Identification of Prognostic Factors in Patients with Early Stage Unfavorable Hodgkin’s Lymphoma: An Individual Patient Data Meta-Analysis.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5577-5577
Author(s):  
Julia Bohlius ◽  
Heinz Haverkamp ◽  
Volker Diehl ◽  
Houchingue Eghbali ◽  
Jeremy Franklin ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Missing Data ◽  
Hodgkin’S Lymphoma ◽  
Individual Patient Data ◽  
Early Stage ◽  
Patient Data ◽  
Hodgkin's Lymphoma ◽  
Cochrane Library ◽  
Bulky Disease ◽  
Laboratory Parameters

Abstract Background: In patients with early stage unfavorable Hodgkin’s lymphoma (HL) event-free-survival (EFS) is low compared to patients with early favorable or advanced stage disease. An international collaborative study was initiated to identify prognostic factors that could help to define among early stage unfavorable patients those who might benefit from more intensive treatment. Methods: Medline and Cochrane Library were systematically searched for randomized controlled trials in stage I/II HL. Trials should concern patients with one or more risk factors (age, sex, stage, B-symptoms, bulky disease, number of areas involved, laboratory parameters) receiving 4–6 cycles of ABVD or similar chemotherapy and radiotherapy. Only trials with ≥ 100 patients per study arm were considered. Individual patient data were collected. Results: Six studies were identified: GHSG: HD5, HD8, HD11; EORTC: H6U, H7U, H8U. Data from 4,235 patients enrolled between 08/1982 and 01/2003 were available for analysis. The proportion of missing data was very low for demographic and clinical characteristics (< 1%); it was acceptable (1.5–9%) for laboratory parameters with the exception of albumin (41% missing values, not recorded in 3 trials). Patient characteristics are listed below. The median follow up was 58.4 months (95% CI 56–61). At the time of analysis 612 patients had experienced an event (disease progression, relapse or death) leading to a 5-year EFS rate of 85%. Using an univariate Cox-regression stratified by study and treatment arm several parameters showed significant influence on EFS. Conclusion: The data set available is sufficiently powered to identify relevant prognostic factors. A multivariate analysis using updated data will be presented. Baseline parameter of inlcuded studies Age (median years) Male sex Sage (I/II) B symptoms Bulky disease Hb (median g/dL) All patients, n=4,325 32 2,039 (48.1%) I: 546 (12.9%), II: 3,688 (87.1%) 1,490 (35.2%) 1,936 (45.7%) 12.9 Missing data 1 (< 1%) 0 1 (< 1%) 35 (< 1%) 0 82 (1.9%)

Prognostic and predictive factors in early stages of classic Hodgkin’s lymphoma

2022 ◽  
pp. 7-15
Author(s):  
T. I. Bogatyreva ◽  
A. O. Afanasov ◽  
A. Yu. Terekhova ◽  
N. A. Falaleeva
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Hodgkin’S Lymphoma ◽  
Early Stage ◽  
Hodgkin's Lymphoma ◽  
Cure Rate ◽  
First Line ◽  
Bulky Disease ◽  
Cox Regression Analysis ◽  
Early Stages

