scholarly journals Prognostic factors and treatment outcome in primary progressive Hodgkin lymphoma: a report from the German Hodgkin Lymphoma Study Group

Blood ◽  
2000 ◽  
Vol 96 (4) ◽  
pp. 1280-1286 ◽  
Author(s):  
Andreas Josting ◽  
Ulrich Rueffer ◽  
Jeremy Franklin ◽  
Markus Sieber ◽  
Volker Diehl ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Prognostic Factors ◽  
Hodgkin Lymphoma ◽  
Intermediate Stage ◽  
Salvage Radiotherapy ◽  
High Dose ◽  
Study Group ◽  
Karnofsky Performance Score ◽  
Primary Progressive ◽  
Lymphoma Study Group

To determine prognostic factors and treatment outcome, patients with primary progressive Hodgkin lymphoma (HD) registered in the database of the German Hodgkin Lymphoma Study Group (GHSG) were analyzed retrospectively. Detailed records from randomized prospective multicenter trials performed between 1988 and 1998 of 3807 patients recruited in these trials were reviewed. The median age of the 206 patients available was 34 years (range, 16-71). Fifty-seven patients (28%) in intermediate stage and 149 patients (72%) in advanced stage developed progressive disease (PD). One hundred and fifty-three patients (74%) were treated with salvage chemotherapy, 47 patients (23%) with salvage radiotherapy, and 6 patients (3%) did not receive any therapy due to rapid PD. Seventy patients (34%) were treated with high-dose chemotherapy (HDCT) and autologous stem cell transplantation. The 5-year freedom from second failure (FF2F) and overall survival (OS) for all patients were 17% and 26%, respectively. The 5-year FF2F and OS for patients treated with HDCT were 31% and 43%, respectively. In multivariate analysis low Karnofsky performance score at the time of progression (P < .0001), age above 50 years (P = .019), and failure to attain a temporary remission on first-line treatment (P = .0003) were significant adverse prognostic factors for OS. Patients with none of these risk factors had a 5-year OS of 55% compared with 0% for patients with all 3 of these unfavorable prognostic factors. Although HDCT is a reasonable option for selected patients with primary progressive HD, the majority did not receive HDCT. Interestingly, salvage radiotherapy gave promising results in patients with localized PD.

scholarly journals Prognostic factors and treatment outcome in primary progressive Hodgkin lymphoma: a report from the German Hodgkin Lymphoma Study Group

Blood ◽  
2000 ◽  
Vol 96 (4) ◽  
pp. 1280-1286 ◽  
Author(s):  
Andreas Josting ◽  
Ulrich Rueffer ◽  
Jeremy Franklin ◽  
Markus Sieber ◽  
Volker Diehl ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Prognostic Factors ◽  
Hodgkin Lymphoma ◽  
Intermediate Stage ◽  
Salvage Radiotherapy ◽  
High Dose ◽  
Study Group ◽  
Karnofsky Performance Score ◽  
Primary Progressive ◽  
Lymphoma Study Group

Abstract To determine prognostic factors and treatment outcome, patients with primary progressive Hodgkin lymphoma (HD) registered in the database of the German Hodgkin Lymphoma Study Group (GHSG) were analyzed retrospectively. Detailed records from randomized prospective multicenter trials performed between 1988 and 1998 of 3807 patients recruited in these trials were reviewed. The median age of the 206 patients available was 34 years (range, 16-71). Fifty-seven patients (28%) in intermediate stage and 149 patients (72%) in advanced stage developed progressive disease (PD). One hundred and fifty-three patients (74%) were treated with salvage chemotherapy, 47 patients (23%) with salvage radiotherapy, and 6 patients (3%) did not receive any therapy due to rapid PD. Seventy patients (34%) were treated with high-dose chemotherapy (HDCT) and autologous stem cell transplantation. The 5-year freedom from second failure (FF2F) and overall survival (OS) for all patients were 17% and 26%, respectively. The 5-year FF2F and OS for patients treated with HDCT were 31% and 43%, respectively. In multivariate analysis low Karnofsky performance score at the time of progression (P &lt; .0001), age above 50 years (P = .019), and failure to attain a temporary remission on first-line treatment (P = .0003) were significant adverse prognostic factors for OS. Patients with none of these risk factors had a 5-year OS of 55% compared with 0% for patients with all 3 of these unfavorable prognostic factors. Although HDCT is a reasonable option for selected patients with primary progressive HD, the majority did not receive HDCT. Interestingly, salvage radiotherapy gave promising results in patients with localized PD.

