Role of Hematotoxicity and Sex in Patients With Hodgkin's Lymphoma: An Analysis From the German Hodgkin Study Group

2005 ◽  
Vol 23 (31) ◽  
pp. 8003-8011 ◽  
Author(s):  
Beate Klimm ◽  
Thorsten Reineke ◽  
Heinz Haverkamp ◽  
Karolin Behringer ◽  
Hans T. Eich ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Protective Role ◽  
Hodgkin's Lymphoma ◽  
Study Group ◽  
Similar Response ◽  
Who Grade ◽  
Female Patients ◽  
German Hodgkin Study Group ◽  
Severe Leucopenia

Purpose Several scores have described sex as a prognostic factor in patients with Hodgkin's lymphoma (HL). However, little is known how sex-specific factors influence treatment outcome. We systematically investigated sex differences with regard to pretreatment characteristics and therapy-related variables, and examined their influence on the outcome of HL patients. Patients and Methods This analysis comprises 4,626 HL patients of all prognostic risk groups who were enrolled onto the multicenter studies HD4 to HD9 of the German Hodgkin Study Group. At 5.5 years, 2,050 female and 2,576 male patients were analyzed. Results Male and female patients had similar prognostic factors. There was more acute chemotherapy-related hematotoxicity in women, especially more severe leucopenia (WHO grade 3/4, 69.9% female and 55.2% male; P < .0001). Importantly, this did not translate into more infections. Female patients had similar response rates but fewer relapses and deaths, leading to a significantly better freedom from treatment failure (FFTF; at 66 months, 81% female [95% CI, 79% to 82%] and 74% male [95% CI, 72% to 76%]). Severe leucopenia during chemotherapy was strongly associated with better FFTF, both for males and females. In addition, when only those patients who developed severe leucopenia within the first two cycles of chemotherapy were included, the factor maintained its protective role. Conclusion The protective role of severe leucopenia suggests the testing of a more individualized therapy. In future trials, this therapy may be tailored in a response-adapted manner depending on the individual toxicity profile within the first cycles.

Leucopenia during Treatment Is a Good Prognostic Risk Factor for Patients Undergoing Chemotherapy for Hodgkin’s Lymphoma: An Analysis of the German Hodgkin Study Group (GHSG).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2674-2674
Author(s):  
Beate Klimm ◽  
Thorsten Reineke ◽  
Heinz Haverkamp ◽  
Hans T. Eich ◽  
Karolin Behringer ◽  
...  
Keyword(s):  
Protective Role ◽  
Hodgkin's Lymphoma ◽  
Who Grade ◽  
Male And Female ◽  
Female Patients ◽  
Male Patients ◽  
Severe Leucopenia ◽  
Who Grade Iii ◽  
Grade Iii

Abstract Purpose: A systematic analysis of gender-specific factors in Hodgkin’s lymphoma (HL) studies previously revealed a better outcome for female HL patients. Factors contributing to better prognosis among female patients not only included more favorable risk factors at diagnosis, but also more treatment-induced severe leuopenia (WHO grade III/IV). The purpose of the current analysis was to characterize and investigate the protective role of severe leucopenia for both, male and female HL patients. Patients and Methods: 4626 HL patients including 2050 females (f) and 2576 males (m) of all prognostic risk groups who were enrolled into the multicenter studies HD4-HD9 of the GHSG were evaluated. The median follow-up after treatment was 5.5 years. Results: Female patients had a significantly better freedom from treatment failure (FFTF) with 81% at 66 months (95% confidence interval 79% – 82%), when compared with male patients (74%; 72% – 76%; p&lt;.0001). This was in part related to the occurrence of more acute chemotherapy-related leucopenia (WHO grade III/IV): 69.9% in female patients and 55.2% in male patients (p&lt;.0001). Furthermore, severe leucopenia during chemotherapy was strongly associated with better FFTF for both, male and female patients. Separate multivariate analyses showed that severe leucopenia remained significant when only male patients were included (0.011). In addition, patients who developed severe leucopenia within the first two cycles of chemotherapy also had a significantly better FFTF (p=.0002) compared with all other patients (Klimm et al, JCO in press). When considering patients with advanced HL undergoing BEACOPP in baseline or escalated dose, the presence of severe leucopenia during chemotherapy (p=.0074) was associated with a better outcome. This finding was also confirmed when only the first two cycles of treatment were analyzed (p =.0205). Conclusion: The protective role of severe leucopenia suggests evaluating of a more individualized therapy in future trials, that may be tailored in a response-adapted manner depending on the individual toxicity profile within the first cycles.

