Steroid resistant hypereosinophilic syndrome found to be Hodgkin’s Lymphoma

Hyperoeosinophilic syndrome (HES) is rare, and clinicians may not recognize its potential association with malignancy. Red flag signs of HES include steroid resistance, older age, and significant lymphadenopathy that can be indicative of malignancy. In this case, an elderly male presenting with right chest wall erythema and axillary lymphadenopathy was initially diagnosed with and treated for cellulitis. Labs were significant for hypereosinophilia. Evidence of end organ damage raised concern for HES. Over the course of three hospitalizations, he was found to have a rising eosinophil count despite high-dose corticosteroid treatment. Further investigation eventually revealed a diagnosis of Hodgkin’s Lymphoma. This case highlights steroid-resistant HES as a presenting sign of malignancy and allows for discussion of potential investigative approaches for HES therapy. Though corticosteroids are first-line treatment for hypereosinophilia and HES, they are well known to have many adverse effects. Biologics, such as mepolizumab and benralizumab, have more acceptable side effect profiles and are effective in treating non-myeloid HES. The use of biologics as first-line treatment for HES has yet to be investigated.

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A pilot study on the use of the proMACE-cytaBOM regimen as a first-line treatment of advanced follicular non-Hodgkin's lymphoma

Cancer ◽

10.1002/(sici)1097-0142(19970315)79:6<1234::aid-cncr24>3.0.co;2-# ◽

1997 ◽

Vol 79 (6) ◽

pp. 1234-1240 ◽

Cited By ~ 5

Author(s):

Luca Baldini ◽

Andrea Guffanti ◽

Paolo Gobbi ◽

Mariangela Colombi ◽

Massimo Federico ◽

...

Keyword(s):

Pilot Study ◽

Hodgkin’S Lymphoma ◽

Hodgkin's Lymphoma ◽

Line Treatment ◽

First Line ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma ◽

First Line Treatment

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Standard CHOP-21 as First Line Treatment for Elderly Patients with Hodgkin’s Lymphoma.

Blood ◽

10.1182/blood.v108.11.4675.4675 ◽

2006 ◽

Vol 108 (11) ◽

pp. 4675-4675

Author(s):

Arne Kolstad ◽

Harald Holte ◽

Ole Nome

Keyword(s):

Elderly Patients ◽

Hodgkin’S Lymphoma ◽

Stage I ◽

Hodgkin's Lymphoma ◽

Advanced Stage ◽

Line Treatment ◽

First Line ◽

Involved Field ◽

Involved Field Radiotherapy ◽

First Line Treatment

Abstract Background: Outcome for elderly patients with Hodgkin’s lymphoma is not as good as for younger patients, partly due to inferior capability to tolerate appropriate chemotherapy. There is no consensus on standard treatment. In 2000 we introduced CHOP-21 as standard chemotherapy for elderly Hodgkin’s lymphoma patients at our institution with the aim to improve treatment results. CHOP-21 is known to be well tolerated in older patients with non-Hodgkin’s lymphoma and contains active drugs for Hodgkin’s disease. Patients and methods: Twenty-nine consequtive patients admitted to our institution from 2000–2004, 60 years and older with Hodgkin’s lymphoma were included in this retrospective survey. Stage I/IIA patients received 2–4 cycles of CHOP-21 followed by 30–35 Gy involved field radiotherapy. Stage IIB-IV patients were treated with 6–8 cycles of CHOP-21. Selected cases received 30–35 Gy involved field radiotherapy against residual tumors. Results: The median age was 71 years (range 60–91). Sixty-two percent presented in stage IIB-IV and 38% in stage I-IIA. Forty-five percent of the early stage patients had bulky disease and/or elevated SR. For the advanced stage patients IPS score of 2–3 was the most common category (72%). B-symptoms occurred in 52% of the total population. Nodular sclerosis was the most frequent histology subgroup (38%), followed by mixed cellularity (17%). Fifty-five percent had co-morbidity prior to treatment, cardiac conditions were most common. Two cases of treatment-related deaths were seen (7%). The most common toxicity during therapy was febrile neutropenia (31%). Treatment modifications were necessary in 38% of cases. The complete response rate after CHOP +/− radiotherapy was as high as 93%. Median follow-up for the whole population is now three years. Five patients have relapsed, and four have died from Hodgkin’s lymphoma. Total overall survival (OS) at three year was 80%, and better for the stage I-IIA subgroup (90% versus 60%). Total Hodgkin-specific survival (HSS) at three years was 73%, and 80% versus 60% for early and advanced stages, respectively. No relapses have occurred after 2 years. Outcome with CHOP +/− radiotherapy for Hodgkin’s lymphoma patients 60 years and older Response 29 pts (%) NE = not evaluable, patients died after one cycle of CHOP. CR 27 (93) PR 1 (3) ORR 28 (97) NE 1 (3) Relapsed 5 (18) Cause of death Hodgkin’s lymphoma 4 (14) Toxicity 2 (7) Other 1 (3) Conclusion: The data shows that CHOP-21 is a well tolerated and highly effective first line treatment for elderly patients with Hodgkin’s lymphoma. Of particular interest were the findings that advanced stage patients did so well and that no relapses have been seen after two years.