Cologne High-Dose Sequential Chemotherapy in Relapsed and Refractory Hodgkin Lymphoma - Results of a Large Multicenter Study of the German Hodgkin Lymphoma Study Group (GHSG).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 309-309 ◽  
Author(s):  
Andreas Josting ◽  
Christian Rudolph ◽  
Markus Mapara ◽  
Jan-Peter Glossmann ◽  
Markus Sieber ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Hodgkin Lymphoma ◽  
Late Relapse ◽  
High Dose ◽  
Sequential Chemotherapy ◽  
Eligibility Criteria ◽  
First Results ◽  
First Remission ◽  
Multiple Relapse ◽  
Lymphoma Study Group

Abstract Purpose: Combination chemotherapy can cure patients (pts) with Hodgkin lymphoma (HD), but those with treatment failure or relapse still have a poor prognosis. We thus, designed a dose- and time-intensified high-dose sequential chemotherapy regimen with a final myeloablative course. Patients and Methods: Eligibility criteria included age 18–65 years, histologically proven primary progressive (PD) or relapsed HD. Treatment consists of two cycles DHAP (dexamethasone 40mg d1-4, high-dose cytarabin 2g/m2 12q d2, cisplatinum 100mg/m2 d1); pts with partial (PR) or complete remission (CR) received cyclophosphamide 4g/m2, followed by peripheral blood stem cell (PBSC) harvest; methotrexate 8g/m2 plus vincristine 1,4mg/m2; and etoposide 2g/m2. The final myeloblative course was BEAM followed by PBSCT. Results: 102 pts (median age 34 years, range 18–64) were enrolled. The response rate (RR) at the final evaluation (100 days posttransplantation) was 80% (72% CR, 8% PR). PBSC harvest was succesful in 96% of pts. Toxicity was tolerable. With a median follow-up of 30 months (range 3–61 months) freedom from second failure (FF2F) and overall survival (OS) were 59% and 78% for all patients, respectively. FF2F and OS for patients with early relapse were 62% and 81%, for late relapse 65% and 81%; for PD: 41% and 48% and for multiple relapse 39% and 48%, respectively. In multivariate analysis response after 2 cycles of DHAP (p &lt; 0.0001) and duration of first remission (PD and multiple relapse vs. early and late relapse; p = 0.0127) were prognostic factors for FF2F. Response after DHAP (p &lt; 0.0081), duration of first remission (p = 0.0017) and anemia (p = 0.019) were identified as prognostic factors for OS. Conclusion: We conclude that this regimen is feasible, tolerable and highly effective in poor risk patients with relapsed and refractory HD. Based on these results a prospective randomized european intergoup study was started comparing this intensified regimen with two courses of DHAP followed by BEAM (HD-R2 protocol). First results of the second interim analysis of this study will be presented.

New Prognostic Score Based on Treatment Outcome of Patients With Relapsed Hodgkin’s Lymphoma Registered in the Database of the German Hodgkin’s Lymphoma Study Group

2002 ◽  
Vol 20 (1) ◽  
pp. 221-230 ◽  
Author(s):  
Andreas Josting ◽  
Jeremy Franklin ◽  
Michael May ◽  
Peter Koch ◽  
Maria K. Beykirch ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Hodgkin’S Lymphoma ◽  
Prognostic Score ◽  
Clinical Stage ◽  
Salvage Treatment ◽  
Hodgkin's Lymphoma ◽  
Study Group ◽  
Karnofsky Performance Score ◽  
Lymphoma Study Group ◽  
Time To Relapse

