Procarbazine-Free OEPA-COPDAC Chemotherapy in Boys and Standard OPPA-COPP in Girls Have Comparable Effectiveness in Pediatric Hodgkin's Lymphoma: The GPOH-HD-2002 Study

2010 ◽  
Vol 28 (23) ◽  
pp. 3680-3686 ◽  
Author(s):  
Christine Mauz-Körholz ◽  
Dirk Hasenclever ◽  
Wolfgang Dörffel ◽  
Kathrin Ruschke ◽  
Tanja Pelz ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Pediatric Patients ◽  
Early Stage ◽  
German Society ◽  
Observation Time ◽  
Hodgkin's Lymphoma ◽  
Induction Treatment ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Involved Field

Purpose Vincristine, etoposide, prednisone, and doxorubicin (OEPA)–cyclophosphamide, vincristine, prednisone, and dacarbazine (COPDAC) is derived from standard vincristine, procarbazine, prednisone, and doxorubicin (OPPA)–cyclophosphamide, vincristine, procarbazine, and prednisone (COPP) chemotherapy by replacing procarbazine with etoposide and dacarbazine for a potentially less gonadotoxic regimen for boys with Hodgkin's lymphoma (HL). Patients and Methods Five hundred seventy-three pediatric patients with classical HL were enrolled onto the German Society of Pediatric Oncology and Hematology–Hodgkin's Disease (GPOH-HD) -2002 study between November 2002 and December 2005. Boys received two courses of OEPA and girls received two courses of OPPA for induction. Treatment group (TG) -2 (intermediate stages) and TG-3 (advanced stages) patients received further two or four cycles COPP (girls) or COPDAC (boys), respectively. After chemotherapy all patients received involved-field irradiation with 19.8 Gy, except for patients with early-stage disease (TG-1) in complete remission. Results Five hundred seventy-three patients (287 males and 286 females) were less than 18 years old and fulfilled all inclusion criteria; 195 patients (34.0%) were allocated to TG-1, 139 (24.3%) were allocated to TG-2, and 239 (41.7%) were allocated to TG-3. Toxicity of OEPA-COPDAC was tolerable overall. Hematotoxicity was more pronounced with OEPA than OPPA, whereas it was less pronounced with COPDAC compared with COPP. The median observation time was 58.6 months. Overall survival and event-free survival (EFS) rates (± SE) at 5 years were 97.4% ± 0.7% and 89.0% ± 1.4%, respectively. In TG-1, overall EFS was 92.0% ± 2.0%. EFS of patients without irradiation (93.2% ± 3.3%) was similar to that of irradiated patients (91.7% ± 2.5%), confirming results of the previous GPOH-HD-95 study. In TG-2+3, EFS did not significantly differ between boys and girls (90.2% ± 2.3 v 84.7% ± 2.7, respectively; P = .12). Conclusion In TG-2+3, results in boys and girls are superimposable. OPPA-COPP and OEPA-COPDAC seem to be exchangeable regimens in intermediate- and advanced-stage classical HL in pediatric patients.

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.

scholarly journals Treatment results of Hodgkin’s lymphoma

Medicina ◽  
2009 ◽  
Vol 45 (8) ◽  
pp. 615 ◽  
Author(s):  
Eduardas Aleknavičius ◽  
Konstantinas Valuckas ◽  
Birutė Aleknavičienė ◽  
Laura Norkienė ◽  
Giedrė Smailytė
Keyword(s):  
Overall Survival ◽  
Hodgkin’S Lymphoma ◽  
Early Stage ◽  
Intermediate Stage ◽  
Hodgkin's Lymphoma ◽  
Advanced Stage ◽  
Event Free Survival ◽  
Early Stage Disease ◽  
Free Survival ◽  
Stage Disease

