET/CT to combined modality therapy versus chemotherapy alone have been reported. The current collective findings from these randomized early-stage HL studies have shown that acute relapse rates are lower with combined modality therapy, even in patients with negative interim FDG-PET/CT. Additional randomized response-adapted studies are ongoing and novel FDG-PET/CT applications involving quantitative techniques and innovative imaging modalities are being investigated to identify more robust imaging biomarkers. Treatment of early-stage HL remains a clinical management choice for physicians and patients to make with consideration of acute and long-term outcomes.

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