Early-Stage, Lymphocyte-Predominant Hodgkin's Lymphoma: Patient Outcomes From a Large, Single-Institution Series With Long Follow-Up

2010 ◽  
Vol 28 (1) ◽  
pp. 136-141 ◽  
Author(s):  
Ronald C. Chen ◽  
Michael S. Chin ◽  
Andrea K. Ng ◽  
Yang Feng ◽  
Donna Neuberg ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Early Stage ◽  
Stage I ◽  
Hodgkin's Lymphoma ◽  
Single Institution ◽  
Term Survival ◽  
Long Term Outcome ◽  
Extended Field

Purpose The optimal treatment for early-stage, lymphocyte-predominant Hodgkin's lymphoma (LPHL) is not well defined. Treatment has become less aggressive over time in an attempt to reduce iatrogenic complications, such as cardiac mortality and second cancers, but long-term efficacy is unclear. We present the long-term outcome of patients treated at a single institution. Patients and Methods The study population includes 113 patients with stage I or II LPHL treated between 1970 and 2005. Pathologic diagnosis for all patients was confirmed using standard criteria. Ninety-three patients received radiation therapy (RT) alone, 13 received RT with chemotherapy, and seven received chemotherapy alone. Among patients treated with RT, 25 received limited-field, 35 received regional-field, and 46 received extended-field RT. Results Median follow-up was 136 months. Ten-year progression-free survival (PFS) rates were 85% (stage I) and 61% (stage II); overall survival (OS) rates were 94% and 97% for stages I and II, respectively. PFS and OS did not differ among patients who received limited-field, regional-field, or extended-field RT. In contrast, six of seven patients who received chemotherapy alone without RT developed early disease progression and required salvage treatment. Multivariable analysis adjusting for extent of RT, clinical stage, sex, and use of chemotherapy confirmed that the extent of RT was not significantly associated with PFS (P = .67) or OS (P = .99). The addition of chemotherapy to RT did not improve PFS or OS compared with RT alone. Conclusion RT alone leads to sustained disease control and high long-term survival rates in patients with early-stage LPHL. This study supports the use of limited-field RT alone to treat this disease.

Long-Term Complications of Lymphoma and Its Treatment

2011 ◽  
Vol 29 (14) ◽  
pp. 1885-1892 ◽  
Author(s):  
Andrea K. Ng ◽  
Ann LaCasce ◽  
Lois B. Travis
Keyword(s):  
Late Effects ◽  
Hodgkin’S Lymphoma ◽  
Early Stage ◽  
Large Body ◽  
Hodgkin's Lymphoma ◽  
Long Term Effects ◽  
Early Stage Disease ◽  
Long Term Follow Up

As a result of therapeutic advances, there is a growing population of survivors of both Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). A thorough understanding of the late effects of cancer and its treatment, including the risk of developing a second malignancy and non-neoplastic complications, most notably cardiac disease, is essential for the proper long-term follow-up care of these patients. For HL survivors cured in the past 5 decades, a large body of literature describes a range of long-term effects, many of which are related to extent of treatment. These studies form the basis for many of the follow-up recommendations developed for HL survivors. As HL therapy continues to evolve, however, with an emphasis toward treatment reduction, in particular for early-stage disease, it will be important to rigorously observe this new generation of patients long term to document and quantify late effects associated with modern treatments. Although data on late effects after NHL therapy have recently emerged, the formulation of structured follow-up plans for this heterogeneous group of survivors is challenging, given the highly variable natural history, treatments, and overall prognosis. However, the chemotherapy and radiation therapy approaches for some types of NHL are similar to that for HL; thus, some of the follow-up guidelines for patients with HL may also be transferrable to selected survivors of NHL. Additional work focused on treatment-related complications after NHL will facilitate the development of follow-up programs, as well as treatment refinements to minimize late effects in patients with various types of NHL.

Treatment of Children & Adolescents with Early Stage Nodular Lymphocyte Predominant Hodgkin Lymphoma with a Low Intensity Short Duration Chemotherapy Regimen [CVP] - on Behalf of the EuroNet-PHL Group.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2471-2471 ◽  
Author(s):  
Ananth G. Shankar ◽  
Stephen Daw ◽  
Georgina Hall ◽  
Stephanie Gorde-Grosjean ◽  
Christine Mauz Koerholz ◽  
...  
Keyword(s):  
Pet Imaging ◽  
Hodgkin’S Lymphoma ◽  
Chemotherapy Regimen ◽  
Early Stage ◽  
Hodgkin's Lymphoma ◽  
Current Therapy ◽  
Cross Sectional ◽  
Term Survival ◽  
Low Intensity

