scholarly journals Late Cardiological Sequelae and Long-Term Monitoring in Classical Hodgkin Lymphoma and Diffuse Large B-Cell Lymphoma Survivors. A Systematic Review by the Fondazione Italiana Linfomi

Cancers ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 61
Author(s):  
Stefano Oliva ◽  
Agata Puzzovivo ◽  
Chiara Gerardi ◽  
Eleonora Allocati ◽  
Vitaliana De Sanctis ◽  
...  
Keyword(s):  
Systematic Review ◽  
General Population ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Classical Hodgkin Lymphoma ◽  
Large B Cell Lymphoma ◽  
Increased Risk ◽  
Lymphoma Survivors ◽  
Large B Cell

Cardiotoxicity represents the most frequent cause with higher morbidity and mortality among long-term sequelae affecting classical Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL) patients. The multidisciplinary team of Fondazione Italiana Linfomi (FIL) researchers, with the methodological guide of Istituto di Ricerche Farmacologiche “Mario Negri”, conducted a systematic review of the literature (PubMed, EMBASE, Cochrane database) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, in order to analyze the following aspects of cHL and DLBCL survivorship: (i) incidence of cardiovascular disease (CVD); (ii) risk of long-term CVD with the use of less cardiotoxic therapies (reduced-field radiotherapy and liposomal doxorubicin); and (iii) preferable cardiovascular monitoring for left ventricular (LV) dysfunction, coronary heart disease (CHD) and valvular disease (VHD). After the screening of 659 abstracts and related 113 full-text papers, 23 publications were eligible for data extraction and included in the final sample. There was an increased risk for CVD in cHL survivors of 3.6 for myocardial infarction and 4.9 for congestive heart failure (CHF) in comparison to the general population; the risk increased over the years of follow-up. In addition, DLBCL patients presented a 29% increased risk for CHF. New radiotherapy techniques suggested reduced risk of late CVD, but only dosimetric studies were available. The optimal monitoring of LV function by 2D-STE echocardiography should be structured according to individual CV risk, mainly considering as risk factors a cumulative doxorubicine dose >250 mg per square meter (m2) and mediastinal radiotherapy >30 Gy, age at treatment <25 years and age at evaluation >60 years, evaluating LV ejection fraction, global longitudinal strain, and global circumferential strain. The evaluation for asymptomatic CHD should be offered starting from the 10th year after mediastinal RT, considering ECG, stress echo, or coronary artery calcium (CAC) score. Given the suggested increased risks of cardiovascular outcomes in lymphoma survivors compared to the general population, tailored screening and prevention programs may be warranted to offset the future burden of disease.

scholarly journals The Impact of Healthy Lifestyles on Late Sequelae in Classical Hodgkin Lymphoma and Diffuse Large B-Cell Lymphoma Survivors. A Systematic Review by the Fondazione Italiana Linfomi

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3135
Author(s):  
Carla Minoia ◽  
Chiara Gerardi ◽  
Eleonora Allocati ◽  
Antonella Daniele ◽  
Vitaliana De Sanctis ◽  
...  
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Healthy Lifestyles ◽  
Classical Hodgkin Lymphoma ◽  
Large B Cell Lymphoma ◽  
The Impact ◽  
Lymphoma Survivors ◽  
Large B Cell

Background: In recent years, the scientific community has been paying ever more attention to the promotion of lifestyles aimed at the prevention of late toxicities related to anti-cancer treatments. Methods: Fondazione Italiana Linfomi (FIL) researchers conducted a systematic review in order to evaluate the evidence in favor of the promotion of lifestyles aimed at the prevention of the main sequelae of long-term classical Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL) in survivors treated at adulthood with first-line or second-line therapy, including autologous stem cell transplants (ASCTs). Pubmed, Embase and Cochrane Library were searched up to December 2020. Results: Seven studies were ultimately included in this systematic review; some of them were eligible for multiple PICOS. The majority of the studies emerged from data extraction regarding cHL; less evidence resulted for DLBCL survivors. Five studies in favor of physical activity provided consistent data for a reduction of the cardiovascular risk in cHL and also in survivors who underwent ASCT. A beneficial effect of physical activity in reducing chronic fatigue was found. Being overweight was associated with a higher risk of coronary heart disease in cHL survivors in one of the two eligible studies. Studies aiming to evaluate the impact of the Mediterranean diet on late toxicities and secondary cancers were lacking. Tailored survivorship care plans (SCP) seemed to represent an optimal tool to guide the follow-up and promote healthier lifestyles in the one eligible study. Thus, promotion of healthy lifestyles and empowering of lymphoma survivors should be implemented through structured models. The study also brought to light numerous areas of future clinical research.