Rationale. In the early stages of classical Hodgkin’s lymphoma (cHL), the cure rate reaches 85–95 %, but the long-term effects of therapy can worsen overall survival. Current trials for early stages of Hodgkin’s lymphoma with favorable prognosis address the task of maintaining cure rates while reducing sequelae. For early unfavorable stages, the challenge is to improve cure rate without increasing toxicity.Purpose. To assess the potential significance of individual risk factors for optimal choice of the first line chemotherapy in early-stage Hodgkin lymphoma.Materials and methods. This single-center retrospective study included 290 patients with early stage cHL who had received ABVD – based (n = 249; 86 %) or BEACOPP‑21 – based (n = 41; 14 %) combined modality therapy from 2000 to 2017. Progression-free survival (PFS) and overall survival (OS) were assessed in Cox regression analysis including 12 clinical parameters.Main results. At a median follow up of 60 months for the entire group, OS was 95 % and PFS was 89 %. In a multivariate analysis PFS, at 5 years, was significantly inferior in patients with mediastinal bulk, baseline lymphocytopenia (≤ 0.6 × 109/L, р = 0.002; < 1.0 × 109/L, р = 0.000) and male gender; OS was inferior only in patients with an absolute lymphocytopenia (AL). In patients with AL, PFS after ABVD-based regimen was, respectively, 12 % in the high-risk group with mediastinal bulk and 56 % without it. PFS of patients without AL when treated with ABVD did not differ compared to BEACOPP‑21 within the same prognostic group: 95.2 % vs. 92.3 % for non-bulky and 86.4 % vs. 84.2 % for bulky disease. In the absence of AL, mediastinal bulk remained the main and only risk factor in multivariate analysis.Conclusions. The ABVD regimen is highly effective in the first line of chemotherapy for cHL, except for cases with baseline lymphocytopenia, in which the early usage of the BEACOPP regimen in the escalated or 14-day variants might be justified. In patients with mediastinal bulk, standard chemotherapy is not effective enough even in the absence of AL; therefore, if an intermediate PET/CT scan is available, it seems more appropriate to use a milder ABVD regimen on the first line and leave intensive therapy for patients with proven refractory disease. Prospects for improving the efficiency are opened with the new N-AVD and A-AVD schemes, the benefits of which should be evaluated, first of all, in patients with AL and mediastinal bulk.

Combined-Modality Therapy for Clinical Stage I or II Hodgkin's Lymphoma: Long-Term Results of the European Organisation for Research and Treatment of Cancer H7 Randomized Controlled Trials

2006 ◽  
Vol 24 (19) ◽  
pp. 3128-3135 ◽  
Author(s):  
Evert M. Noordijk ◽  
Patrice Carde ◽  
Noëlle Dupouy ◽  
Anton Hagenbeek ◽  
Augustinus D.G. Krol ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Disease Control ◽  
Hodgkin’S Lymphoma ◽  
Early Stage ◽  
Combined Modality Therapy ◽  
Clinical Stage ◽  
Stage I ◽  
Hodgkin's Lymphoma ◽  
Long Term Results ◽  
Experimental Therapy

Purpose In early-stage Hodgkin's lymphoma (HL), subtotal nodal irradiation (STNI) and combined chemotherapy/radiotherapy produce high disease control rates but also considerable late toxicity. The aim of this study was to reduce this toxicity using a combination of low-intensity chemotherapy and involved-field radiotherapy (IF-RT) without jeopardizing disease control. Patients and Methods Patients with stage I or II HL were stratified into two groups, favorable and unfavorable, based on the following four prognostic factors: age, symptoms, number of involved areas, and mediastinal-thoracic ratio. The experimental therapy consisted of six cycles of epirubicin, bleomycin, vinblastine, and prednisone (EBVP) followed by IF-RT. It was randomly compared, in favorable patients, to STNI and, in unfavorable patients, to six cycles of mechlorethamine, vincristine, procarbazine, prednisone, doxorubicin, bleomycin, and vinblastine (MOPP/ABV hybrid) and IF-RT. Results Median follow-up time of the 722 patients included was 9 years. In 333 favorable patients, the 10-year event-free survival rates (EFS) were 88% in the EBVP arm and 78% in the STNI arm (P = .0113), with similar 10-year overall survival (OS) rates (92% v 92%, respectively; P = .79). In 389 unfavorable patients, the 10-year EFS rate was 88% in the MOPP/ABV arm compared with 68% in the EBVP arm (P < .001), leading to 10-year OS rates of 87% and 79%, respectively (P = .0175). Conclusion A treatment strategy for early-stage HL based on prognostic factors leads to high OS rates in both favorable and unfavorable patients. In favorable patients, the combination of EBVP and IF-RT can replace STNI as standard treatment. In unfavorable patients, EBVP is significantly less efficient than MOPP/ABV.