Abstract Background: Nodular Lymphocyte Predominant Hodgkin’s Lymphoma (NLPHL) is a distinct clinicopathologic subtype of Hodgkin’s lymphoma [HL]. Reports in published literature suggest that very little, and occasionally, no chemotherapy is sufficient for long term survival in patients with LPHL and that this disease appears to have a more indolent course than classical HL. The optimum therapy for early stage NLPHL is not known, but it is likely that current therapy for classical Hodgkin’s lymphoma is unnecessarily toxic and intensive for this indolent, slowly progressive, CD 20 positive disease. Adverse treatment related late effects are the major causes of morbidity and death. Consequently children with early stage NLPHL represent ideal candidates for low intensity treatment. Study Objectives: To assess whether a non-intensive chemotherapy regimen consisting of cyclophosphamide [500mg/m2 iv- day 1], vinblastine [6 mg/m2 iv-day1 & 8] and oral prednisolone [40 mg/m2 - days 1–7] (CVP) every 14–21 days, count dependent, could replace standard chemotherapy protocols used for classical HL without compromising efficacy in children and young people with NLPHL. Patients and Methods: Between May 2004 and April 2006 18 patients with stages IA [n=12] and IIA [n=6] biopsy proven NLPHL were treated with 3 cycles of CVP chemotherapy. Three of the eighteen patients were initially treated with surgical resection alone and received CVP at first relapse. Ten patients were males and the median age at diagnosis was 10 years (range 7–15 years). Staging investigations at diagnosis included both conventional cross sectional as well as 18 fluro-deoxyglucose [FDG] PET imaging. Remission status at the end of 3 cycles of CVP was confirmed by both conventional cross sectional and PET imaging. Results: 17 patients achieved a complete remission [CR] after 3 courses of CVP and 1 patient a very good partial remission [VGPR]. To date, only 1 patient has relapsed while all the remaining patients remain in continuous CR. Median duration of follow up is 12 months (range 2–26 months). The overall survival is 100% and event free survival is 94%. No significant early or late toxicity has been observed to date. Conclusions: Nothithstanding the relatively short follow up period, CVP is an effective non toxic chemotherapy regimen with 95% of patients with early stage NLPHL achieving a CR after 3 courses. Based on these preliminary results, we have designed a prospective European study for patients with stage IA & IIA NLPHL to confirm these results in a larger cohort of patients.

Long-Term Follow-Up Analysis of HD9601 Trial Comparing ABVD Versus Stanford V Versus MOPP/EBV/CAD in Patients With Newly Diagnosed Advanced-Stage Hodgkin's Lymphoma: A Study From the Intergruppo Italiano Linfomi

2011 ◽  
Vol 29 (32) ◽  
pp. 4227-4233 ◽  
Author(s):  
Teodoro Chisesi ◽  
Monica Bellei ◽  
Stefano Luminari ◽  
Antonella Montanini ◽  
Luigi Marcheselli ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Disease Free Survival ◽  
Hodgkin's Lymphoma ◽  
Advanced Stage ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Free Survival ◽  
Significant Difference

Purpose The Intergruppo Italiano Linfomi HD9601 trial compared doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) versus doxorubicin, vinblastine, mechloretamine, vincristine, bleomycin, etoposide, and prednisone (Stanford V [StV]) versus the combination of mechlorethamine, vincristine, procarbazine, prednisone (MOPP) with epidoxorubicin, bleomycin, vinblastine (EBV), lomustine, doxorubicin, and vindesine (CAD) (MOPP/EBV/CAD [MEC]) for the initial treatment of advanced-stage Hodgkin's lymphoma to select which regimen would best support a reduced radiotherapy program (limited to two or fewer sites of either previous bulky or partially remitting disease). Superiority of ABVD and MEC to StV was demonstrated. We report analysis of long-term outcome and toxicity. Patients and Methods Patients with stage IIB, III, or IV were randomly assigned among six cycles of ABVD, three cycles of StV, and six cycles of MEC; radiotherapy was administered in 76, 71, and 50 patients in the three arms, respectively. Results Currently, the median follow-up is 86 months; in the prolonged observation period, eight additional failures, including two relapses, both in the StV arm, and six additional deaths in complete response were recorded. The 10-year overall survival rates were 87%, 80%, and 78% for ABVD, MEC, and StV, respectively (P = .4). The 10-year failure-free survival was 75%, 74%, and 49% in the ABVD, MEC, and StV arms, respectively (P < .001). The 10-year disease-free survival of patients treated or not with radiotherapy (RT) showed no difference for ABVD or MEC (85% v 80% and 93% v 68%), and a statistically significant difference for StV (76% v 33%; P = .004). No significant long-term toxicity was recorded. Conclusion The long-term analysis confirmed ABVD and MEC superiority to StV. The use of RT after StV was established as mandatory. ABVD is still to be considered as the standard treatment with a good balance between efficacy and toxicity.