During last decades, there are strengthening attitudes to optimize the treatment of Hodgkin’s lymphoma considering prognostic groups and risk factors. Based on the data of Vilnius University Clinics, a retrospective study was carried out, and treatment methods and outcomes of the patients treated during 1999– 2004 were analyzed. Medical histories of 114 patients younger than 60 years were reviewed. Median age was 28 years. In 83% of cases, classic nodular sclerotic Hodgkin’s lymphoma was diagnosed. Advanced-, intermediate-, and early-stage disease was diagnosed in 55%, 38%, and 7% of cases, respectively. The patients with early-stage disease underwent four ABVD chemotherapy courses; 88% of them underwent radiotherapy afterwards. The patients with intermediate-stage disease underwent 4–6 courses of ABVD or in minor cases (12% of patients with intermediate-stage disease) – 4 standard BEACOPP chemotherapy courses. After this treatment, 88% of patients with intermediate-stage disease underwent radiotherapy. Patients with advanced-stage disease underwent 8 escalate (44%) or standard BEACOPP (29%) chemotherapy courses. More than half of these patients (71%) underwent radiotherapy after chemotherapy. Patient follow-up median was 65 months. One hundred seven patients (94%) after primary treatment achieved complete remission, in 7 patients (6%) primary progression was observed, 12 patients (11%) relapsed, and 8 patients died. Overall survival and event-free survival in patients with early-stage disease was 100%. Overall survival in patients with early/intermediate- and advanced-stage disease was 95.1% and 84.0%, respectively. Event-free survival in patients with early/intermediate- and advanced-stage disease was 91.7% and 76.2%, respectively. In the groups of intermediate- and advanced-stage disease, the results of treatment were worse in the subgroup, which underwent extended-field radiotherapy (P<0.05). Overall survival in the group of patients with advanced-stage disease was the best who underwent ABVD scheme, but the event-free survival (70.6%) and disease-free survival (81.3%) in ABVD subgroup were worse compared to BEACOPP subgroup. According to our results, there was no statistically significant difference in survival of patients with advanced-stage disease who underwent or did not radiotherapy (P>0.05).

Primary Non-Hodgkin’s Lymphoma of the Lung.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4402-4402
Author(s):  
Thomas Fong ◽  
Izidore Lossos ◽  
Daniel Morgensztern
Keyword(s):  
B Cell ◽  
Rare Disease ◽  
Hodgkin’S Lymphoma ◽  
Early Stage ◽  
Lung Tumors ◽  
Hodgkin's Lymphoma ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Primary Lung Tumors ◽  
Non Hodgkin's Lymphoma

Abstract Background: Unlike the relatively common secondary involvement of the lung in patients with widespread disease, primary lung lymphoma (PLL) is a rare disease with a few reports in the literature and information based mainly from small series of patients. We conducted a study in a large population database to improve the current knowledge of this malignancy. Methods: The SEER database was searched for primary non-Hodgkin’s lymphoma (NHL) of the lung in patients aged 20 or older and diagnosed between 1988 and 2003. Entry criteria included lung malignancies with codes for histology 9670–9699 (mature B-cell lymphomas), 9700–9719 (mature T and NK-cell lymphomas), 9720–9729 (precursor cell lymphoblastic lymphomas) and NHL at primary sites labeled C34.0 (main bronchus), C34.1 (upper lobe), C34.2 (middle lobe), C34.3 (lower lobe), C34.8 (overlapping), and C34.9 (lung NOS). All primary lung NHLs (also including histology codes 9590–9599, malignant lymphoma, NOS or diffuse) were used in the calculation as a percentage of total NHLs and primary lung tumors, but only patients with known histology were used for further analysis. Results: There were 1,652 cases of PLL, which accounted for 5.2% of all extranodal NHL and 1.7% of all NHL. PLL represented 0.4% of all primary lung cancers, but 51% of non-carcinoma histologies. Among the PLL cases, 355 did not have histological definition, leaving 1,297 eligible for further analysis. The median age at diagnosis was 65 years, and the disease was slightly more common in males (53.2% male; male/female ratio of 1.14). Most of the patients were Caucasians (85.6%), and the most common histologies were diffuse large B-cell (DLBCL) (51%), marginal zone B-cell lymphoma (MZL) (25.2%), small lymphocytic lymphoma (SLL) (9.2%), and follicular lymphoma (FL) (5.3%). Stage distribution was as follows: stage IE - 45.2%, stage IIE - 18.1%, stage IIIE/IIIES - 2.7%, and stage IV - 34.0%. Most patients presented with early-stage (IE/IIE) disease (63.3%). Surgery and radiation were the initial therapy in 36.2% and 13.1% of the patients respectively. Median overall survival was 58 months, and 5-year survival was 48.5%. The 5-year survival rates for patients with early stage disease (IE and IIE) according to histology were as follows: DLBCL - 36%, MZL - 78%, SLL - 71%, and FL - 81%. Conclusions: PLL is a rare disease with limited information from the literature. Although it accounts for a small fraction of both NHLs and primary lung tumors, it is the most common pulmonary malignancy of non-carcinoma histology. It occurs most commonly in elderly patients, with a slight male predominance. Nearly two-thirds of the patients present with early-stage disease, and approximately half of the patients are alive at 5 years.