Combined VBM Chemotherapy and Involved Field (IF) Radiotherapy in Early Stage Hodgkin’s Lymphoma (HL): A Single Centre Experience.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4463-4463
Author(s):  
Emilia Cocorocchio ◽  
Fedro A. Peccatori ◽  
Federica Gigli ◽  
Simona Bassi ◽  
Luca Nassi ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Early Stage ◽  
Alkylating Agents ◽  
Performance Status ◽  
Low Risk ◽  
Hodgkin's Lymphoma ◽  
Cell Transplant ◽  
Bulky Disease ◽  
Before And After

Abstract Early stage HL patients (pts) benefit from a short course of chemotherapy combined with IF radiotherapy. In our previous experience six courses of VBM chemotherapy (Stanford regimen) were administered with IF radiotherapy. However, despite good clinical results, the schedule was modified in terms of total chemotherapy cycles delivered, in order to reduce the risk of long term toxicities. PET and CT scan were performed at staging to identify a low risk patients (pts) group. From May 2001 to November 2006, 32 treatment naïve Hodgkin’s lymphoma pts (18 male, 14 female) were treated with four courses of VBM chemotherapy (D1, 8: Vinblastine 6 mg/sm, Bleomycin 10 mg/sm, Methotrexate 30 mg/sm, repeated every 28 days) followed by IF radiotherapy. Median age was 37 years (range 16–73). Main histology was classical HL in 26 pts, while lymphocyte predominant was observed in 6 pts. Pts were all stage I-IIA (no bulky disease), no more than three sites involved, performance status 0–1 and ESR < 50. CT scans were performed before and after chemotherapy and radiotherapy. PET scans were performed before and after chemotherapy in 26 pts, and after radiotherapy if not performed before or in case of positivity after chemotherapy. Chemotherapy was usually well tolerated: three pts experienced G3-4 neutropenia while the main non- haematological toxicities recorded were G3 transaminitis in 3 pts and G1-2 neuroconstipation/abdominal pain in 18 pts. IF radiotherapy was performed one month after the last chemotherapy cycle; median dose administered was 30Gy (range 26–30.4). At the end of chemotherapy 7 pts were PET positive. While one patient developed progressive disease, the other six pts became negative after radiotherapy and are still in complete remission (CR). 29 pts (90%) completed the whole program obtaining a CR. Two pts progressed before radiotherapy, while one patient shifted to an anthracycline containing schedule after two cycles due to stable disease. With a median follow-up of 42 months (range: 7–73), all pts are alive. 1 out of 29 CR pts progressed and is now receiving intensive chemotherapy program with autologous stem cell transplant. In our experience four cycles of VBM chemotherapy combined with IF radiotherapy is an effective program. Furthermore this regimen that doesn’t contain alkylating agents or anthracyclines avoids alopecia and decreases the risk of long term toxicity. PET scan effectively helps to identify low risk early stage HL pts that can take advantage of this therapeutic approach.

Involved-Field Radiotherapy Is Equally Effective and Less Toxic Compared With Extended-Field Radiotherapy After Four Cycles of Chemotherapy in Patients With Early-Stage Unfavorable Hodgkin’s Lymphoma: Results of the HD8 Trial of the German Hodgkin’s Lymphoma Study Group

2003 ◽  
Vol 21 (19) ◽  
pp. 3601-3608 ◽  
Author(s):  
Andreas Engert ◽  
Petra Schiller ◽  
Andreas Josting ◽  
Richard Herrmann ◽  
Peter Koch ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Early Stage ◽  
Survival Rates ◽  
Observation Time ◽  
Hodgkin's Lymphoma ◽  
Bulky Disease ◽  
Acute Side Effects ◽  
Extended Field ◽  
Lymphoma Study Group ◽  
Involved Field