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Bendamustine-rituximab: a cost-utility analysis in first-line treatment of indolent non-Hodgkin’s lymphoma in England and Wales

Journal of Medical Economics ◽

10.3111/13696998.2013.873044 ◽

2014 ◽

Vol 17 (2) ◽

pp. 111-124 ◽

Cited By ~ 7

Author(s):

Sarah Dewilde ◽

Beth Woods ◽

Jean-Gabriel Castaigne ◽

Christopher Parker ◽

William Dunlop

Keyword(s):

Hodgkin’S Lymphoma ◽

Cost Utility ◽

Cost Utility Analysis ◽

Hodgkin's Lymphoma ◽

Line Treatment ◽

Utility Analysis ◽

First Line ◽

England And Wales ◽

Non Hodgkin's Lymphoma ◽

First Line Treatment

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Rituximab for the first-line treatment of stage III/IV follicular non-Hodgkin’s lymphoma

Health Technology Assessment ◽

10.3310/hta13suppl1-04 ◽

2009 ◽

Vol 13 (Suppl 1) ◽

pp. 23-28

Author(s):

Y Dundar ◽

A Bagust ◽

J Hounsome ◽

C McLeod ◽

A Boland ◽

...

Keyword(s):

Cost Effectiveness ◽

Hodgkin’S Lymphoma ◽

Hodgkin's Lymphoma ◽

Stage Iii ◽

Line Treatment ◽

First Line ◽

Non Hodgkin’S Lymphoma ◽

Non Hodgkin's Lymphoma ◽

The Impact ◽

First Line Treatment

This paper presents a summary of the evidence review group (ERG) report into the clinical and cost-effectiveness of rituximab for the first-line treatment of stage III/IV follicular non-Hodgkin’s lymphoma (FNHL) based upon the manufacturer’s submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The manufacturer’s scope restricts the intervention to rituximab in combination with CVP (cyclophosphamide, vincristine and prednisolone) (R-CVP); the only comparator used was CVP alone. The evidence from the one included randomised controlled trial (RCT) suggests that the addition of rituximab to a CVP chemotherapy regimen has a positive effect on the outcomes of time to treatment failure, disease progression, overall tumour response, duration of response and time to new lymphoma treatment in patients with stage III/IV FNHL compared with CVP alone. Adverse events were comparable between the two arms. This study was confirmed as the only relevant RCT. The economic analyses provided by the manufacturer were modelled using a three-state Markov model with with the health states being defined as progression-free survival (PFS), progressed (in which patients have relapsed) and death (which is an absorbing state). The model generated results for a cohort of patients with an initial age of 53 and makes no distinction between men and women. The model is basic in design, with several serious design flaws and key parameter values that are probably incompatible. Attempting to rectify the identified errors and limitations of the model did not increase the incremental cost-effectiveness ratio (ICER) above £30,000. Although the cost-effectiveness results obtained appear to be compelling in support of R-CVP compared with CVP for the trial population the results may not be so convincing for a more representative population. The results of the ERG analysis on the impact of age suggest that ICERs increase steadily with age, as the proportion of PFS that can be converted to overall survival (OS) is diminished by rising mortality rates in the general population. For the most extreme scenario (no OS gain) the ICER appears to remain below £30,000 per QALY gained. On balance the evidence indicates that R-CVP is more cost-effective than CVP. The guidance issued by NICE in July 2006 as a result of the STA states that rituximab within its licensed indication (in combination with cyclophosphamide, vincristine and prednisolone) is recommended as an option for the treatment of symptomatic stage III/IV follicular non-Hodgkin’s lymphoma in previously untreated patients.

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