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.

Hodgkin's Lymphoma: Basing the Treatment on the Evidence

Hematology ◽  
2001 ◽  
Vol 2001 (1) ◽  
pp. 178-193 ◽  
Author(s):  
Joseph M. Connors ◽  
Evert M. Noordijk ◽  
Sandra J. Horning
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Clinical Investigation ◽  
Early Stage ◽  
Late Toxicity ◽  
Hodgkin's Lymphoma ◽  
Cooperative Groups ◽  
Current Standard ◽  
Early Stage Disease ◽  
Clear Cut ◽  
Choice Of Treatment

Abstract This paper examines the evidence available to guide treatment decisions in three areas of Hodgkin's lymphoma management. In Section I Dr. Evert Noordijk describes evolving strategies for patients with early stage disease outlining the eras during which the focus has changed from initially accomplishing cure through refining and intensifying the treatment to one of maximizing cure rates and finally into a patient-oriented era in which the twin goals of maintaining high rates of cure and minimizing late toxicity are being achieved. In Section II Dr. Sandra Horning reviews the way in which the cooperative groups of North America and Europe have built upon initial observations from single centers to assemble the trials that have defined the treatment for advanced stage Hodgkin's lymphoma. Over a period of almost three decades, these well-constructed trials have defined a current standard of treatment, ABVD chemotherapy and are now investigating innovative approaches to move beyond this standard. She also indicates the need to appreciate diagnostic factors and the implications of prognostic factor models for the design and interpretation of clinical trials. In Section III Dr. Joseph Connors summarizes the evidence available to inform our choice of treatment for the uncommon but important entity of lymphocyte predominance Hodgkin's lymphoma. Once again, the guidance that can be derived from carefully conducted clinical investigation is used to address the issues surrounding choice of treatment, reasonable monitoring in long term follow-up and the clear-cut need to base diagnosis on objective immunohistochemical evidence.

Causes of death in nodular lymphocyte predominant Hodgkin's lymphoma.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e20016-e20016
Author(s):  
Anas M Saad ◽  
Ahmed Afifi ◽  
Mohamed Gad ◽  
Muneer J. Al-Husseini ◽  
Firas Baidoun ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Late Stage ◽  
Hodgkin’S Lymphoma ◽  
Causes Of Death ◽  
Early Stage ◽  
Hodgkin's Lymphoma ◽  
Disease Stage ◽  
Advanced Stage ◽  
Stage Disease ◽  
Late Stage Disease