Purpose: To investigate whether radiotherapy can be reduced without loss of efficacy from extended field (EF) to involved field (IF) after four cycles of chemotherapy. Patients and Methods: Between 1993 and 1998, patients with newly diagnosed early-stage unfavorable HD were enrolled onto this multicenter study. Patients were randomly assigned to receive cyclophosphamide, vincristine, procarbazine, and prednisone (COPP) + doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) for two cycles followed by radiotherapy of 30 Gy EF + 10 Gy to bulky disease (arm A) or 30 Gy IF + 10 Gy to bulky disease (arm B). Results: Of 1,204 patients randomly assigned to treatment, 1,064 patients were informative and eligible for the arm comparison (532 patients in arm A; 532 patients in arm B). The median observation time was 54 months. Five years after random assignment, the overall survival (OSran) for all eligible patients was 91% and freedom from treatment failure (FFTFran) was 83%. Survival rates at 5 years after start of radiotherapy revealed no differences for arms A and B, respectively, in terms of FFTF (85.8% and 84.2%) and OS at 5 years (90.8% and 92.4%). There also were no differences between arms A and B, respectively, in terms of complete remission (98.5% and 97.2%), progressive disease (0.8% and 1.9%), relapse (6.4% and 7.7%), death (8.1% and 6.4%), and secondary neoplasia (4.5% and 2.8%). In contrast, acute side effects including leukopenia, thrombocytopenia, nausea, gastrointestinal toxicity, and pharyngeal toxicity were more frequent in the EF arm. Conclusion: Radiotherapy volume size reduction from EF to IF after COPP + ABVD chemotherapy for two cycles produces similar results and less toxicity in patients with early-stage unfavorable HD.

Identification of Prognostic Factors in Early Unfavorable Stage Hodgkin’s Lymphoma (HL): An Individual Patient Data Meta-Analysis.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2473-2473 ◽  
Author(s):  
Julia Bohlius ◽  
Heinz Haverkamp ◽  
Volker Diehl ◽  
Houchingue Eghbali ◽  
Christopher Ferme ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mediastinal Tumor ◽  
Proportional Hazards ◽  
Individual Patient Data ◽  
Early Stage ◽  
Collaborative Study ◽  
Patient Data ◽  
Stage I ◽  
Cochrane Library ◽  
Treatment Optimization

Abstract Background: In patients with early unfavorable stage HL, generally defined as stage I and II patients with mediastinal bulk, elevated ESR, 3 3 involved nodal regions, older age or extranodal involvement, progression-free-survival (PFS) is low compared to patients with early favorable or advanced stages disease. This indicates suboptimal treatment strategies and clinical heterogeneity within the group of patients with early unfavorable stage HL. An international collaborative study was initiated to identify factors that may predict for poor prognosis in this patient group. Methods: Medline and Cochrane Library were systematically searched for randomized controlled trials (n>100 patients per study arm) in early stage HL patients with one or more risk factors receiving 4–6 cycles of ABVD or similar chemotherapy plus radiotherapy. Individual patient data were collected and risk factors for PFS (including disease progression, relapse or death) identified using multivariate analysis (linear stepwise proportional hazards) stratified by study. Results: Six studies were identified; data from 4,490 adult patients enrolled between 08/1982 and 01/2003 were available for analysis. The median follow up was 64 months; 663 patients experienced an event leading to an overall 5-year PFS rate of 85% (95% CI 83%–88%). Six factors were significantly (P<0.01) associated with poor PFS: male gender (Hazard ratio (HR) 1.69), age (HR per additional life year 1.03), B symptoms (HR 1.25), anemia (HR per 1 g/dL Hb decrease 1.09), WBC (HR per 1000 WBC increase 1.02) and large mediastinal tumor (HR 1.54). Split into quintiles by predicted risk, observed 5-year PFS rates differed significantly (p<0.001): 80% of patients with early unfavorable stage HL achieved 5-year PFS rates ranging from 84% (95% CI 81%–87%) to 92% (95% CI 90%–94%) while 20% of patients had poor 5-year PFS, i.e. 76% (95% CI 73%–79%). Compared to low risk patients, those with high risk were more often male (81% vs 40%), older (median age 50 vs 29 years) and presented more often with B symptoms (62% vs 28%) and large mediastinal tumor (42% vs 27%). These data show that among stage I and II patients with at least one risk factor heterogeneity exists. Conclusion: Using basic characteristics and routine tests, it is possible to identify a subgroup of early unfavorable stage patients with poor PFS while receiving 4–6 cycles of ABVD or similar chemotherapy plus radiotherapy. For these patients, treatment optimization is open to discussion in particular when compared to that of patients with advanced stage disease.