A Pilot Study of Combined Escalated BEACOPP-ABVD Therapy for Advanced Hodgkin’s Lymphoma Patients with High IPS Score: The Israel Cooperative Lymphoma Group.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4576-4576
Author(s):  
Abraham Avigdor ◽  
Shlomo Bulvik ◽  
Noga Shemtov ◽  
Itai Levi ◽  
Miriam Berkowicz ◽  
...  
Keyword(s):  
Pilot Study ◽  
Hodgkin’S Lymphoma ◽  
Intensive Therapy ◽  
Hodgkin's Lymphoma ◽  
Who Grade ◽  
Term Survival ◽  
Advanced Hodgkin’S Lymphoma ◽  
Grade Iii

Abstract ABVD is widely considered as the gold standard treatment for advanced Hodgkin’s lymphoma (HL), although about 40% of patients relapse or do not respond to initial treatment. Recently, the HD9 trial of the German Hodgkin’s Lymphoma Study Group has shown that escalated (esc) BEACOPP regimen can achieve better disease control than ABVD, but has a high incidence of acute and long-term toxicities including high occurrence of AML/MDS. In an attempt to decrease toxicity while preserving the potential benefit of upfront intensive therapy, we conducted a pilot study, which tested the feasibility, toxicity and efficacy of combined escBEACOPP-ABVD regimen as therapy for newly diagnosed patients with high risk (IPS≥3) stage III–IV HL. Patients initially received 2 cycles of escBEACOPP followed by reevaluation with CT and gallium or PET/CT-FDG scans. When complete response (CR) or partial response (PR) was achieved, patients continued to receive 4 cycles of ABVD, while those failing to achieve a response were withdrawn from the study. Since August 2001, 21 patients entered the study and at the time of present analysis four of them are still receiving therapy. Three (18%) of 17 patients, who completed chemotherapy, received consolidative radiotherapy. Median age at diagnosis was 26 years (range 18–56) and 11 (57%) were males. Stage IV and B symptoms were evidenced in 19 (90%) and 17 (81%), respectively, and 7 (33%) had bulky mediastinal mass. Histology included nodular sclerosis in 18 patients (86%), mixed cellularity in 2 (10%) and lymphocyte predominance in 1 (5%). Following the first 2 cycles of escBEACOPP the overall response rate (CR+PR) was 100%. At the end of all therapy 15 patients (88%) were in CR, one patient in PR and only a single patient had progressive disease. With a median follow-up of 20 months no patient relapsed or died. Toxicity included WHO grade III–IV granulocytopenia in 15 patients (88%) and grade III–IV infection in one patient. Hospitalization for intravenous antibiotics was necessary in 10 patients (59%). Almost all of these events occurred during the first two cycles of escBEACOPP, while acute toxicity during the ABVD phase was mild. In conclusion, the combined escBEACOPP-ABVD regimen is well tolerated and is associated with a high CR rate when used in advanced HL patients with high IPS scores. Further follow-up is obviously required in order to determine long-term survival and late complications of this regimen.

Long-Term Follow-up Analysis of HD2000 Trial Comparing ABVD Versus BEACOPP Versus Copp/EBV/CAD in Patients with Newly Diagnosed Advanced-Stage Hodgkin's Lymphoma: A Study from the Fondazione Italiana Linfomi

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 499-499 ◽  
Author(s):  
Francesco Merli ◽  
Stefano Luminari ◽  
Caterina Mammi ◽  
Nicola Cascavilla ◽  
Alessia Bari ◽  
...  
Keyword(s):  
Overall Survival ◽  
Hodgkin’S Lymphoma ◽  
Conflicts Of Interest ◽  
Previous Analysis ◽  
Hodgkin's Lymphoma ◽  
Advanced Stage ◽  
Term Outcome ◽  
Long Term Outcome