The Superior Prognosis of Female Patients with Hodgkin’s Lymphoma Is Related to More Treatment-Induced Leucopenia and Warrants a More Individualized Therapy.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1313-1313
Author(s):  
Beate Klimm ◽  
Thorsten Reineke ◽  
Heinz Haverkamp ◽  
Hans T. Eich ◽  
Andreas Josting ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Retrospective Analysis ◽  
Hodgkin’S Lymphoma ◽  
Protective Role ◽  
Individualized Therapy ◽  
Hodgkin's Lymphoma ◽  
Female Patients ◽  
Male Patients ◽  
Severe Leucopenia ◽  
Grade Iii

Abstract Purpose: Several scores have described gender as an important prognostic factor in patients with Hodgkin’s lymphoma (HL), particularly in advanced-stages. However, so far there is no larger analysis to systematically evaluate possible gender-specific factors. The purpose of this analysis was to investigate sex differences with regard to pre-treatment and therapy-related variables and to evaluate their influence on the outcome of HL patients. Patients and Methods: From 1988 to 1998 the GSHG conducted two generations of clinical trials for early, intermediate and advanced HL (HD4 - HD9). The present analysis comprises 4626 patients of all stages, aged 15 to 75 years, who were enrolled into these multicenter studies and treated according to the GHSG-study protocols. Results: At a median observation time of 5.5 years, 2050 female and 2576 male patients were suitable for this retrospective analysis. Patients in each group had very similar profiles in terms of age, performance status, stage, histological subtype, clinical risk factors and prognostic factors. Slightly more nodular sclerosis subtypes and mediastinal masses were observed in women. In contrast, more men had a mixed cellularity subtype, older age, advanced stage of disease, and B-symptoms at diagnosis. Acute chemotherapy-related toxicity was distributed almost equally. However, there was more hematotoxicity in females. This difference was most obvious for leucopenia [WHO grade III/IV: 69.9 % versus 55.2 %]. Importantly, there was no higher risk of infections in female patients. Response rates being similar in both groups, however, a lower rate of relapse and death was observed in females. Univariate analyses revealed significant better outcome in terms of FFTF and OS for females. In multivariate analyses, sex was not identified as an independent prognostic factor, however, lower stages of disease (p&lt;.0001), less B-symptoms (p&lt;.0001), younger age (p&lt;.0001), and leucopenia grade III/IV (p&lt;.0001) were significant variables to which better outcome in females can be related. Particularly, the high prevalence of leucopenia grade III/IV during chemotherapy has a clear impact on better FFTF in females. The smaller proportion of males expressing severe leucopenia also had better outcomes. In addition, when only those patients were included who developed leucopenia grade III/IV within the first two cycles of chemotherapy, the factor maintains its protective role. Conclusion: In this large retrospective analysis of the GHSG database, a better outcome is observed for female patients compared to male patients with HL. The protective role of severe leucopenia supports the rationale for a more individualized therapy, that may be tailored in a response-adapted manner depending on the individual toxicity profile within the first cycles.

The role of surgery in abdominal non-Hodgkin's lymphoma: Experience from the childrens cancer study group

1992 ◽  
Vol 27 (2) ◽  
pp. 230-235 ◽  
Author(s):  
Michael P. LaQuaglia ◽  
Charles J.H. Stolar ◽  
Mark Krailo ◽  
Philip Exelby ◽  
Stuart Siegel ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Study Group ◽  
Cancer Study ◽  
Cancer Study Group ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

Hodgkin's Lymphoma in Adolescents Treated With Adult Protocols: A Report From the German Hodgkin Study Group

2009 ◽  
Vol 27 (36) ◽  
pp. 6079-6085 ◽  
Author(s):  
Dennis A. Eichenauer ◽  
Henning Bredenfeld ◽  
Heinz Haverkamp ◽  
Horst Müller ◽  
Jeremy Franklin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Hodgkin’S Lymphoma ◽  
Age Groups ◽  
Hodgkin's Lymphoma ◽  
Study Group ◽  
Cox Regression Analysis ◽  
German Hodgkin Study Group ◽  
Study Protocols ◽  
Adolescent Patients