Lymphocyte-Predominant and Classical Hodgkin's Lymphoma: A Comprehensive Analysis From the German Hodgkin Study Group

2008 ◽  
Vol 26 (3) ◽  
pp. 434-439 ◽  
Author(s):  
Lucia Nogová ◽  
Thorsten Reineke ◽  
Corinne Brillant ◽  
Michal Sieniawski ◽  
Thomas Rüdiger ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Complete Remission ◽  
Hodgkin’S Lymphoma ◽  
Early Stage ◽  
Treatment Strategies ◽  
Hodgkin's Lymphoma ◽  
Tumor Control ◽  
Study Group ◽  
Advanced Stage ◽  
German Hodgkin Study Group

Purpose Lymphocyte-predominant Hodgkin's lymphoma (LPHL) is rare and differs in histologic and clinical presentation from classical Hodgkin's lymphoma (cHL). To shed more light on the prognosis and outcome of LPHL, we reviewed all LPHL patients registered in the German Hodgkin Study Group (GHSG) database, comparing patient characteristics and treatment outcome with cHL patients. Patients and Methods We analyzed retrospectively 8,298 HL patients treated within the GHSG trials HD4 to HD12, of whom 394 had LPHL and 7,904 had cHL. Results Complete remission and unconfirmed complete remission after first-line treatment was achieved in 91.6% v 85.9% of patients in early favorable stages, 85.7% v 83.3% of patients in early unfavorable stages, and 76.8% v 77.8% of patients in advanced stages of LPHL compared with cHL, respectively. Tumor control (freedom from treatment failure [FFTF]) for LPHL and cHL patients at a median observation of 50 months was 88% and 82% (P = .0093) and overall survival (OS) was 96% and 92%, respectively (P = .0166). In LPHL patients, negative prognostic factors were advanced stage (P = .0092), Hb less than 10.5 g/dL (P = .0171), and lymphopenia (P = .010) for FFTF. Age ≥ 45 years (P = .0125), advanced stage (P = .0153), and Hb less than 10.5 g/dL (P = .0014) were negative prognostic factors for OS. Conclusion The better prognosis of LPHL as compared with cHL might allow different treatment strategies, particularly for early-stage LPHL patients.

Prospective Evaluation of the International Prognostic Score (IPS) in All Stages of Hodgkin’s Lymphoma Treated with ABVD Plus Involved-Field Radiotherapy (IFRT).

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1454-1454
Author(s):  
Santiago Pavlovsky ◽  
Claudia Corrado ◽  
Miguel A Pavlovsky ◽  
Virginia Prates ◽  
Lucia Zoppegno ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Complete Remission ◽  
Hodgkin’S Lymphoma ◽  
Prognostic Score ◽  
Hodgkin's Lymphoma ◽  
Therapeutic Approaches ◽  
Bulky Disease ◽  
Number Of Patients ◽  
Involved Field ◽  
Involved Field Radiotherapy

Abstract Background: The prognostic score for Hodgkin’s lymphoma was defined as the number of adverse prognostic factors presented at diagnosis. Seven factors had similar independent prognostic effects. This model was validated retrospectively in advanced disease using different therapeutic approaches (D Hasenclever et al N Eng J Med339:1506–14, 1998). Methods: From December 1996 up to October 2005, the GATLA completed a risk-adapted therapy with ABVD and IFRT. Patients with stages I-IIIA without bulky disease, who achieved complete remission (CR) after three cycles of ABVD, favorable group (FG) received only IFRT 25 GY to areas of &gt;2 cm at diagnosis. Patients with FG not in CR after three cycles of ABVD, slow responders (FGSR), all stages IIIB-IV and all bulky disease, unfavorable group (UG) received six cycles of ABVD and IFRT 30 GY at remaining areas after 3 cycles of ABVD. A total of 584 patients, completed therapy; of them 513 were evaluated with the IPS. Patients were divided in three groups according to the number of adverse prognostic factors 0–1, 2–3, and ≥ 4. Results: The number of patients, complete remission (CR) rate, event-free survival (EFS) and overall survival (OSV) at 5 years according to prognostic factors in the 513 patients were as follows: IPS # patients (%) # CR (%) % EFS % OSV 0–1 224 (44) 217 (97) 86 95 2–3 241 (47) 213 (88) 73 90 ≥4 48 (9) 40 (83) 65 72 P&lt; 0.020 0.001 0.001 A total of 200 patients with FG had a 5 years EFS and OSV of 89% and 98% while 53 patients with FGSR had an EFS and OSV of 66% and 88% respectively (P&lt;0.001). The IPS in FG and FGSR was 0–1 of 61% versus 49%, 2–3 of 38.5% versus 43% and ≥4 of 0.5% versus 8% respectively (p=0.003). In UG with an EFS and OSV of 72% and 87%, the incidence of IPS 0–1 was 29%, 2–3 was 54% and ≥4 was 17%. Conclusion: The IPS is an excellent tool to predict outcome. Patients with stages I-IIIA without bulky tumour who did not achieve CR after three cycles of ABVD (FGSR) had poorer IPS than FG. In spite of receiving six cycles of ABVD, those with FGSR instead of three of those with FG had statistically a poor outcome. In the PET-TC era, patients who remain positive after three cycles of ABVD will need an intensified therapy with the purpose of improving the bad prognosis.