scholarly journals Late Neurological and Cognitive Sequelae and Long-Term Monitoring of Classical Hodgkin Lymphoma and Diffuse Large B-Cell Lymphoma Survivors: A Systematic Review by the Fondazione Italiana Linfomi

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3401
Author(s):  
Silvia Franceschetti ◽  
Maria Antonietta Annunziata ◽  
Giulia Agostinelli ◽  
Chiara Gerardi ◽  
Eleonora Allocati ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Anxiety And Depression ◽  
Classical Hodgkin Lymphoma ◽  
Neuropsychological Sequelae ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Background: The continuously improving treatment outcome for classical Hodgkin lymphoma (cHL) and diffuse large B-cell lymphoma (DLBCL) over the last 25 years has led to a high number of long-term survivors. The impact of treatment, however, can sometimes be dramatic and long-lasting. Focusing on peripheral neuropathy (PN), cognitive impairment, fatigue, anxiety, and depression, researchers of the Fondazione Italiana Linfomi conducted a systematic review of the literature to collect the available data on sequelae incidence as well as evidence of follow-up strategies for long-term cHL and DLBCL survivors. Methods: The review was carried out under the methodological supervision of the Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy. The literature search was conducted on three databases (MEDLINE, Embase, and the Cochrane Library) updated to November 2019. The selection process and data extraction were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: A total of 2236 abstracts were screened, 247 full texts were analyzed, and 35 papers were included in the final analysis. Fatigue was the most extensively studied among neuropsychological sequelae, with a mean prevalence among cHL survivors of 10–43%. Although many of the papers showed an increased incidence of PN, cognitive impairment, and anxiety and depression in long-term cHL and DLBCL survivors, no definite conclusions can be drawn because of the methodological limitations of the analyzed studies. No data on monitoring and follow-up strategies of PN and other neuropsychological sequelae were highlighted. Conclusions: Based on our findings, future studies in this setting should include well-defined study populations and have a longitudinal trial design to assess the outcomes of interest over time, thus as to structure follow-up programs that can be translated into daily practice.

Treatment-specific risk of second malignancies in five-year survivors of diffuse large B-cell lymphoma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12072-12072
Author(s):  
Yvonne M. Geurts ◽  
Suzanne I.M. Neppelenbroek ◽  
Cynthia So-Osman ◽  
Joost S.P. Vermaat ◽  
Dick Johan van Spronsen ◽  
...  
Keyword(s):  
General Population ◽  
B Cell ◽  
Cumulative Incidence ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Malignant Neoplasms ◽  
Large B Cell Lymphoma ◽  
Increased Risk ◽  
Large B Cell

12072 Background: Due to the historically less favorable prognosis of diffuse large B cell lymphoma (DLBCL), the burden of second malignant neoplasms (SMNs) has been rarely studied in DLBCL survivors. However, radiotherapy and chemotherapy may increase SMN risk among DLBCL patients. Anthracyclines may increase the risk of hematological malignancies, but it is not clear whether they also increase solid cancer risk. Methods: We established a multicenter cohort of 2,384 5-year DLBCL survivors treated at ages 15-60 years with radiotherapy and/or immuno-chemotherapy between 1989 and 2012. Observed numbers of SMNs were compared with expected cancer incidence in the general population to compute standardized incidence ratios (SIRs), absolute excess risks (AERs, per 10.000 person-years) and cumulative incidence. Treatment specific incidence was compared with general population rates and assessed within the cohort using Cox regression. Results: Most DLBCL patients received alkylating agents (95%), anthracycline-containing chemotherapy (95%) or radiotherapy (61%); 46% received rituximab. Median follow-up was 13.3 years; 17% of patients was followed ≥20 years. In total, 308 5-year survivors developed an invasive SMN (SIR 1.6; 95% confidence interval (CI), 1.4 to 1.8), translating into 56.2 excess cancers per 10.000 person-years (see Table for specific sites). In 20-year survivors of DLBCL, the SIR was 1.8 (95% CI 1.3-2.6). The 20-year cumulative incidence of any SMN was 18.7% (95% CI 16.5-21.0%). The SIR for any SMN was higher in patients <40 years at first treatment (SIR ≤40 years: 2.8, SIR >40 years: 1.4; p<0.001). Treatment specific results will be presented at ASCO21. Conclusions: DLBCL survivors experience higher risk of SMNs than the general population. Identification of patients at increased risk could improve follow-up care.[Table: see text]

scholarly journals Long-Term Follow-Up of Classical Hodgkin Lymphoma and Diffuse Large B-Cell Lymphoma Survivors: Aims and Methodological Approach for Fondazione Italiana Linfomi Systematic Reviews