PURPOSE: To evaluate salvage treatment outcome of patients with relapsed Hodgkin’s disease (HD) and to distinguish different risk groups using identified prognostic factors. PATIENTS AND METHODS: From 4,754 patients registered in the German Hodgkin’s Lymphoma Study Group (GHSG) database between 1988 and 1999, 422 patients with early (n = 170) or late (n = 252) relapsed HD were identified. One hundred seven patients (25%) relapsed after radiotherapy (RT) for early stages, 133 patients (32%) after combined-modality therapy for intermediate stages, and 182 patients (43%) after chemotherapy (CT) and RT to initial bulky disease or residual lymphoma for advanced stages. At relapse, characteristics of these 422 patients (median age, 38 years; range, 17 to 77) were stage III/IV, 45%; B symptoms, 24%; elevated erythrocyte sedimentation rate, 29%; anemia, 13%; and Karnofsky performance score, less than 90 in 13%. At first relapse, salvage treatment was RT in 13%, CT in 54%, and high-dose chemotherapy (HDCT) with autologous stem-cell transplantation (ASCT) in 33%. RESULTS: Median follow-up time after relapse was 45 months. Freedom from second failure (FF2F) and overall survival (OS) were 81% and 89% for relapse after RT, 33% and 46% for early relapse after CT, and 43% and 71% for late relapse after CT, respectively. In multivariate analysis, independent risk factors were time to relapse, clinical stage at relapse, and anemia at relapse. Four subgroups with significantly different FF2F and OS were identified. The prognostic score was predictive for patients who relapsed after RT, CT with conventional CT salvage, and CT with HDCT/ASCT. CONCLUSION: In the GHSG database, time to relapse and clinical stage and anemia at relapse are relevant factors and can be used to form a prognostic score for HD patients at relapse.

Salvage Radiotherapy in Patients With Relapsed and Refractory Hodgkin’s Lymphoma: A Retrospective Analysis From the German Hodgkin Lymphoma Study Group

2005 ◽  
Vol 23 (7) ◽  
pp. 1522-1529 ◽  
Author(s):  
Andreas Josting ◽  
Lucia Nogová ◽  
Jeremy Franklin ◽  
Jan-Peter Glossmann ◽  
Hans Theodor Eich ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Treatment Failure ◽  
Progressive Disease ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Patient Characteristics ◽  
Salvage Radiotherapy ◽  
Late Relapse ◽  
Study Group ◽  
Lymphoma Study Group

Purpose To evaluate treatment outcome and prognostic factors in patients with refractory or first relapsed Hodgkin’s disease (HD) treated with salvage radiotherapy (SRT) alone. Patients and Methods From 4,754 patients registered in the database of the German Hodgkin Study Group from 1988 to 1999, 624 patients were identified with progressive disease (n = 202), or with early (n = 170) or late (n = 252) relapsed HD. At first treatment failure, SRT alone was given to 100 patients. Patient characteristics were: median age, 36 years; progressive disease, 47%; early relapse, 23%; late relapse, 30%; and “B” symptoms, 14%. Eighty-five percent of the patients relapsed after cyclophosphamide, vincristine, procarbazine, and prednisone/doxorubicin, bleomycin, vinblastine, and dacarbazine (COPP/ABVD) –like regimens; 8% after bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) regimens, 7% after first-line radiotherapy alone. Results The volume irradiated was mantle field in 43% of patients, inverted-Y in 8%, total nodal irradiation in 12%, and involved-field in 37%. The median SRT dose was 40 Gy (range, 15 to 50 Gy). Seventy-seven patients achieved a complete remission and four patients achieved a partial remission. The 5-year freedom from treatment failure and overall survival (OS) rates were 28% and 51%, respectively. In multivariate analysis, significant prognostic factors for OS were B symptoms (P = .018) and stage at relapse (P = .014). For freedom from second failure (FF2F) Karnofsky performance status (P = .0001) was significant. In patients with limited stage at progression/relapse, duration of first remission was significant (P = .04) for FF2F. Conclusion SRT offers an effective treatment for selected subsets of patients with relapsed or refractory HD.

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