scholarly journals Predictors of clinical outcome in pediatric oligodendroglioma: meta-analysis of individual patient data and multiple imputation

2018 ◽  
Vol 21 (2) ◽  
pp. 153-163 ◽  
Author(s):  
Kevin Yuqi Wang ◽  
Emilian R. Vankov ◽  
Doris Da May Lin
Keyword(s):  
Prognostic Factors ◽  
Missing Data ◽  
Multiple Imputation ◽  
Statistical Power ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Systematic Search ◽  
Initial Presentation ◽  
Subtotal Resection

OBJECTIVEOligodendroglioma is a rare primary CNS neoplasm in the pediatric population, and only a limited number of studies in the literature have characterized this entity. Existing studies are limited by small sample sizes and discrepant interstudy findings in identified prognostic factors. In the present study, the authors aimed to increase the statistical power in evaluating for potential prognostic factors of pediatric oligodendrogliomas and sought to reconcile the discrepant findings present among existing studies by performing an individual-patient-data (IPD) meta-analysis and using multiple imputation to address data not directly available from existing studies.METHODSA systematic search was performed, and all studies found to be related to pediatric oligodendrogliomas and associated outcomes were screened for inclusion. Each study was searched for specific demographic and clinical characteristics of each patient and the duration of event-free survival (EFS) and overall survival (OS). Given that certain demographic and clinical information of each patient was not available within all studies, a multivariable imputation via chained equations model was used to impute missing data after the mechanism of missing data was determined. The primary end points of interest were hazard ratios for EFS and OS, as calculated by the Cox proportional-hazards model. Both univariate and multivariate analyses were performed. The multivariate model was adjusted for age, sex, tumor grade, mixed pathologies, extent of resection, chemotherapy, radiation therapy, tumor location, and initial presentation. A p value of less than 0.05 was considered statistically significant.RESULTSA systematic search identified 24 studies with both time-to-event and IPD characteristics available, and a total of 237 individual cases were available for analysis. A median of 19.4% of the values among clinical, demographic, and outcome variables in the compiled 237 cases were missing. Multivariate Cox regression analysis revealed subtotal resection (p = 0.007 [EFS] and 0.043 [OS]), initial presentation of headache (p = 0.006 [EFS] and 0.004 [OS]), mixed pathologies (p = 0.005 [EFS] and 0.049 [OS]), and location of the tumor in the parietal lobe (p = 0.044 [EFS] and 0.030 [OS]) to be significant predictors of tumor progression or recurrence and death.CONCLUSIONSThe use of IPD meta-analysis provides a valuable means for increasing statistical power in investigations of disease entities with a very low incidence. Missing data are common in research, and multiple imputation is a flexible and valid approach for addressing this issue, when it is used conscientiously. Undergoing subtotal resection, having a parietal tumor, having tumors with mixed pathologies, and suffering headaches at the time of diagnosis portended a poorer prognosis in pediatric patients with oligodendroglioma.

scholarly journals Curative resection plus adjuvant chemotherapy for early stage primary gastric non-Hodgkin's lymphoma: a retrospective study with emphasis on prognostic factors and treatment outcome