Abstract PURPOSE: The HD2000 trial compared doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) versus bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) versus the combination of cyclophosphamide, vincristine, procarbazine, prednisone (COPP) with epidoxorubicin, bleomycin, vinblastine (EBV), lomustine, doxorubicin, and vindesine (CAD) (MOPP/EBV/CAD [CEC]) in 305 eligible patients with advanced-stage Hodgkin's lymphoma (HL). The previous analysis with 41 months median follow-up had indicated that BEACOPP was associated with a significantly improved Progression Free Survival (PFS) compared with ABVD, with a predictable higher acute toxicity. At time of previous analysis none of the study arms resulted in a better Overall Survival (OS). We here report analysis of long-term outcome and toxicity. PATIENTS AND METHODS: Three hundred and five eligible patients with stage IIB, III, or IV were randomly assigned to receive six courses of ABVD (n=103), four escalated plus two standard courses of BEACOPP (n=100), or six courses of CEC (n=102), plus a limited radiation therapy program; radiotherapy was administered in 46, 42, and 42 patients in the three arms, respectively. Study enrolment was completed in June 2007. In January 2014 we updated the study follow-up with the aim of providing data on survival and on late events. RESULTS: At time of current analysis the median follow-up was 119 months (range 1-169) with 92% of patients with a last contact later than January 2012. In the prolonged observation period 23 additional failures (cumulative=82)were recorded, including 17 new relapses/progression (cum=71) and 6 deaths not related to lymphoma progression (cum=11). Additional relapses and progressions were observed in 5, 7 and 5 patients treated with ABVD (cum=31), BEACOPP (cum=17), and CEC (cum=23), respectively. No death unrelatedto lymphoma progression was recorded among patients treated with ABVD, while 8 (+4) and 3 (+2) events were documented among patients treated with BEACOPP or CEC, respectively. The 10-year PFS was 69%, 74% and 74% in the ABVD, BEACOPP and CEC arm, respectively (P=0.639). Using ABVD as reference, Hazard Ratio for PFS for BEACOPP and CEC was 0.73 (CI95% 0.43-1.25) and 0.80 (0.47-1.36); this result was adjusted by IPS. Overall 42 patients died (+19), 13 (+5) in the ABVD arm, 15 (+7) in the BEACOPP arm and 14 (+7) in the CEC arm. The 10-year overall survival rates were 84%, 84% and 86% for ABVD, BEACOPP and CEC, respectively (P =0.883). A total of 11 second malignancies were documented including 2 MDS/AML (1 BEACOPP and 1 CEC), 2 non-Hodgkin’s Lymphoma (1 BEACOPP and 1 CEC), and 7 solid cancers: 2 lung cancer (BEACOPP), 2 bladder cancer (2 CEC), 1 sarcoma (BEACOPP), 1 Kaposi sarcoma (BEACOPP) and 1 thyroid cancer (ABVD). The risk of second malignancy at 10-year was 6.7, 4.4 and 0.9 for BEACOPP, CEC and ABVD, respectively; the difference between BEACOPP and ABVD was statistically significant (P=0.027). CONCLUSION : With the updated follow-up of the HD2000 trial we confirm that patients with advanced HL have similar high chances of survival when treated with ABVD, BEACOPP or CEC. With this long-term analysis we were not able to confirm the previously observed superiority of BEACOPP over ABVD in terms of PFS mainly due to a higher rate of secondary malignancies observed after BEACOPP. Disclosures No relevant conflicts of interest to declare.

Can abdominal ultrasound replace CT scanning in long-term follow-up of male patients with germ cell tumor?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4602-4602
Author(s):  
Arthur Gerl ◽  
Adina Hauck ◽  
Marcus Hentrich
Keyword(s):  
Early Stage ◽  
Ct Scanning ◽  
Abdominal Ultrasound ◽  
Stage I ◽  
Ct Scans ◽  
X Rays ◽  
International Consensus ◽  
Long Term Outcome

4602 Background: To date, there is no international consensus on how best to follow patients (pts) with GCT after their initial management. In the absence of a generally accepted follow-up schedule the possible benefits of regular CT scanning must be weighed against their cost, potential contrast media reactions and the long term risk of cumulative X-ray exposure. The present study focuses on the role of abdominal ultrasound in the follow-up of males with GCT and raises the question whether CT-scanning may be replaced by abdominal ultrasound. Methods: This retrospective single-center cohort study included 887 GCT pts followed between January 2001 and November 2011. The follow-up schedule was predominately based on abdominal ultrasound performed by the same physician (A.G.). Patterns of recurrence and the long-term outcome were analyzed. Results: 462 of 887 pts (52.1%) had stage I, 258 (29.1%) stage II and 130 (14.7%) stage III disease (not evaluable in 37 pts). The median time between baseline and the most recent follow-up examination was 5.0 years. A total of 14.604 abdominal ultrasound examinations (16.5/pt.), 1170 CT scans (1.32/pt.), and 956 chest X-rays (1.08/pt) were performed. A relapse occurred in 58 pts (6.5%) with 11 of 58 pts experiencing multiple relapses. 34 of 58 relapses (58.6%) were detected in pts with stage I GCT. The sites of relapse included the abdomen (n=42), other sites (n=10), and marker elevation only (n=10). 33 of 42 abdominal relapses (78.6%) were detected by abdominal ultrasound. The median size of abdominal lymph nodes was 25 mm (range, 6 - 67 mm). After a median follow-up of 5 years the GCT specific survival of the entire cohort was 98.4%. Regarding the subgroup of pts with relapse the GCT specific survival was 94.7%. Conclusions: Ultrasound appears to be an appropriate method to detect abdominal recurrences in pts with GCT. However, training and cumulative experience is necessary to detect retroperitoneal recurrences at an early stage. The number of expensive and potentially harmful CT scans may be markedly decreased by abdominal ultrasound.

Sign in / Sign up

Export Citation Format

Share Document