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2976
Author(s):  
Chiara Gerardi ◽  
Eleonora Allocati ◽  
Carla Minoia ◽  
Attilio Guarini ◽  
Rita Banzi
Keyword(s):  
B Cell ◽  
Systematic Reviews ◽  
Hematological Malignancies ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Classical Hodgkin Lymphoma ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Advances in diagnosis and treatment of hematological malignancies has boosted attention on optimal follow-up care of survivors after cancer. To collect evidence that could inform the development of an optimal model for Italian hematology centers and the scientific community, Fondazione Italiana Linfomi (FIL) commissioned an analysis of the international follow-up approaches for long-term survivors after classical Hodgkin lymphoma (cHL) or diffuse large B-cell lymphoma (DLBCL). FIL set up multidisciplinary teams, representing all different skills relevant for cancer survivors. They conducted a series of systematic reviews focused on three main aspects: incidence of long-term toxicity; comparison of old or standard therapies and more recent ones; and evidence on specific follow-up approaches. The teams applied this framework to cardiological, endocrine-metabolic, neurological/cognitive, and psychological disorders, secondary cancers, fertility preservation, and lifestyles. Each team conducted comprehensive literature searches on PubMed, Embase and Cochrane Library databases up to 2020. Screening followed the PRISMA statement for reporting systematic reviews. The reviews report the results of this wide project covering the main areas of late toxicity and conditions in the long-term survival of cHL and DLBCL patients and their follow-up. From a clinical point of view, the series confirmed that the evidence on follow-up tended to focus on solid tumors with scant evidence on hematological malignancies.

scholarly journals Diffuse Large B-Cell Lymphoma Survivorship: Risk of Second Malignancies in Long Term Survivors

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3921-3921 ◽  
Author(s):  
Lakshmi Suryateja Gangavarapu ◽  
Rakesh Surapaneni
Keyword(s):  
High Risk ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Second Malignancies ◽  
Large B Cell Lymphoma ◽  
Increased Risk ◽  
Long Term Survivors ◽  
Large B Cell

Abstract Background: Survivors of Diffuse Large B-Cell Lymphoma (DLBCL) are at increased risk of subsequent malignancies secondary to their genetic makeup, environmental and treatment factors. Specific data on the long term risk of subsequent malignancies are underreported in the literature. Most oncologists release patients to be followed by their general physicians at five years. We studied the incidence rates of all second malignancies in survivors of DLBCL five years after their initial diagnosis. Methods: We analyzed data from the Surveillance, Epidemiology and End Results 9 database, Nov 2014 Sub {1973-2012} to determine the risk of second malignancies in five year survivors of DLBCL. For our analysis we included only patients with initial diagnosis between 1992 and 2007 as there was a change in classification in 1992 and this will also give at least 5 year of follow up for all patients. With these criteria we had 10,905 patients and 58,192 patient years of follow up. The risk of subsequent malignancies is reported as a standardized incidence ratio (observed incidence [O]/expected incidence [E]). Results: After five years from diagnosis of DLBCL, patients have the highest risk of a second cancer of Hodgkin's Lymphoma (O/E: 11.23; CI: 7.19-16.70; N=24). The risk of recurrence of Non-Hodgkin's Lymphoma also remains high after 5 years with an O/E ratio of 2.07 (CI: 1.63-2.59; N=76), with Extranodal NHL being at an especially high risk (O/E: 2.99; CI: 2.10-4.12; N=37). Survivors of DLBCL are also at high risk of Acute Non-Lymphocytic Leukemia (O/E: 4.38; CI: 3.03-6.12; N=34). There is also a high risk of Laryngeal cancer (O/E: 1.96; CI: 1.01-3.42; N=12). Furthermore, patients are also at a high risk of Cancer of the Colon excluding the Rectum (O/E: 1.28; CI: 1.01-1.58; N=82) and Anal Cancer (O/E: 3.26; CI: 1.41-6.42; N=8). Conclusion: There are several second malignancies that long term survivors of DLBCL are at increased risk of, even after 5 years. This information may help physicians effectively monitor survivors of DLBCL for any second cancers. Disclosures No relevant conflicts of interest to declare.

Disparities in the long-term survival of adolescent and young adult diffuse large B cell lymphoma survivors

2021 ◽  
Vol 75 ◽  
pp. 102044
Author(s):  
Amy M. Berkman ◽  
Clark R. Andersen ◽  
Vidya Puthenpura ◽  
J.A. Livingston ◽  
Sairah Ahmed ◽  
...  
Keyword(s):  
Young Adult ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Adolescent And Young Adult ◽  
Term Survival ◽  
Large B Cell Lymphoma ◽  
Lymphoma Survivors ◽  
Large B Cell
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