2006 ◽  
Vol 43 (1) ◽  
pp. 30-36 ◽  
Author(s):  
Jaques Waisberg ◽  
Eduardo Antonio André ◽  
Maria Isete Fares Franco ◽  
Júlio Zaki Abucham-Neto ◽  
Daniela Wickbold ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Adjuvant Therapy ◽  
Hodgkin’S Lymphoma ◽  
Gastric Resection ◽  
Early Stage ◽  
Gastric Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Management Approaches

BACKGROUND: There is controversy regarding the optimal therapy for primary non-Hodgkin gastric lymphoma with some authors defending surgical extirpation either alone or in association with radiotherapy and or chemotherapy, especially in relation to the earlier stages of the disease. AIM: To analyze the clinical-pathological features and the results of management approaches for patients with primary early-stage non-Hodgkin's lymphoma of the stomach operated in Surgical Gastroenterology Department, "Hospital do Servidor Público Estadual", São Paulo, SP, Brazil. The literature is reviewed to highlight the aspects of diagnosis, prognostic factors and role of the various treatment regimens. METHOD: Sixteen patients with primary early-stage gastric lymphoma underwent curative surgical treatment. The variables analyzed were age, sex, location, size, type of surgery, number of lesions, depth of invasion, histological type in accordance with Kiel's classification, involvement of lymph nodes, Ann Arbor stage classification modified by Musshoff and Schmidt-Vollmer, histological grade, margins, adjuvant therapy, clinical course and survival. RESULTS: Ten patients (62.5%) underwent subtotal gastrectomy and six (37.5%) underwent total gastrectomy. The majority (9/56.2%) of the lesions were located in the antrum. Single lesions (10/62.5%) were more frequent than multiple lesions (6/37.5%). Thirteen patients (81.2%) were classified as stage IE and three (18.7%) as stage IIE1. Primary gastric lymphoma classified histologically as low or high grade was presented by 10 (62.5%) and 6 (37.5%) patients, respectively. The most frequent histological types were the lymphoplasmocytic cytoid (4/25.0%) and centroblastic (4/25.0%). Ten patients (62.5%) received adjuvant treatment (chemotherapy and/or radiotherapy). Nine patients (56.2%), all in stage IE, reached a survival greater than 5 years and of these eight (50.0.%) had received adjuvant therapy. Two (12.5%) patients with stage IIE1 presented peritoneal relapse and died 3.0 years and 3.5 years after their respective operations. The mean overall survival was 42,5 months. CONCLUSIONS: Among the patients with primary early-stage gastric lymphoma (IE and IIE1), the gastric resection enabled an accurate clinicopathological staging, in addition to obtaining sufficient material for histopathological study and extirpation of the lesion. Furthermore, for patients with stage IE disease, the gastric resection combined with adjuvant therapy was associated with a greater than 5-year survival. Until prospective randomized studies are realized in order to evaluate the real efficacy of the different types of treatment for primary early-stage gastric lymphoma, management approaches should be individually tailored.