PurposeThe standard of care for adolescent patients with Hodgkin's lymphoma (HL) is undefined, particularly the choice between pediatric and adult protocols. Thus, we compared risk factors and outcome of adolescents and young adults treated within study protocols of the German Hodgkin Study Group (GHSG).Patients and MethodsThree thousand seven hundred eighty-five patients treated within the GHSG studies HD4 to HD9 were analyzed; 557 patients were adolescents age 15 to 20 years, and 3,228 patients were young adults age 21 to 45 years.ResultsLarge mediastinal mass and involvement of three or more lymph node areas were more frequent in adolescents (P < .001). The incidence of other risk factors did not differ significantly between age groups. With a median observation time of 81 months for freedom from treatment failure (FFTF) and 85 months for overall survival (OS), log-rank test showed no significant differences between age groups regarding FFTF (P = .305) and a superior OS (P = .008) for adolescents. Six-year estimates for FFTF and OS were 80% and 94%, respectively, for adolescents and 80% and 91%, respectively, for young adults. After adjustment for other predictive factors, Cox regression analysis revealed age as a significant predictor for OS (P = .004), with a higher mortality risk for young adults. Secondary malignancies were more common in young adults (P = .037).ConclusionOutcome of adolescent and young adult patients treated within GHSG study protocols is comparable. These data suggest that adult treatment protocols exhibit a safe and effective treatment option for adolescent patients with HL. However, longer follow-up, including assessment of late toxicity, is necessary for final conclusions.

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

2011 ◽  
Vol 29 (29) ◽  
pp. 3914-3920 ◽  
Author(s):  
Beate Klimm ◽  
Jeremy Franklin ◽  
Harald Stein ◽  
Dennis A. Eichenauer ◽  
Heinz Haverkamp ◽  
...  
Keyword(s):  
Risk Factors ◽  
Complete Remission ◽  
Hodgkin’S Lymphoma ◽  
Treatment Strategies ◽  
Progression Free Survival ◽  
Hodgkin's Lymphoma ◽  
Study Group ◽  
German Hodgkin Study Group ◽  
Dose Dense ◽  
Histologic Subtypes

Purpose To investigate the clinical characteristics and treatment outcome of patients with lymphocyte-depleted classical Hodgkin's lymphoma (LDCHL) compared with other histologic subtypes of Hodgkin's lymphoma (HL). Patients and Methods From a total of 12,155 evaluable patients with biopsy-proven HL treated within the German Hodgkin Study Group trials HD4 to HD15, 10,019 patients underwent central expert pathology review. Eighty-four patients with LDCHL (< 1%) were identified and confirmed. The median follow-up time was 67 months. Results Patients with LDCHL, compared with patients with other histologic subtypes, presented more often with advanced disease (74% v 42%, respectively; P < .001) and “B” symptoms (76% v 41%, respectively; P < .001). Other risk factors were also more frequent in patients with LDCHL. Complete remission or unconfirmed complete remission was achieved in 82% of patients with LDCHL compared with 93% of patients with other HL subtypes (P < .001), and more patients with LDCHL had progressive disease. At 5 years, progression-free survival (PFS) and overall survival (OS) were significantly lower in patients with LDCHL compared with patients with other HL subtypes (PFS, 71% v 85%, respectively; P < .001; OS, 83% v 92%, respectively; P = .0018). However, when analyzing the subgroup of patients who underwent treatment with intensified or dose-dense bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone, patients with LDCHL (n = 39) had similar outcomes when compared with patients with other subtypes of HL (n = 3,564; P = .61). Conclusion LDCHL has a different pattern from other HL subtypes with more clinical risk factors at initial diagnosis and significantly poorer prognosis. Patients with LDCHL should be treated with modern dose-intense treatment strategies.

scholarly journals Assessment of male fertility in patients with Hodgkin's lymphoma treated in the German Hodgkin Study Group (GHSG) clinical trials

2008 ◽  
Vol 19 (10) ◽  
pp. 1795-1801 ◽  
Author(s):  
M. Sieniawski ◽  
T. Reineke ◽  
A. Josting ◽  
L. Nogova ◽  
K. Behringer ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Male Fertility ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Study Group ◽  
German Hodgkin Study Group
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