e20016 Background: Nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL) accounts for 5% of all cases of HL. The outcomes of patients with NLPHL is generally regarded as better than those with classical HL. However, causes of death (COD) of patients with NLPHL have not been previously described. Methods: The National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program was used to identify all patients with NLPHL diagnosed between 1990 and 2015. Patient characteristics and disease stage, using the Ann-Arbor system, was extracted and tabulated. COD were identified and proportions were calculated for deaths within 5 years and after 5 years of diagnosis for patients with early and late stage NLPHL. Results: We identified 1,937 cases of NLPHL. The majority were younger than 65 years (86%), white (70%), male (67%), and diagnosed between 2001-2015 (85%), when rituximab was introduced. Of all cases, 1336 (69%) were classified as early stage. At a median follow-up of 91 months (IQR 41, 152) for early stage disease, and 73 months (IQR 30-123) for late stage disease, the median cancer-specific or overall survival were not reached. The estimated 5-year survival was 92% and 81% for early stage and late stage disease, respectively. Of all patients with early stage NLPHL, 186 (14%) died by the end of 2015, and 87 (46%) deaths occurred within 5 years of diagnosis. During the first 5 years after diagnosis, COD was NLPHL in 30 (35%). Beyond 5 years from diagnosis, NLPHL was the COD in 27% followed by other cancers (23%), and cardiovascular disease (18%). Of all patients with late stage NLPHL, 107 (21%) died, and 75 (70%) of deaths occurred within 5 years of diagnosis. During the first 5 years after diagnosis, COD was NLPHL in 44 (59%). Beyond 5 years from diagnosis, cardiovascular disease was the COD in 25%, followed by NLPHL (22%). Conclusions: The prognosis of NLPHL is excellent. Of all patients with NLPHL, those with advanced stage disease are more likely to die of their disease within 5 years of diagnosis. Patients with early and advanced stage disease beyond 5 years of diagnosis are more likely to die of causes other than NLPHL.

Evaluation of Early Stage Hodgkin’s Lymphoma Treatment: Two Decades of Progress.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4581-4581
Author(s):  
Eyad F. Alsaeed ◽  
Rajiv Samant ◽  
Gallant Victor ◽  
Lother Huebsch ◽  
Wayne Kendal
Keyword(s):  
Overall Survival ◽  
Treatment Modality ◽  
Hodgkin’S Lymphoma ◽  
Early Stage ◽  
Disease Free Survival ◽  
Hodgkin's Lymphoma ◽  
Combined Modality Treatment ◽  
Combined Modality ◽  
Involved Field ◽  
Disease Free

Abstract Introduction The treatment of early stage Hodgkin’s lymphoma is controversial. Radiotherapy alone, chemotherapy alone or a combination of radiotherapy and chemotherapy are all considered effective options. Purpose The purpose of this study is to review the treatment approaches and outcomes used for early stage Hodgkin’s lymphoma over the past two decades at ORCC Methods Retrospective chart review of all patients with stage IA /IIA treated from 1984–2002 was performed. Patients were separated into three groups according to initial treatment modality: radiation alone (Rads), chemotherapy alone (Chemo), or combined modality (Combined). Disease-free survival and overall survival were estimated using the Kaplan-Meier analysis. Result Between May 1984 and January 2003, 172 patients with newly diagnosed Hodgkin’s lymphoma (28% stage 1A, 72% stage 2A) were seen at our centre. Treatment was as follows: 49% Rads, 13% Chemo and 38% Combined. The median age was 33.7 years (range: 17 – 82 years) and the median follow-up of 73 months (range: 3 – 204 months). The 5-year disease free and overall survival rates for the entire group were 90% and 96 % respectively. The 5-year disease-free and overall survival by treatment modality was: Rads 87% and 93 %; Chemo 80 % and 100 %; Combined 97 % and 98%. In the Combined group, there was no difference in outcome between patients receiving involved-field radiation and those receiving extended-field radiotherapy. The relapse rate in a patient who received abbreviated chemotherapy and greater than four cycles was 4.3% (1 out of 23) and 2.4% (1 out of 41) respectively. The incidence of acute Grade 3 and 4 toxicities were 9 % and 0.5% respectively. Conclusions Our data confirms the excellent prognosis of early stage Hodgkin’s lymphoma with all the approaches used at our centre. At present, we favour combined modality treatment with involved-field radiotherapy and our results support its continued use.

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