Treatment of Early Stage Classic Hodgkin's Lymphoma Outcome: Kuwait Experience

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4948-4948
Author(s):  
Salem H Alshemmari ◽  
Rehab S Elhagracy ◽  
Amany Elbasmy
Keyword(s):  
Survival Rate ◽  
Regression Model ◽  
Hodgkin’S Lymphoma ◽  
Early Stage ◽  
Hodgkin's Lymphoma ◽  
Bulky Disease ◽  
Early Stages ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Abstract 4948 Treatment of early stage classical Hodgkin's lymphoma (CHL) I&II had been changed over the last decades. This study evaluated the treatment outcome for early stages CHL patients who were treated by 6 versus 4 ABVD cycles with or without radiotherapy (RT) to the residual or bulky sites. The study retrospectively analyzed cases with early stage CHL patients diagnosed & treated in Kuwait Cancer Control Center from 2001–2010. Staging confirmed by computed tomography, nuclear studies:Gallium or recently Positron emission tomography. Data analyzed by SPSS version 15 & described using mean and standard deviation (SD) or frequencies according to data type. Chi square test was used for comparison of qualitative variables; survival analysis was performed by Kaplan-Meir analysis and regression model performed with Cox regression model. Significance considered if p ≤0.05 & highly significant if ≤0.01. The study included 105 patients that were further subdivided into Group A included 34 patients treated with 4 cycles and group B included 71 patients were treated by 6 cycles. Table(1)demonstrated cases characteristics. There were 61 males and 44 female with male:female ratio 1.3:1. Nodular sclerosis attributed to 66.6%, mixed cellularity 26.6%, lymphocyte rich 5.7% and lymphocyte depleted 0.9% of cases.Table (1):Characteristic Differences between group A & B.ParametersGroup A n=34Group B n=71pAge mean±SD37.41±16.15928.44±11.4740.005Sex female/males n (%)13(38.2)/21(61.7)31(43.6)/40(56.3)0.675B symptoms positive n (%)6 (17.6)32 (45)0.009Stage I n (%) II n (%)13 (38.2) 21 (61.7)7 (9.8) 64 (90.1)0.001IA 18 (17.1%)12 (35.2)6 (8.4)IIA 49 (46.6%)16 (47)33 (46.4)IB 2 (1.9%)1 (2.9)1 (1.4)IIB 36 (24%)5 (14.7)31 (43.6)Presence of Bulky disease n (%)5 (14.7)21 (29.5)0.146Presence of Extranodal site n (%)4 (11.7)4 (5.6)0.329Groups of lymph node ≥412(35.3)41(57.7%)ESR ≥ 50mm/hr n (%)36(34.28)6(17.6)30(42.2)mean±SDmean±SDTLC X109/L8.09± 3.10810.42±4.4580.007HB g/L12.36±2.1211.67±1.900.09Plat X109/L349.21±88.429400.17±151.4880.033Lymphocytes X109/L1.65±0.6711.74±0.7900.491ESR mm/hr28.21±22.15347.69±33.4500.001Max mass size by CM4.94±2.7955.39±3.0260.464Albumin g/L39.59±4.65936.62±6.0320.013LDH IU/L178.41±46.639183.90±85.3420.727 Age was significantly lower in group B (p=0.005), that may attributed to the heterogeneity of population. Group B significantly had more B symptoms, higher platelets, ESR, TLC & lower albumin level. RT was delivered to total 60(57.1%) cases; 28(82.3%) in group A and 32(45%) in group B. Thirty six of cases received 30 Gy and 20 received 36 Gy. The commonly radiated sites were cervical nodes 53.3% followed by the mediastinum in 41.6%. Complete remission (CR) achieved in 84 (80%) of cases, while 6 (5.7%) showed residual disease (RD) & progression (PD) on therapy and 15 (14.3%) of cases developed relapse on follow up. In group A; 82.2% of patients achieved CR compared to 76.1%. Relapse incidence was 16.9%(12) in group B compared to 8.8%(3) in group A. Thirteen patients were treated by high dose chemotherapy followed by ASCT; 7 with relapse (2 from A & 5 from B) & 6 cases with SD/PD (1 from A & 5 from B). Among relapsed cases 6 died (4 from group B & 2 from group A). Four patients with RD/PD died (3 from group B, 1 from group A). No significant difference was found between the two groups regarding CR, PD or relapse incidence (p=0.40). Kaplan-Mayer survival study showed 5-years survival rate was 86%; without significant difference between group A 85 % or group B 87% (p=0.51). Those without B symptoms had significantly better 5-years survival rate 92% compared to those with B symptoms 73 % (p=0.02). Although those patients with bulky disease showed inferior 5-years survival rate 77 % compared to those without bulky disease 89%,the difference was not statistically significant (p=0.1). Lower ESR < 50 mm/hr had better 5-years survival 89 % compared to high ESR ≥ 50 mm/hr 82 % with no significant difference (p=0.51). Events free survival time was difficult to determine attributed to minor events among patients. There were no cardiopulmonary toxicities or secondary malignancy detected in patients on 5-years follows up. This suggests that treatment of early stage CHL by combined chemo-radiotherapy associated with better survival. ABVD 4 cycles is adequate as 6 cycles in early stages. Disclosures: No relevant conflicts of interest to declare.

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